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HeadWay Issue #200 Why Your Migraine Meds Might Not Work
April 21, 2021

In this issue:

Why Your Migraine Meds May Not Be Working

Say what?! Gastric Motility

I know - I should have done something special for the 200th issue of HeadWay! Well, we can celebrate later, can't we? Today I want to highlight some quick but important tips that might help you find better treatment.

Why Your Migraine Meds May Not Be Working

If these migraine medications are supposed to be so effective, why aren't they working for me?

It's a common question, and there can be many answers. But a recent review is highlighting a reason - or more accurately, a group of reasons - why your meds might not work. And there might be something you can do about it.

This set of problems has to do with your gut, so we're talking about medication that is taken orally. Let's say you swallow a pill - is that medication really getting into your system the way it should?

There are several reasons why that might not be the case:
  • Vomiting: This is the obvious one. If you can't keep your medication down, of course it won't do much good. Cyclic vomiting syndrome is one manifestation of this problem (and it's becoming more common in adults). But what if you can keep it down for only an hour? Or two? Is that enough? Well, that brings us to some of the other possible problems.
  • Gastric Stasis and Gastroparesis: In this case, your medication may just sit in your gut, maybe for hours. What good is that? These are common issues for migraine patients - and not just during an attack. Which means it can affect other medications that you're taking for other reasons. More here: Gastroparesis and Headaches
  • Functional dyspepsia: A type of "indigestion" - with a lot of overlapping symptoms with the above. Read more here: Functional dyspepsia
So what can be done about it?

A few things to consider:
  1. Get tested: Especially if you're experiencing nausea, abdominal pain, or frequent indigestion, you may want to have tests done, such as a breath test or a scintigraphy.
  2. Treat both: Treating migraine may actually help your stomach problems, and vice versa. If you're experiencing gut/abdominal symptoms, don't ignore them. Treatment may be key to fighting your migraine symptoms.
  3. Bypass the gut: This is not the only option, but a medication that bypasses the gut, such as an injection or a skin patch, may help. However, remember that some of these conditions can cause other problems, and should still be treated.
  4. Metoclopramide: This is a drug sometimes used to treat heartburn and gastroparesis. Some patients have found that taking it with their migraine medication helps make their meds effective - but be sure to talk to your doctor first.
  5. Switch Medications: Some medications may actually make matters worse (there is some evidence that this may be the case with sumatriptan - see the article below). Simply switching to a new migraine medication or treatment may make a huge difference.
Although technical, the recent review published in the journal Headache is packed with more information if you'd like to do a deep dive: A link between gastrointestinal disorders and migraine: Insights into the gut–brain connection

Say What?! Gastric Motility

The problem in many of these conditions is simply a lack of gastric motility. Gastric - relating to the stomach or gut. Motility - movement - in this case, spontaneous or automatic movement.

So Gastric motility is the way that the smooth muscle of the stomach liquefies your food and forces it into the small intestine.

If there is some kind of dysfunction in gastric motility, it can keep your medication from being properly absorbed.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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