Research Summary

Vomiting Linked to Migraine Pain Relief in Cross-Sectional Questionnaire Study

Anthony Calabro, MA

Key Highlights

  • In this exploratory, cross-sectional questionnaire study, 77.4% of patients with migraine reported vomiting during migraine attacks.
  • Among patients who vomited, 54.9% reported vomiting-induced migraine pain relief, including 14.6% of all vomiting patients who experienced complete attack cessation.
  • Attacks with vomiting were more painful than attacks without vomiting, with median numerical rating scale scores of 9 vs 7, respectively.
  • Voluntary vomiting induction was reported by 26.8% of patients who vomited and was more common among those with prior vomiting-induced pain relief.

Vomiting was associated with pain relief or pain freedom in more than half of patients with migraine who experienced emesis during attacks, according to an exploratory cross-sectional questionnaire study published in Headache. The study characterized the prevalence, timing, and extent of vomiting-induced migraine pain relief (VIMPR), a phenomenon the authors noted has been recognized anecdotally but not well described clinically.

The researchers conducted a questionnaire-based study at the Headache Center of Careggi University Hospital in Florence, Italy, from June to December 2023. The analysis included 106 adults who met International Classification of Headache Disorders, 3rd edition, criteria for migraine without aura, migraine with aura, or chronic migraine. Patients completed a structured questionnaire assessing vomiting frequency, number of vomiting episodes, migraine pain intensity with and without vomiting, timing of pain relief after vomiting, recurrence patterns, and voluntary vomiting induction.

Study Findings

Among the 106 patients included, 82 patients reported vomiting during migraine attacks, corresponding to a prevalence of 77.4% (95% CI, 68.5%-84.3%). The study population was predominantly female (85.8%), with a mean age of 43.4 years. Most patients had episodic migraine (82.1%), while 17.9% had chronic migraine and 18.9% had migraine with aura.

Migraine attacks accompanied by vomiting were significantly more painful than attacks without vomiting. Median pain intensity on a 0-to-10 numerical rating scale was 9 for attacks with vomiting vs 7 for attacks without vomiting (Wilcoxon signed-rank test, V = 70.00; P < .001; r = 0.77). In addition, 85.4% of patients who vomited reported that attacks with vomiting were more painful than those without emesis.

Pain relief after vomiting was reported by 45 of 82 patients (54.9%; 95% CI, 44.1%-65.2%). Among these 45 patients, 12 reported pain freedom, while 33 reported temporary pain reduction followed by recurrence. Relief occurred within seconds in 28.9%, within minutes in 40%, and within hours in 31.1% of patients with VIMPR.

Voluntary vomiting induction was reported by 22 of 82 patients who vomited, or 26.8% (95% CI, 18.4%-37.3%). This behavior was more common among patients who had experienced VIMPR than among those who had not, occurring in 40% vs 10.8%, respectively (χ2[1] = 7.39; P = .007).

Clinical Implications

According to the study authors, the findings suggest that vomiting may have a dual clinical role in migraine: it is associated with more severe attacks but may also provide pain relief or pain freedom in a substantial proportion of patients. They stated that the rapid onset of VIMPR and the learned behavior of voluntarily induced vomiting are consistent with possible endogenous antinociceptive mechanisms.

The authors noted several limitations, including the exploratory, retrospective, self-reported design; use of an ad hoc, nonvalidated questionnaire; lack of attack-level data on acute medication use; single-center recruitment; small sample size; and absence of objective neurobiological measures.

Expert Commentary

“In this exploratory questionnaire-based study, we found that vomiting is associated with pain relief or pain freedom in over half of patients with migraine who experience emesis during attacks,” the researchers concluded.

Reference
Munafò A, Burgalassi A, Vigani G, Iannone LF, De Cesaris F, Chiarugi A. Beyond symptom: exploring the analgesic properties of vomiting in patients with migraine. Headache. Published online May 27, 2026. doi:10.1111/head.7010