Neurological

Complex interaction between migraine symptoms and gastrointestinal comorbidities

Gastrointestinal comorbidities are common in migraineurs. The relationship of the gut-brain connection to migraines was discussed in a narrative review published in Headache.

Researchers from Impel NeuroPharma and Stanford University searched publication databases for studies on the intestinal-brain connection, migraines and gastric disorders.

There is evidence of a common pathophysiology between migraine headache and gastrointestinal comorbidities such as gut-brain interaction disorders (DGBI), including inflammatory mediators, gut microbiota, serotonin pathway, and neuropeptides. Autonomic nervous system abnormalities have been observed in patients with migraines and upper gastrointestinal (GI) disorders. The migraine symptom profile includes delayed gastric emptying, nausea, and vomiting.

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In the United States, the prevalence of diagnosed gastroparesis is estimated to be 24.2 per 100,000 people. Symptoms of gastroparesis can include abdominal pain, vomiting, early satiety, gas, and delayed gastric emptying.

Aurora and colleagues studied gastric emptying in 29 patients with migraines. Ten patients in the group with interictal migraines had a longer mean time to half emptying (standard deviation (SD: 188.8 ± 100.6 minutes) compared to the control group (n = 10, SD: 118.8 ± 38.6) Minutes) However, some conflicting data has been published, and the relationship between migraines and gastrointestinal disorders needs further investigation.

Patients with gastroparesis can have comorbid functional dyspepsia, a condition that affects 5 to 40% of the world’s population. DiStefano and colleagues found that migraines are common in patients with functional dyspepsia and postprandial distress syndrome (PDS).

They examined 60 patients with functional dyspepsia (n = 38 with PDS; n = 22 with epigastric pain) [EPS]). Reporting of patients with migraines without aura (n = 38), 54% (n = 12) of patients with PDS (not correlated with eating a meal) and 76% (n = 29) with PDS suffered migraines (89%, n =.) 26, correlates with food intake). The study authors concluded that migraines are common in patients with EPS and PDS. 1

It is reported that 0.07% to 2% of adults in the US, Canada, and the UK have cyclic vomiting syndrome (CVS), although CVS is typically a pediatric problem.

Gastrointestinal symptoms can hinder management of migraine symptoms. In a survey of 500 migraineurs, 30.5% and 42.2% of the patients stated that they did not take any oral medication during a migraine attack because of nausea or vomiting. Delayed gastric emptying and slower absorption have been noted during migraine episodes, preventing timely release of a drug’s active ingredient.

The review authors concluded that there were few studies focusing on the gut-brain connection and that gastrointestinal comorbidities were likely underdiagnosed in patients with migraines. More research is needed to uncover the complex biological networks responsible for these connections.

Disclosure: Several authors stated links to industry. For a full list of the author’s disclosures, see the original article.

References

  1. Aurora SK, Shrewsbury SB, Ray S, Hindiyeh N, Nguyen L. A link between gastrointestinal disorders and migraines: insights into the gut-brain connection. A headache. 2021; 61 (4): 576-589. doi: 10.1111 / head.14099
  2. Stefano M., Pucci E., Miceli E., Pagani E., Brondino N., Nappi G, et al. Prevalence and pathophysiology of postprandial migraines in patients with functional dyspepsia. Cephalalgia. 2019; 39: 1560-1568. doi: 10.1177 / 0333102419857596

This article originally appeared on Clinical Pain Advisor

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