Gastroparesis and migraine

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Have you ever taken an oral acute medication and thought “this just isn’t working?”  It could be that your stomach just can’t absorb your medications during a migraine attack.  

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Gastroparesis is a condition that can occur during migraine attacks that impacts the way that your acute migraine medications work.  Gastroparesis also is referred to as delayed gastric emptying, meaning that your stomach isn’t contracting or digesting as quickly as usual. 

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Patients who experience nausea and vomiting during their migraine attacks likely are experiencing gastroparesis, and, according to a study published by Dr. Lawrence Newman in the Headache Journal, gastrointestinal manifestations of migraine contribute to triptan and acute medication failure.  So what does this mean?  

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When you experience gastroparesis during a migraine attack, your stomach does not digest oral medications (like Sumatriptan or Ubrelvy) as quickly as it would when you’re not having a migraine attack.  So something that typically would take fifteen or thirty minutes to digest would take hours when you have gastroparesis… and we all know that timing is essential when acutely treating migraine attacks.  

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Symptoms of gastroparesis

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Common symptoms for gastroparesis include nausea, vomiting, and feeling full when you’ve eaten just a tiny amount of food.  Other symptoms include stomach pain and cramping, bloating, constipation and/or diarrhea.  And migraine patients experiencing gastroparesis during their attacks will notice that their oral acute medications don’t work like they should.  

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Migraine medications for patients with gastroparesis

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This is why many migraine patients find that quick-melt, IV, injectable or intranasal medications are more effective than a traditional oral medication because they are absorbed by the body more efficiently.  This also is why Reglan (metoclopramide) often is given in migraine cocktail IVs because Reglan improves the rate of medication absorption.  

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If you experience nausea during your migraine attacks and find that your oral acute medications do not work as effectively, talk to your provider about acute medications and treatments that bypass the stomach.  Options to discuss include: 

• Quick-melt acute medications like Maxalt MLT or Nurtec
• Injectable acute medications like Ketorolac or Sumatriptan Succinate Injection
• Intranasal acute medications like Sprix Nasal Spray (intranasal ketorolac) or the forthcoming Zavegepant
• Neuromodulation devices like Nerivio, Cefaly or Gammacore

As always, Neura Health’s headache specialists are available for a video consultation if you want to explore the best treatment options for your individual case.