Table 2.

Management of nausea and vomiting in migraine

Main goals	1. Stop migraine attack itself – Early onset of treatment – With the effective drugs – At the effective doses – Alternative nonoral routes of administration, if needed 2. Symptomatic treatment
Outpatient settings	Migraine and nausea without vomiting	■ NSAIDs	Oral or rectal
		■ Or triptans	Oral or nonoral
		■ And antiemetics
		➢ Metoclopramide	10 mg/8 hours orally
		➢ Domperidone	10–20 mg/6–8 hours orally 60 mg/8–12 hours rectally
		➢ Trimethobenzamide	250–300 mg/6–8 hours orally
		➢ Prochlorperazine	5–10 mg/6–8 hours orally
		➢ Promethazine	25 mg/12 hours rectally
		➢ Dimenhydrinate	12.5–25 mg/4–6 hours orally/rectally 50–100 mg orally
	Migraine with nausea and vomiting ■ Avoid oral drugs	■ First-choice treatment
		○ Triptans, and antimetics	Subcutaneous, intranasal, rectal, or transdermal patches
		○ ± rectal antiemetics
		➢ promethazine	12.5–25 mg/4–6 hours rectally
		➢ prochlorperazine	25 mg/12 hours rectally
		■ Unresponsiveness or no access to other abortive treatments	Intranasal DHE or ergotamine suppositories
	High frequency of nausea and vomiting within migraine attacks	■ Combine an oral antiemetic, before the onset of nausea and vomiting
		■ Consider prophylactic migraine treatment
Inpatient settings	■ Parenteral antiemetics
	➢ Metoclopramide		10 mg/8 hours intramuscularly/intravenously
	➢ Prochlorperazine		5–10 mg/6–8 hours intramuscularly/ intravenously
	➢ Promethazine		12.5–25 mg/4–6 hours intramuscularly/ intravenously
	➢ Trimethobenzamide		200 mg/6–8 hours intramuscularly
	➢ Dimenhydrinate		50–100 mg intramuscularly/intravenously
	■ Associated if needed with parenteral NSAIDs, triptans, DHE, neuroleptics, or corticosteroids, among others

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; DHE, dihydroergotamine.