Migraine as a Cause of Persistent Nausea or Vomiting in Palliative Care: A Case Series

Migraine is common, underdiagnosed, and frequently inadequately treated in the general population. Nausea and vomiting are common reasons for patients to be referred for symptom control. Nausea can be the most prominent feature of migraine; the International Classification of Headache Disorders (ICHD) recognizes cyclical vomiting syndrome as a migraine variant in children, and there is increasing evidence for a similar entity in adults. We present three patients with troublesome nausea uncontrolled by conventional antiemetic therapy. On questioning, all three had other symptoms suggestive of migraine, and two had a family history. Their symptoms settled with the use of various antimigraine therapies. Amitriptyline appears to be particularly useful. A therapeutic trial of prophylaxis may be indicated for patients whose nausea and vomiting may be attributed to migraine.