Common Antiemetics Used in Migraine Treatment

Compazine, Thorazine, and Reglan for Migraine Attacks with Nausea

Nauseus woman bent over toilet
John Lamb/The Image Bank/Getty Images

More than half of people develop nausea and vomiting during a migraine attack. Since the neurotransmitter dopamine has been implicated as the main mediator of nausea during a migraine, medications that block dopamine receptors (called dopamine antagonists) are effective in reducing nausea and vomiting. Interestingly, these antiemetics also reduce migraine pain, and so they are frequently used as sole therapy in treating acute severe migraines.

Compazine in Migraine Treatment

Antipsychotics like Compazine (prochlorperazine) are commonly used to treat severe migraines with associated nausea.

In addition to treating severe nausea and vomiting, Compazine is also used in the treatment of schizophrenia and the short-term treatment of generalized non-psychotic anxiety. Compazine is available as tablets, sustained-released capsules, an oral liquid form, suppositories and vials -- which are given either intravenously (through the vein) or intramuscularly (into the muscle). Due to the difficulty of oral medication with migraine-associated nausea and vomiting, Compazine is given either intravenously or intramuscularly for symptom relief -- usually in an emergency room, urgent care center, or clinic. 

Potential side effects of Compazine include drowsiness, dizziness, blurry vision, skin reaction, low blood pressure, and amenorrhea. Extrapyramidal effects may also occur like muscle spasms, restlessness, parkinsonism, or tardive dyskinesia.

A rare but potentially life-threatening reaction to Compazine (and other antipsychotics) is Neuroleptic Malignant syndrome, which causes a variety of symptoms including fever, muscle rigidity, and confusion. 

Thorazine in Migraine Treatment

Thorazine (chlorpromazine) is another antipsychotic sometimes used to treat acute migraines and associated nausea and vomiting.

Like Compazine, it's often given either intravenously or intramuscularly for migraine and nausea relief. In terms of its benefits, according to a 2013 study in the Journal of Emergency Medicine, Thorazine improved headache pain, nausea, and sensitivity to light and sound in people with migraine compared to people taking placebo (saline infusion). But in this study, more people experienced drowsiness and dizziness when standing up when taking Thorazine, as compared to people who received the placebo.

Reglan in Migraine Treatment

Reglan (metoclopramide) also blocks dopamine receptors. But unlike other antipsychotics, it's used to increase gastric motility in people who have problems emptying their stomachs, like in people with diabetes. Similar to Compazine, Reglan is also commonly used to treat migraine-related nausea and vomiting, especially in the emergency room or urgent care setting, and is quite effective. In fact, one 2013 Cochrane review study found that the combination of Reglan and aspirin improved migraine-associated nausea and vomiting with fewer side effects compared to the triptan Imitrex (sumatriptan).

While Reglan tends to have fewer side effects than other antiemetics, common ones include:

  • restlessness
  • tiredness
  • dizziness
  • headache
  • confusion
  • problems sleeping

Like Compazine though, serious side effects like extrapyramidal symptoms and Neuroleptic Malignant Syndrome can occur (very rare). Also, Reglan can increase a person's risk for depression and suicidal thoughts.

Bottom Line

For migraine-associated nausea and vomiting, medications that block dopamine receptors in the brain (dopamine antagonists) are commonly used, especially Compazine, Thorazine, or Reglan. While quite effective, these medications do carry some risk. Be sure to inform the doctor treating you for all health problems and medications, including vitamins, supplements, and over-the-counter therapies.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

View Article Sources
  • Bigal ME, Bordini CA & Speciali JG. Intravenous chlorpromazine in the emergency department treatment of migraines: a randomized controlled trial. J Emerg Med. 2002 Aug;23(2):141-8.
  • Flake ZA, Linn BS & Hornecker JR. Practical selection of antiemetics in the ambulatory setting. Am Fam Physician 2015 Mar 1;91(5):29306.
  • Láinez M JA, García-Casado A & Gascón. Optimal management of severe nausea and vomiting in migraine: improving patient outcomes. Patient Relat Outcome Meas. 2013;4:61-73.
  • U S Food and Drug Administration. Medication Guide: Compazine. Accessed February 4th 2016.  
  • U S Food and Drug Administration. Medication Guide: Reglan (metoclopramide injection). Accessed February 5th 2016.