Headache and nausea: why migraine is more than pain

Headache and nausea together are a common sign of migraine. During a migraine attack, the same brain processes that cause the pain can also upset your stomach, so you may feel sick, go off your food or vomit. If you regularly have a bad headache with nausea, there is a good chance it is migraine.

Many people think of migraine only as intense headache, but nausea is one of its most common symptoms. For many people the two go hand in hand, which makes it hard to keep up normal daily activities during an attack.

Why does migraine cause nausea?

Nausea in migraine comes from the same complex reactions in the brain that cause the headache. During an attack, a nerve in your head, the trigeminal nerve, is stimulated. This leads to the severe headache and to inflammation around the blood vessels in the head. These processes can also affect how your digestive system works, which results in nausea. Digestion can slow down during an attack too, which is one reason tablets sometimes seem to work less well. For some people the nausea is so strong that even the thought of food is too much, or they are sick.

What does it mean when you have a migraine and feel like throwing up?

Feeling like you need to throw up during a migraine attack is a common part of the attack itself. It does not on its own mean something dangerous is going on. It does mean the attack is affecting more than your head, and it is worth mentioning to whoever treats your migraine. If you often vomit, swallowing a tablet can be difficult; some acute migraine medicines also come in other forms, such as a nasal spray, a melt-in-the-mouth tablet or an injection, which your migraine specialist can discuss with you.

What other symptoms come with headache and nausea?

As well as nausea, many people with migraine are sensitive to light, sound and sometimes smells. That makes it hard to carry on with work, daily tasks or social plans, especially when the nausea comes on too. As a result, you often have to withdraw to a quiet, dark room until the attack has passed.

What could be causing my headache and nausea in the morning?

Migraine attacks often start in the early morning, so waking up with a headache and feeling sick can be migraine. Other common causes include too little or poor sleep, not eating or drinking enough the day before, alcohol, missing your usual caffeine, and taking painkillers on many days. See your GP if you regularly wake with a headache and nausea, and especially if the headache wakes you from sleep, is worse when you lie down, cough or strain, or keeps getting worse over days or weeks.

What can you do about headache and nausea?

If nausea comes with your migraine attacks regularly, it is worth discussing with your GP or migraine specialist. There are treatments that can reduce both the headache and the nausea. Acute migraine medicines such as triptans, and the gepants atogepant and rimegepant, treat the attack itself, and the nausea often eases as the attack settles. Separate anti-sickness medicines also exist; your GP can discuss them.

During an attack, some people find it helps to:

• rest in a dark, quiet room
• take small sips of water
• take acute medication early, before the nausea becomes severe

When to get urgent help

Call 999 or go to A&E if you have:

• a sudden, severe headache that reaches its worst within seconds or minutes
• weakness or numbness on one side of your body or face
• slurred speech or difficulty understanding words
• loss of vision that does not come back
• a first ever aura after the age of 50
• a headache with a high temperature and a stiff neck

If you are worried but it is not an emergency, call NHS 111.

Is it migraine?

Not sure whether you have migraine? Take the free migraine test. You can also read what migraine is, how acute medication works, and how to start with a migraine specialist at The Migraine Clinic, online by video and without a referral.