It’s unpopular, but it’s true. Many migraine and headache patients may need to stop taking pills and go to an injection or skin patch or other type of delivery that bypasses the stomach.
We’re frequently told that these other delivery methods, such as injection or IV, get the medication to us “faster”, and that, especially in migraine, faster is better.
And that may be true. But for some people, the pills they take may be sitting in the stomach for hours, while their migraine pain continues.
This is a condition called gastric stasis (delayed gastric emptying), or, in severe cases, gastroparesis.
Gastroparesis and headaches can go together for a number of reasons, not just because your body doesn’t receive the medication you’re trying to give it. When food isn’t properly absorbed, patients can experience bloating, malnutrition, nausea, and problems with blood sugar levels.
In other words, gastric stasis and gastroparesis can cause problems with the body that can trigger headaches – and then the medication you take doesn’t help at all.
That’s why migraine patients can take the exact same medication, the exact same dosage, but if it goes through the stomach it doesn’t help, and if it bypasses the stomach it does.
So what can be done to solve the problem? Your doctor will help diagnose the problem and recommend treatments, such as:
- Treating an underlying condition (for example, gastroparesis can be linked to diabetes)
- Changes in diet – eating smaller amounts more frequently, cooking and chewing foods well, and drinking plenty of water with meals
- Other lifestyle changes, such as gentle exercise after eating and avoiding carbonated beverages and alcohol
- Certain medications such as metoclopramide (Reglan), domperidone (Motilium) and onabotulinumtoxinA (Botox).
- Changing the delivery method of your medications
In very severe cases, surgery may be required to make sure you’re getting nourishment. (More on treating gastroparesis)
Gastric stasis can be a problem for migraine patients even when they’re not having a migraine attack, which can cause problems with regular nutrition and preventative medications. If you’ve found that migraine medication isn’t doing much, this may explain it. Gastroparesis and headaches can both be treated, but they can certainly complicate each other if they are not properly diagnosed.
Gastric stasis can be diagnosed using a gastric emptying study. If you suspect this may be a problem for you, this is something you can discuss with your doctor.