Nausea is often a symptom of a Migraine attack. Some have theorized over the years that the nausea might be caused by gastric stasis, delayed emptying of the stomach. There have also been questions about how gastric stasis might affect treating Migraine attacks because it can slow the disintegration and absorption of medications in the stomach.

The results of a new study, published in the January, 2006, issue of Headache, shed some light on gastric stasis as it relates to Migraine disease.

In a continuing medical education module, "Targeting Multiple Mechanisms in Migraine: New Advances in Acute Care," the principle investigator in this study, Dr. Sheena K. Aurora, asks "Why Should Clinicians Who Treat Migraineurs Care About Gastric Stasis?" Her answer is:

"The emphasis is that although we have known for a long time that perhaps gastric stasis occurs in migraine, this has not been very well quantified. With all the oral treatment that is available... there is a lot of dissatisfaction out there with oral treatment. Perhaps it is the reason that drugs may not be getting absorbed as well in migraine. So it really behooves us to study the GI system in migraine to elucidate those results."

Study Methods:
Ten Migraineurs were compared to 10 people without Migraine, matched by age and gender. After a standard meal, gastric scintigraphy was performed, both during a Migraine and between Migraine attacks.

Study Results:

• Among the Migraineurs, the time to the stomach emptying by half was delayed by 78% during a Migraine attack.
• Among the Migraineurs, the time to the stomach emptying by half was delayed by 80% not during a Migraine attack.
• The time to emptying by half among Migraineurs was significantly longer among the Migraineurs, 188.8 minutes, than the control subjects. 111.8 minutes.

Study Conclusions:

Dr. Aurora and her colleagues concluded that, "nausea is caused by a central process as a part of changes occurring in the brainstem as a part of the acute migraine rather than due to gastric stasis, as the stasis is present even outside an attack and none of these patients were nauseous outside an attack."

Summary:

This study and Dr. Aurora's section of the Medscape CME presentation show a clear need for more studies in this area. For acute Migraine treatment to be successful, we must either find a way to address gastric stasis or decrease our dependency on oral delivery of medications.

At this time, there are some Migraine abortives available in forms other than oral administation:

• DHE45 injections (dihydroergotamine)
• Migranal Nasal Spray (dihydroergotamine)
• Imitrex STATdose injections (sumatriptan)
• Imitex Nasal Spray (sumatriptan)
• Zomig Nasal Spray (zolmitriptan)

Even so, in the Medscape presentation, Dr. Aurora comments, "Patients were asked what their choices were for treatment. The injection was rated the lowest, and the tablet was rated the highest. So even though pain relief, as we've shown, is much better through the nonoral route -- and particularly the injectable route -- still the oral tablets seem to be what patients prefer the most."

Perhaps knowing the impact of gastric stasis on the oral medications will lead more Migraineurs to be open to the nasal sprays and injections. Definitely, this research points to an area in which more research is needed.

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Resources:

Richard B. Lipton, MD; Sheena K. Aurora, MD; Rami Burstein, PhD; Stephen D. Silberstein, MD, FACP. "Targeting Multiple Mechanisms in Migraine: New Advances in Acute Care." Medscape CME Circle. 2005.

Aurora, Sheena K., Kori, Shashidhar H., Barrodale, Pat, McDonald, Susan A. & Haseley, David (2006) "Gastric Stasis in Migraine: More Than Just a Paroxysmal Abnormality During a Migraine Attack." Headache: The Journal of Head and Face Pain 46 (1), 57-63. doi: 10.1111/j.1526-4610.2006.00311.x

Published April 20, 2006
© Teri Robert