Migraine Associated with Gastrointestinal Disorders: Review of the Literature and Clinical Implications

This article starts with an A++++ overview of migraine

Migraine is a common headache disorder with a lifetime prevalence of 13% in men and 33% in women (1). There are ictal (migraine attack) and interictal periods. Migraine is a highly disabling disease with high personal and social costs (2). Migraine can be considered as a complex neurogenic inflammatory disorder (3–5) but the pathophysiology is still not fully understood (6). It is a disease of the brain, possibly of the brainstem and is associated with increased synthesis and release of calcitonin gene related peptide (CGRP). A migraine attack can be blocked with CGRP antagonists (3, 7, 8). The actual pain is generated by nociceptors of trigeminal nerve endings in the dura. Low serotonin levels may sensitize the nociceptors of trigeminal neurons (9). Existing data support that serotonin is low interictal but increased ictally in migraineurs (10, 11). Ictally serotonin agonist, like triptans and ergotamins, which decrease serotonin are associated with relief of acute pain (7–9). In contrast tricyclic antidepressants and selective serotonin and
noradrenaline reuptake inhibitors, which are associated with increases in serotonin, are utilized for migraine prevention (11). Migraine attacks can be triggered by intrinsic cerebral factors (CGRP release), nitric oxide like tri-nitroglycerine, corticotrophin releasing hormone (stress), pro-inflammatory cytokines, and degranulation of mast cells located in the dura (1, 3, 8). Migraine has a genetic background, but the concordance in monozygotic twins is only 20%, indicating the importance of environmental factors in
getting the disease (12).

Study goes on to describe links between migraine and various gut problems – gastroparesis, celiac, colic, IBD, IBS.

I was especially interested in the IBS link because it suggested a diet that helped both migraine AND IBS and we even have some ideas about how it could be working.

Experimental evidence for an association between IBS and migraine comes from a study in which an IgG-based elimination diet was given to migraine patients with IBS. Twenty-one patients were included in the double blind, randomized, controlled, cross-over clinical trial with usual diet, elimination diet, and provocation diet (44). Compared with baseline, the elimination diet was associated with a significant reduction in migraine attack count, duration and severity. Also a significant reduction in IBS complaints was observed, demonstrating an association between the two diseases.

The rest of the paper is primarily an exploration of how on earth your guts and migraines could be so tied up together:

This overview of the literature suggests the existence of a rather strong relationship between GI disorders and migraine. One of the links between inflammatory diseases and migraine are enhanced pro-inflammatory immune responses (60).

There’s also some stuff about how based on how we think things might be going wrong, certain probiotics could help. But there’s basically no evidence on that yet and the person writing this works for a probiotics company…. They’re really pushing leaky-gut stuff, which is pretty controversial still and whatever is going on, we definitely don’t have a good handle on it.