Health Conditions / Neurological Health / Migraines

If you feel a queasy, uneasy sensation in your stomach during a migraine attack, it’s probably not from the late-night takeout you ate. According to a 2017 study in the Journal of Pain Research, nausea occurs in about 58% of people during a migraine episode—and that’s a conservative assessment.1 Data from an older, self-reported survey published in the journal Headache found most people experience vomiting and nausea during an episode, with estimates closer to 70 to 90%, respectively.2For non-migraine folks, those numbers may seem surprising. After all, throbbing head pain and visual disturbances are typically viewed as the telltale signs that a migraine is on the horizon. So, how can symptoms that happen way down in the stomach have anything to do with the above-the-neck signs that most people associate with a migraine? For people living with migraine, nausea is just another piece of this complex puzzle.Fortunately, we have some answers about why you feel nauseous with a migraine, and more importantly, tips on how you can stop the pain and discomfort before it goes too far.What causes migraine with nausea and vomiting?The who and why of migraine attacks are already a bit of a mystery, but symptoms can be Clue level head-scratchers. Even though nausea tops the list of migraine symptoms for many people, why this happens is not clear-cut. The good news is experts have a few theories that shed light on the link between migraine and nausea.Migraine involves certain areas of the brainstem.A migraine commonly includes things like nausea, but sometimes vomiting and diarrhea too. Jack Schim, M.D., F.A.H.S., F.A.A.N., co-director of the Neurology Center of Southern California, tells SELF that experts think at least part of this is due to migraine affecting different brainstem areas involved in autonomic functions—the things your body just does automatically—such as digestion. The idea is that migraine attacks irritate the nerves that activate this system, triggering those not-so-fun symptoms.Migraine decreases serotonin levels.Another theory according to Medhat Mikhael, M.D., pain management specialist and medical director of the non-operative program at the Orange Coast Medical Center’s Spine Health Center, is that migraine decreases serotonin levels in the brain, which is believed to contribute to nausea. Serotonin is generally known as the happy chemical keeping our mood on an even keel (among many other important functions in the body). So, it’s no surprise that a decrease in our feel-good chemicals could have noticeable side effects. Dr. Mikhael also says that a decrease in serotonin can trigger motion sickness, another uneasy feeling.Migraine triggers changes in blood vessels in the brain.It’s thought that migraine attacks change blood vessel diameter in the brain. Typically, the diameter increases in size and tugs on the meninges (shock absorber between your skull and brain), which causes throbbing or pulsating pains. “When these changes affect parts of the brain that regulate nausea and vomiting, you may experience stomach problems,” Clifford Segil, D.O., a neurologist at Providence Saint John’s Health Center in Santa Monica, California tells SELF.He says one area of the brain, in particular, is on the shortlist of suspects that may trigger nausea and vomiting in people with migraine. That area is called the rostral dorsal medulla and essentially relays sensory information from the spinal cord to the brain. According to a 2014 study published in the Journal of Headache and Pain, nausea in the prodrome phase of a migraine—basically the opening act—is linked to activity in this part of the brain.3Migraine causes a certain neurotransmitter to be released.Migraine pain is linked to the release of a neurotransmitter—one of your body’s messengers—called calcitonin gene-related peptide (CGRP).4 In fact, certain migraine medications act on this very thing to try to stop a migraine attack from occurring in the first place. Dr. Schim says this neurotransmitter is also prevalent in the gut, which could have something to do with that I’m-going-to-hurl feeling when you have a migraine.Types of migraine and headaches that can cause nauseaBy now you’ve probably figured out that migraine attacks are complicated—we don’t yet know exactly what triggers all the symptoms. What we do know is that certain types of migraine are more likely to cause nausea and vomiting. Oh, and to make matters even more confusing, some headaches—that are not migraines—may also make you toss your cookies.

“The typical story is that somebody is laying down in bed, and they experience a real spinning sensation like they’re on a carousel,” Clifford Hume, M.D., associate professor of head and neck surgery at the University of Washington and a researcher at the Virginia Merrill Bloedel Hearing Research Center. “The sensation usually lasts for about a minute, then goes away.”In some cases it can stick around for a few days or weeks, and could require treatment like canalith repositioning, which is a series of slow head movements to move those tiny crystals back into an area of the ear that doesn’t cause vertigo, according to the Mayo Clinic. Surgery is also an option if that doesn’t work.Overdoing it during workoutsExercise without replenishing your fluids or having enough calories for energy is a surefire way to feel dizzy. It may not seem like a big deal, but if you’re constantly feeling this way during physical activity, focus on hydrating and eating a snack to give you additional energy, according to the Cleveland Clinic. If the problem stops, you have your answer. If you continue to feel dizzy despite properly fueling your body, it’s worth a trip to see your doctor. Getting dizzy at the gym or out on a run could cause you to fall and injure yourself.Though not as common, it is possible to exercise so intensely that you’re gasping for air, which leads to hyperventilation—rapid breathing that causes carbon dioxide levels in the blood to drop, resulting in lightheadedness. If that sounds like you, know that it’s OK to take a break during your HIIT class (It really isn’t a competition!)Nutritional deficienciesEating a colorful array of foods is a good way to meet your nutritional needs, but sometimes you may still end up not getting enough vitamins and minerals. An iron deficiency, in particular, can lead to symptoms of dizziness, as it can cause iron-deficiency anemia (another cause on this list), and involves not having enough healthy red blood cells. Other vitamin deficiencies could also be to blame, though, including a lack of folate, vitamin B12, and vitamin D.To ensure vitamin deficiencies aren’t a cause for your dizziness, try adding more dark leafy green vegetables, fortified foods, nuts, and fish into your diet, according to the Mayo Clinic.What causes sudden or random dizzy spells?If your dizzy spells seem to come on suddenly without warning, it could be another cause. It’s worth looking into things like:MedicationsThere are a lot of meds that could be the culprit here, but to name a few, anti-seizure drugs, antidepressants, and sedatives are all known to cause dizziness as a side effect. Blood-pressure-lowering medications could also make you dizzy if they work a little too well and your blood pressure drops excessively low, per the Mayo Clinic.When in doubt, make an appointment with your doctor to review your medication list (don’t forget to include any supplements you take) to see if something could be giving you that lightheaded feeling. Even if you suspect a certain medication is the culprit, don’t stop taking it without your doctor’s advice first.Meniere’s diseaseThose with Meniere’s disease typically experience a sudden loss of hearing in one ear, ringing in their ears, along with vertigo and dizziness, says Dr. Hume. Since dizziness and vertigo can go from zero to 60 within a few minutes, it can be really alarming, but thankfully episodes typically only last for 20 minutes to a few hours, according to the Mayo Clinic.

Another possible cause, and one you have absolutely no control over, is genetics. If one of your parents has a history of migraine, there’s a 50% chance that you’ll have the condition, too. Add both parents to the mix, and your odds increase to 75%, according to the Cleveland Clinic.Unfortunately, migraine triggers are different for everyone, so it’s hard to say if one thing will or will not set off symptoms for each person with the condition. That’s because things like genetic factors, age, biological sex, hormonal changes, reactions to physical and emotional stress, and sleep patterns differ from person to person, Medhat Mikhael, M.D., pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center, tells SELF.Even if you have some idea of what to avoid, personal migraine triggers can be confusing. For instance, if you ate some fancy cheese and suspected it triggered a migraine, and then you ate the same cheese a month later and nothing happened, you were probably left scratching your head.Often, one specific migraine trigger doesn’t spur an attack each time you’re exposed to it. So, a better working theory about migraine attacks might consider a combination of triggers instead of one cause alone. And there are some common culprits that seem to tip the scales towards triggering a migraine for a lot of people.Non-food-related migraine triggersWe’ll dive into food-related triggers next, but let’s start with ones that aren’t on your dinner plate.HungerYou might want to think twice before skipping breakfast, or any other meal for that matter. That’s because foregoing meals or skimping on calories causes your blood sugar to drop, which can trigger a headache or a full-blown migraine episode, according to the National Headache Foundation.Stress and anxietyStress is something we all experience to some degree. But if you’re also susceptible to migraine, any increase in life stress, worry, or anxiety can trigger a migraine. In fact, stress is a trigger for migraine attacks in nearly 70% of people who experience migraines.4 Some studies even suggest that people with generalized anxiety disorder and panic disorder, in particular, have an increased incidence of migraine, according to the Anxiety and Depression Association of America, though the exact link isn’t known.DehydrationOne way to trigger a horrendous headache—including migraine—is to let yourself get dehydrated. While a lack of fluids may be the main culprit for some headaches, it seems that dehydration can aggravate a number of underlying medical conditions such as primary headache disorders, which includes our good friend migraine.5Weather changesEver thought your head was a weather psychic? You might be right. Drastic changes in heat, humidity, wind, and barometric pressure may be a migraine trigger for some people, according to the American Headache Society. While the research linking these two is sparse, it’s worth noting if you experience symptoms with the changing weather.ExerciseAccording to the American Migraine Foundation, exercise can both trigger and treat migraines. On one hand, regular exercise can reduce the frequency of migraines. That’s because exercise releases the natural painkillers in our brain called endorphins. It can also reduce stress and help us sleep better at night—two other migraine triggers. On the other hand, exercise has been known to trigger migraine in certain people. It’s not totally known why that’s the case, but it may have something to do with exercise increasing blood pressure, which affects the nerves in the brain.AllergiesAh, the smell of the outdoors. Blooming buds and tree pollen abound. For some people that may only lead to never-ending bouts of sneezing, wheezing, and congestion. But for others, these outdoor allergic offenders may also increase migraine frequency, too.7Light, sound, and smellThink about this the next time you’re considering a spritz of very potent perfume: Sensory stimuli, including bright light, loud sound, or strong smells can trigger migraine. Clifford Segil, M.D., a neurologist at Providence Saint John’s Health Center in Santa Monica, California, tells SELF that among sensory triggers, visual stimulation appears to be the most common. Some people describe migraine being provoked by bright or flashing lights, while others report being triggered by certain visual patterns.Certain medicationsMedications can be a lifesaver for many chronic health conditions, including migraine attacks. But if you deal with regular migraine episodes and take acute pain medication more than 15 days a month, you may experience medication overuse headache (MOH), according to the American Migraine Foundation. This can happen if you start taking more medication—particularly pain medications like narcotics, triptans, and others—in response to an increase in attacks. Why this happens isn’t totally understood, but it is thought to have something to do with how these medications lower your threshold for pain while simultaneously reinforcing pain pathways in the brain.Teeth grindingBruxism (teeth grinding and clenching) can trigger headaches and even migraine episodes, according to the Mayo Clinic, since clenching your teeth at night can put a lot of stress on the temporomandibular joint and the supporting head and neck muscles. While wearing a nightguard or a custom orthotic appliance might not be the sexiest look, it could help you avoid your next migraine attack.Computer screensWe’re all guilty of staring at a screen too long sometimes. But if you’re susceptible to migraine, you may want to think twice before binge-watching your favorite Netflix series. According to Sage Journals,8 spending over two hours daily gazing at a screen is associated with migraine in young adults.Too much or too little sleepSleep is another big trigger for migraine, but like many things on this list, it’s not a simple explanation. Not sleeping enough can trigger a migraine, but so can sleeping too much, according to The Migraine Trust. The idea is that basically your circadian rhythm—what tells you when it’s time to sleep and wake up—gets all out of whack and triggers a migraine as a result.Certain hormonesAccording to Dr. Mikhael, fluctuations in female hormone levels, particularly estrogen, play an important role in the pathophysiology of migraine. Around the menstrual period, estrogen levels rapidly drop causing major changes in the chemical neurotransmitter serotonin, which can trigger a migraine attack.

Prodrome: This is the “pre-headache” phase where you may start to see some warning signs like neck stiffness, mood changes, and frequent yawning. The prodrome phase can happen about 24 to 48 hours before the headache starts. Approximately 30% of people who get migraine experience these pre-headache symptoms.Aura: Up to 20% of people with migraine will experience sensory changes known as an aura. Most commonly, an aura changes how you see things, so you might notice sparkles, dots, flashing lights, wavy lines, or blind spots in your vision. Aside from affecting your eyes, an aura can make you feel numb, tingly, and cause ringing in your ears. These symptoms usually disappear just before the pain in the head begins. Headaches that occur with auras are known as “migraine with aura,” and headaches that don’t are known as “migraine without aura”Attack: This is when the actual migraine head pain hits—and you may also have nausea, vomiting, and sensitivity to light or sound, as we mentioned above.Postdrome: After an attack ends, some people get a “migraine hangover,” meaning they feel depleted, fatigued, and just out-of-it for a day or so. Postdrome is more common than prodrome, with roughly 80% of people who deal with migraine getting to this stage.The entire sequence can last anywhere from eight hours to three days, depending on how many stages you experience, the severity of the migraine, and whether you treat your migraine symptoms.What are the best migraine treatments for relief?Migraine treatment is very individualized, so you’ll want to speak with your doctor about how to find the best option for you and your symptoms. In some cases, your doctor may refer you to a neurologist, who better understands the intricacies of brain disorders.“When patients have headaches that are not being well-controlled, we take into account their medical history, what other medical problems they may have, and what the possible side effects of each medication are,” Anne Csere, D.O., an assistant professor in the Department of Neurology, Pain, and Headache Medicine at the University of South Florida, tells SELF. For example, certain migraine treatments are not recommended for people who plan to become pregnant or who have a history of heart disease, she explains. Price is also an important factor because some medications are expensive and not covered by insurance.Here’s a breakdown of the most common treatment options for migraine relief:Abortive medicationsAbortive medications are designed to stop migraine once it has started, and these can include both prescription and over-the-counter drugs. “The important thing with these medications is to take them soon after the headache starts,” says Dr. Csere. “These medications work best early in the migraine’s phase.”Abortive medications include OTC pain relievers you probably already have on hand, like ibuprofen, naproxen sodium, and acetaminophen. Your doctor might recommend taking one of these medications with caffeine if you aren’t sensitive to it because it causes your blood vessels to contract, which can help relieve some of your pain. (This also makes the medications more effective).