My doctors have just diagnosed me with gastric stasis and it impacts how effective the triptans and nausea drugs that I take for a migraine attack are. Sometimes, the gastric stasis is worse than others, so it affects the drugs more. When the gastric stasis is at its worst, my migraine drugs do pretty much nothing. What’s really worse though is not knowing if my meds are going to work when I get a migraine. Can you give me some suggestions? Thanks a lot, Reggie.
We’re sorry you have to deal with the complication of gastric stasis. This paralysis of the stomach and delayed emptying of the stomach, which is also called gastroparesis, can indeed make it impossible for oral migraine and nausea meds to work effectively and efficiently.
There are a couple of primary issues here, of course:
- Triptans are more effective when we take them and get them into our systems early in a migraine attack.
- There’s simply no way to know how gastric stasis is going to act on any given day, so you can’t plan around it.
The most fool-proof way to address both of those issues is to switch your triptans and antiemetic (medication for nausea) to non-oral methods of administration. For the triptans, this means, subcutaneous injections, nasal sprays, the new iontophoretic sumatriptan patch (Zecuity), or the new inhaled sumatriptan powder (ONZETRA Xsail). You can find comprehensive information about which triptans are available in the various delivery methods in Triptans for Migraine – Forms and Uses.
Antiemetic medications also come in non-oral forms - most commonly IM injectable and suppositories. Some to discuss with your doctor are promethazine (Phenergan), prochlorperazine (Compazine), and ondansetron (Zofran).
A note on both triptans and antiemetics - some of these medications are available in orally disintegrating tablets. It’s a misconception that they’re absorbed through the mucosa under the tongue. They’re absorbed through the gastrointestinal tract after disintegrating and being swallowed. Thus, they do not avoid the issues associated with gastric stasis.
Thank you for your question,
Dave Watson and Teri Robert
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© David Watson and Teri Robert, 2016.
Dr. David Watson is a UCNS certified migraine and headache specialist and the director of the West Virginia University Headache Center. Dr. Watson takes a special interest in migraines, cluster headaches, and tension-type headaches. He strives to stay up-to-date on current research and treatments and regularly attends continuing medical education conferences. “Dr. Dave” is also very active in the migraine community, taking part in and leading advocacy efforts to benefit the entire community. He is the founder and chairman of the board of Runnin’ for Research, a nonprofit organization that helps interested patients and doctors set up races in their areas to raise research funding for headache disorders. He’s also a regular participant in the Alliance for Headache Disorders Advocacy’s “Headache on the Hill” event and is co-secretary of the American Headache and Migraine Association. You can follow Dr. Watson on Twitter.
Teri Robert is a leading patient educator and advocate in the area of migraine and other headache disorders, and has been writing for the HealthCentral migraine site since 2007. She is a co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association. She received the National Headache Foundation’s Patient Partners Award for “ongoing patient education, support, and advocacy,” in 2004 and a Distinguished Service Award from the American Headache Society in 2013. You can find links to Teri’s work on her web site and blog and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.
Do you have questions about Migraine? Reader questions are answered by UCNS certified Migraine and headache specialist Dr. David Watson, and award-winning patient educator and advocate Teri Robert. Questions may be submitted via our submission form. Accepted questions will be answered by publishing the answers in our Ask the Clinician column. For an overview of how we can help and questions we can and can’t answer, please see Seeking Migraine and Headache Diagnoses and Medical Advice.