Why do we get “butterflies” in our stomach when we have to give a speech? Why do some people get a bellyache when they worry or feel anxious? Why do nausea and migraine appear together so often? These are examples of the gut-brain axis, or connection. The brain and the gut are in close conversation with one another — so it makes sense that migraine significantly affects the gastrointestinal system as well.
One Body, Two “Brains”
Nausea occurs in about 80 percent of those with migraine, and vomiting in about 30 percent; the symptoms typically coincide with the headache phase or slightly after. It can get so bad that many people with migraine say that the nausea and vomiting — and not the headaches — are the most debilitating aspect of an attack.
Migraine also generates other gastrointestinal disorders including constipation, diarrhea, and indigestion. On top of that, a migraine attack can bring on a condition called gastroparesis, which is the delayed emptying of the stomach. This delay causes an unfortunate result. If you’ve taken your medicine after gastroparesis has set it, the medications will sit helplessly in your stomach, unable to get into your bloodstream and ease your headache.
- Tip: If nausea, vomiting or gastroparesis are preventing you from taking, absorbing or keeping down your oral migraine meds, there are other delivery methods. Injectable or suppository medicines bypass the GI system altogether and typically bring rapid results. Intravenous drugs may be a solution in extreme gastrointestinal situations, and would be administered by medical professionals.
The migraine-gut connection reaches back to our embryonic development. Fetal brain and gut nerve cells form at the same time, with the brain nerve cells forming the central nervous system and the gut nerve cells forming the enteric (gut) nervous system. Deep within our guts, the enteric nerve cells make up a vast network that interacts with every aspect of our digestive system and basically acts like a second brain!
Communication between the gut and central nervous systems is thought to be a constant two-way street, with the gut sending information to the brain and vice versa. All that information-sharing is important to keep the body in balance. But people with migraine have sensitive brains that overreact to stimulation — and so the brain amplifies messages of pain or distress traveling along the gut-brain axis, making gut pain worse.
Managing GI Symptoms With Migraine
First, ask your doctor if you need to rule out any other GI disorders that might require different and specific treatment (such as celiac disease or irritable bowel syndrome).
Prevention. The best way to avoid migraine-related GI problems is to prevent a migraine attack in the first place.
- Healthy habits. Maintain a healthy, predictable diet and stay well hydrated. Exercise regularly and keep a routine sleep schedule.
- Reduce stress. Stress can be a prominent trigger for GI troubles. Biofeedback, mindfulness, and meditation can have amazing results to calm down the brain and quiet the gut.
- Manage the microflora in your gut. Our digestive tracts are home to trillions of microorganisms, which interact with our bodies to create a healthy microbiome. It reduces our inflammation and cortisol levels, and can even improve mood and anxiety. Make sure you have a diverse diet that includes probiotics (good bacteria that improve the workings of the gut) and prebiotics (which help that bacteria flourish), such as yogurt, kefir, fermented foods, kombucha, almonds, garlic, chickpeas, onions, and cabbage.
Medication for Acute Attacks. Several approaches are available.
- Antiemetics target nausea and vomiting head-on, though they don’t address head pain. The prescription drug Reglan is a common go-to fix for nausea and vomiting, and also helps treat gastroparesis.
- Over-the-counter medicines that can reduce nausea include diphenhydramine (Benadryl) and dimenhydrinate (Dramamine).
- Neuroleptics reduce the intensity of nerve function and are used to treat significant nausea and vomiting. There’s evidence they help treat migraine pain, too. These drugs include prochlorperazine (Compazine), droperidol, haloperidol, and chlorpromazine (Thorazine).
Alternative remedies. Many people find nausea relief through complementary therapies.
- Ginger. Popular choices are ginger candies, ginger tea, and ginger ale.
- Essential oils. Ginger and peppermint oil are popular to help alleviate nausea.
- Acupressure. Traditional Chinese medicine believes nausea is a sign of the body out of balance. One technique it advocates to rebalance the body’s systems is to stimulate certain pressure points on the forearm. Acupressure can be administered by a practitioner, or can be self-administered.
- Cannabis. Medical marijuana is often used to treat nausea and vomiting from chemotherapy. Though no studies have been proven for migraine nausea, there seems to be potential for relief.
The gut-brain axis is an important factor to consider in the management of migraine. It is uniquely intertwined with this neurological disease so it is important not to overlook how the GI system interacts with pain and medications when assembling your best treatment plan.