If you take triptans, you should not take ergot derivatives, as the combination can cause a serious drug interaction. And if you are a woman who is pregnant or nursing, or if you have a history of heart disease, severe high blood pressure, angina, coronary artery disease (CAD), reduced liver or kidney function, or peripheral vascular disease, you should not take ergot derivatives. People with mild high blood pressure or hyperthyroidism should consult with their doctor before taking these drugs.
Ergot derivatives are often combined with other medications to increase their efficacy and reduce side effects. Ergotamine and caffeine combinations are available in generic form and under the brand names Cafergot and Migergot. These formulations are available in pill or suppository form. Suppositories may be preferred when nausea and vomiting are severe.
Nausea and vomiting are common features of migraine. Approximately 8o percent of migraine attacks are accompanied by nausea, and an estimated 3o percent are accompanied by vomiting. Antiemetics are drugs that treat nausea and vomiting. They are sometimes combined with analgesics, ergotamines, or triptans (although triptans have their own nausea-relieving properties). Adding an antiemetic to migraine therapy — either within a combination drug or as a separate medication — can help you keep oral medications down and ease stomach discomfort.
Antiemetics — What’s Available
Antiemetics are available in oral, injectable, suppository, and intravenous formulations. Oral formulations are most useful when they are taken early in a migraine episode, as vomiting later in an attack can prevent proper absorption. Suppositories and injections are helpful if medicine is not staying down. Intravenous formulations of prochlorperazine (Compazine) or chlorpromazine (Thorazine) may be administered in a doctor’s office, urgent care, or emergency department setting.
Prescription antiemetics include ondansetron (Zofran), promethazine (Phenergan), and metodopramide (Reglan).
Side Effects of Antiemetics
Drugs with antiemetic properties fall into several different pharmaceutical categories, so their side effects can vary. Some antiemetics, including promethazine, include antihistamines that can cause dizziness, drowsiness, and dry mouth. Prochloraperazine and chlorpromazine are both antipsychotic drugs that can cause these same side effects, along with constipation, chills, blurred vision, and nasal congestion.
One particular side effect of the antipsychotic drugs used as antiemetics, called acute dystonia, is uncommon but striking when it occurs. This consists of a sustained set of movements affecting the eyes or the head and neck or the limbs that can last for hours. It is a benign phenomenon, but can be quite distressing. Fortunately it is quickly relieved by anticholinergic medications such as diphenhydramine (Benadryl).
Metoclopramide increases gastrointestinal motility, so it may cause diarrhea in some people. In rare cases, long-term use of metoclopramide can cause tardive dyskinesia — involuntary tremors or muscle spasms that persist even after the drug is no longer used.
Biofeedback is a nondrug therapy that has been extensively studied and proven effective in clinical trials to relieve migraine head pain, and in some cases, to prevent the occurrence of migraine. As the name implies, biofeedback is a system of monitoring your body’s biological signals, such as temperature, heart rate, and muscle tension, and learning how to regulate those functions through relaxation and visualization techniques. It requires formal training
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