Nausea and vomiting are often significant problems that
are associated with migraine. These reflect a problem with gastric stasis which has the additional disadvantage
of reducing the absorption of migraine relieving drugs into the blood stream. For this reason a drug that
helps empty the stomach, as well as reduce nausea and vomiting (prokinetic) is needed, rather than an anti-sickness drug.
Two drugs are available – Domperidone and Metoclopramide.
A European Medicines Agencies Review found that Domperidone may have a small effect on the heart. This
evidence has been reviewed by the UK Medicines and Healthcare Regulatory Agency (April 2014) and its updated advice is that
Domperidone should not be used by people who have a serious underlying heart condition, it should be used at the lowest effective
dose for the shortest time and should be used at no higher dose than 10 mg 3 times a day.
We have changed our guidance from an initial dose of Domperidone of 20 mg to one of 10 mg, with a maximum of 3 tablets
in any 24-hour period. It should not be used for people with a significant underlying heart condition.
The conclusion of Headache Experts is that its benefits for the treatment of migraine far outweigh the very small risks