If nausea is a problem, or if simple pain relievers alone do not relieve the pain of migraine, they can be taken with medicines to treat nausea and vomiting. These are recommended as Step 2 in managing migraines.
The recommended treatments are:
- domperidone (Motilium)
- metoclopramide (Maxalon, Pramin)
- prochlorperazine (Nausetil, ProCalm).
Combination medicines containing paracetamol and metoclopramide are also available (e.g. Anagraine, Metomox).
Medicines for nausea and vomiting should be taken at the first sign of symptoms and can be repeated every 6 to 8 hours if needed, or as prescribed by your doctor.
In addition to their anti-nausea/anti-vomiting effects, domperidone and metoclopramide can speed up stomach emptying and may improve the absorption (and hence effectiveness) of pain relievers.
If you’re having trouble keeping medicines down because of nausea and vomiting, your doctor can give you metoclopramide (e.g. Maxalon) by injection. Prochlorperazine is available in injectable and suppository form.
If you suffer from constant, persistent vomiting during a migraine attack — so much so that you can’t even keep liquids down — you may be at risk of dehydration. In this situation you may need to go to hospital to get migraine treatment by injection and fluids via an intravenous drip.
If pain relievers — with or without medicines for nausea or vomiting — are not relieving your migraine symptoms, triptan medicines are usually the next step.
Domperidone causes less sleepiness than metoclopramide — which, depending on your circumstances may or may not be an advantage. Domperidone is also less likely to cause the rare side effect of altered-movement symptoms, such as abnormal eye or tongue movements, spasms of the tongue, eyes, face or jaw, twisting of the head and neck or arching of the back. These distressing and frightening side effects are more common in children.
Note about medicine names
Most medicines have two names: the active ingredient and the brand name. The active ingredient is the chemical in the medicine that makes it work. The brand name is the name given to the medicine by its manufacturer. There may be several brands that contain the same active ingredient. This website uses active ingredient names, with brand names in brackets. We also discuss medicines in groups or ‘classes’, when their effects or actions are very similar.
To find out more about active ingredients and brand names see our Brand choices information.
- British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. www.bash.org.uk (accessed 13 December 2011)
- Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
- Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.