Study Describes Relationship Between Migraine, Postoperative Nausea and Vomiting

Migraine is a significant risk factor for postoperative nausea and vomiting (PONV), according to results of a retrospective study published in the Journal of Clinical Medicine.

Although PONV are the most frequent adverse effects of anesthesia, few studies have focused on the relationship between the impact of migraine and these adverse effects. As many as 80% of high-risk surgical patients experience PONV, according to authors, while the symptoms occur in 10% to 30% of all surgical patients.

“The gastrointestinal (GI) tract can become distended after anesthesia and surgery, and nausea or vomiting is likely to occur in situations where there is dysfunction of the lower esophageal sphincter, such as in gastroesophageal reflux disease (GERD),” researchers wrote.

In addition, “migraine is accompanied by nausea and vomiting, which is therefore one of the diagnostic criteria. Migraine is also associated with GI disorders, such as gastroparesis, GERD, and irritable bowel syndrome, and is often accompanied by various upper GI symptoms.”

To better articulate the impact of migraine, among other factors, on PONV, investigators retrospectively analyzed clinical data from the Smart Clinical Data Warehouse of Hallym University Medical Center in Sweden.

Data from patients 18 years and older who had undergone surgery with general anesthesia between January 2010 and October 2019 were included in the analysis. Any patients who were reoperated on within 24 hours, were unconscious after surgery, underwent ventilator therapy after surgery, or experienced nausea and vomiting before surgery were excluded from the study.

Patients included in the study had to have a diagnosis of migraine by a board-certified neurologist, 2 or more consecutive visits to the neurology department, and a history of triptan use prior to surgery.

Researchers defined PONV as nausea or vomiting within the first 24 hours after surgery. Of the 187,706 patients included in the study, 19,786 developed PONV within 24 hours after general anesthesia and 1982 had migraine. Overall, PONV occurred in 300 of the patients with migraine (1.5%).

Analyses revealed:

• The unadjusted and fully adjusted odds ratios (ORs) for PONV in subjects with and without migraine were 1.52 (95% CI, 1.34-1.72; P < .001) and 1.37 (95% CI, 1.21-1.56; P < .001), respectively.
• The OR for PONV in patients with migraine was also high (OR, 1.37; 95% CI, 1.13-1.66; P = .001) after propensity score matching.
• No significant difference was observed in any clinical variable between the propensity score–matched patients with and without migraine.

Nausea is a subjective sensation involving the activation of certain neural pathways, whereas vomiting is a complex reflex under the control of 2 functionally distinct medullar centers, authors wrote. “However, our study did not consider nausea and vomiting as separate outcomes because they have identical risk factors and predictors. Postoperative nausea is considered as a risk factor for vomiting and there is a strong association between the 2 symptoms,” researchers said.

Because the study included data from subjects who visited 1 university medical center with 5 hospitals, authors cautioned against generalizing results to a wider population, as the possibility of selection bias must be considered. Additional prospective population-based studies are warranted to confirm the association between migraine and PONV.

Reference

Kim J, Lim M, Lee S, Kwon Y, Lee J, Sohn J. Consideration of migraines among risk factors for postoperative nausea and vomiting. J Clin Med. Published online September 29, 2020. doi:10.3390/jcm9103154