100 Migraine Drugs, A to Z: domperidone

Domperidone (Motilium) is not a champagne (that would be Dom Perignon and it can give you a headache) but an excellent nausea medication which is often used for the treatment of nausea associated with migraines. It is available in 58 countries but unfortunately not in the US. In desperate cases I’ve had some patients get it from Canada or Europe.

Domperidone works in a different way from other nausea medications and can be effective when other drugs are not. Besides being good at relieving nausea, one study suggested that it can prevent migraine attacks if taken in the prodrome period, 6 to 12 hours before the attack. Prodrome is a prelude to a migraine attack and it can consist of one or more of the following symptoms: fatigue, elation, irritability, depression, yawning, increased urination, food cravings, and other. Not every person has a prodrome, although some people are just not aware of the warning symptoms which can occur a day or two before the attack.

Domperidone was also shown to shorten migraine attacks when taken with paracetamol (acetaminophen, or Tylenol in the US). This combination of domperidone with paracetamol (Domperamol) is as effective as 50 mg of sumatriptan (Imitrex, Imigran).

A study comparing domperidone with metoclopramide (Reglan), a drug very popular in the US showed that they are equally effective for nausea in diabetics with gastric motility problems, but domperidone had fewer neurological side effects. These neurological side effects included drowsiness, reduced mental acuity, restlessness, fatigue, and depression. Very rarely, metoclopramide, prochlorperazine (Compazine), and similar drugs can lead to a devastating side effect – persistent involuntary movements of the face and other parts of the body.

Domperidone has very few side effects, but should be used with caution in older patients because it can cause serious cardiac arrhythmias.