Patients with migraine often present with gastrointestinal comorbidities. The relationship of the gut-brain connection to migraine was discussed in a narrative review published in Headache.

Researchers from Impel NeuroPharma and Stanford University searched publication databases for studies of the gut-brain connection, migraine, and gastric disorders.

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

In the US, the prevalence of diagnosed gastroparesis is estimated to be 24.2 per 100,000 individuals. Symptoms of gastroparesis may include abdominal pain, vomiting, early satiety, bloating, and delayed gastric emptying.


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Aurora and colleagues evaluated gastric emptying in 29 patients with migraine. Ten patients in the interictal migraine group showed mean time to half emptying to be longer (standard deviation (SD): 188.8±100.6 minutes) compared to the control group (n=10, SD: 118.8±38.6 minutes). However, some contradictory data has been published, and the relationship between migraine and GI disorders requires further investigation.

Patients with gastroparesis may have comorbid functional dyspepsia, a condition that affects 5{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} to 40{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} of the global population. DiStefano and colleagues found migraine common in patients with functional dyspepsia and postprandial distress syndrome (PDS).

They studied 60 patients with functional dyspepsia (n=38 with PDS; n=22 with epigastric pain [EPS]). Reporting on patients with migraine without aura (n=38), 54{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} (n=12) of patients with PDS (not correlated to ingesting a meal) and 76{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} (n=29) with PDS experienced migraine (89{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc}, n=26, correlated to meal ingestion). The study authors concluded migraine is common in patients with EPS and PDS.1

Cyclic vomiting syndrome (CVS) is reported to affect 0.07{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} to 2{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} of adults in the US, Canada, and the UK, although CVS is typically a pediatric concern.  

Gastrointestinal symptoms may impede the treatment of migraine symptoms. In a survey of 500 patients with migraine, 30.5{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} and 42.2{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} of patients reported they were reluctant to take an oral medication due to symptoms of nausea and vomiting, respectively, during a migraine attack. Delayed gastric emptying and slower absorption have been detected during migraine episodes, impeding timely release of a drug’s active ingredient.

The review authors concluded there have been few studies which have focused on the gut-brain connection and that gastrointestinal comorbidities have likely been underdiagnosed among patients with migraine. More research is needed to uncover the complex biological networks responsible for these connections.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

References

  1. Aurora S K, Shrewsbury S B, Ray S, Hindiyeh N, Nguyen L. A link between gastrointestinal disorders and migraine: insights into the gut-brain connection. 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 post-prandial migraine in patients with functional dyspepsia. Cephalalgia. 2019;39:1560-1568. doi:10.1177/0333102419857596

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