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Migraine and ibs: Migraine in young females with irritable bowel syndrome: still a challenge

by alexxlab

Are Individuals with IBS More Likely to Have Migraines?

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Are Individuals with IBS More Likely to Have Migraines?GIS2022-01-28T11:55:43-08:00

Irritable bowel syndrome (IBS) is a functional digestive condition defined by abdominal pain, bloating, and constipation and/or diarrhea. It is so common that you likely know at least one person who has it, yet people rarely speak about having IBS due to the taboo nature of digestive symptoms. IBS symptoms are chronic and can be difficult to treat in some people, and it can affect many areas of life, including physical health, mental health, social activities, and work.

Migraine is a neurological condition that results in painful, throbbing headaches. These episodes are recurring, typically felt on one side of the head, and generally cause moderate to severe pain. Most individuals experience several other symptoms with the migraine headache, including nausea, vomiting, dizziness, and sensitivity to light and sound. In addition, many can tell when a migraine is coming because they experience symptoms up to a day before the headache, known as the prodromal phase, including fatigue, mood changes, muscle stiffness, difficulty sleeping, nausea, constipation, and diarrhea. Some individuals also experience an aura phase between the prodromal phase and the headache, which typically involves visual disturbances such as wavy lines, blurring, or loss of part of the visual field, and can also include difficulty speaking and sensory disturbances such as tingling or numbness in the extremities. A migraine can last anywhere from a few hours to several days. As with IBS, migraine can affect many areas of life, as the symptoms can lead to missed work and social events.

In a recent study,1 researchers analyzed data obtained from the UK Biobank, a biomedical database and research resource that contains detailed information from nearly half a million individuals, to look for connections between migraine and gastrointestinal diseases and disorders. Past research has shown a potential link between migraine and a variety of digestive conditions, including IBS, peptic ulcers, Helicobacter pylori infection, Crohn’s disease, ulcerative colitis, and celiac disease.

The study involved 489,753 participants between the ages of 37 and 69 years, so while it is a very large cohort, it is lacking data on children, young adults, and seniors. Another possible limitation of this study is a healthy participant bias, as those who participated in the study tended to have fewer health conditions than those found in an average population. The rates of gastrointestinal conditions and migraine in this group were both lower than expected in a random selection of people.

After analyzing the data, the researchers found that those with IBS were 2.25 times more likely than the control subjects to experience migraines. The research also showed that individuals with peptic ulcer disease were 1.63 times more likely to suffer from migraines than the control subjects. However, despite H. pylori infection being a primary cause of peptic ulcers, individuals who had H. pylori infection without ulcers were not at an increased risk of migraines. While past research has shown a potential correlation, this study found that those who had Crohn’s disease, ulcerative colitis, or celiac disease were no more likely to suffer from migraine than the controls.

The study authors speculate that the correlation between IBS and migraine could be related to disruptions to the gut-brain axis. One possible mechanism is problems with serotonin levels. Previous research shows that migraine might be related to chronically low serotonin levels that increase during active migraines. In addition, it’s possible that some cases of IBS might occur due to low levels of serotonin in the gut, which is why selective serotonin reuptake inhibitors can be an effective treatment method for individuals with IBS. In addition, both IBS and migraine are more common in women than in men, so female hormones might also play a role.

Further research is needed to fully understand why this link exists, and whether individuals with other digestive conditions might be at an increased risk of experiencing migraine.

First published in the

Inside Tract® newsletter issue 219 – 2021

Photo: Keira Burton | Pexels.com
1.Welander NZ

et al. Migraine and gastrointestinal disorders in middle and old age: A UK Biobank study [published online ahead of print, 2021 Jul 21]. Brain Behav. 2021;10.1002/brb3.2291. doi:10.1002/brb3.2291.

 

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Survey Highlights Relationship Between IBS and Migraine

New survey findings reveal a significant association between migraine and irritable bowel syndrome.

Findings of a nationwide survey conducted in Saudi Arabia revealed that patients with migraine were 4.13 times more likely to have irritable bowel syndrome (IBS), and those with IBS were also more likely to experience migraine. Results were published in BioMed Research International.

Apart from throbbing pain, migraine can be accompanied by symptoms including nausea, photophobia, and phonophobia, whereas IBS is characterized by “abdominal pain that persists for more than 1 day per week in the previous 3 months and begins more than 6 months before diagnosis,” authors explained.

IBS is also one of the most common gut-brain connection disorders, with an estimated global prevalence between 3.8% and 9.2%.

Previous research has supported the claim that the gut-brain axis can substantially affect how neuronal disorders affect the gastrointestinal tract. Additional factors like serotonin, central and visceral hypersensitivity, and hereditary traits also serve as common pathogenesis pathways for both migraine and IBS.

To measure the prevalence of migraine and IBS in Saudi Arabia and elucidate the relationship between the 2 syndromes, researchers carried out an observational cross-sectional analytical study between March and June 2021.

All participants were at least 15 years old and completed an online self-administration survey. The survey was divided into 3 sections focusing on the patients’ personal and demographic information; their migraine symptoms, measured via the Migraine Screen Questionnaire (MS-Q), and severity, measured by the migraine severity (MIGSEV) scale; and IBS manifestations, measured using the IBS module of the Rome IV Diagnostic Questionnaire (R4DQ).

A total of 2802 individuals were included in the analysis, a slight majority of whom were male (52.5%).

Analyses revealed:

  • Prevalence of migraine was 27.4%, and prevalence of IBS was 16.4%.
  • Females had a considerably higher prevalence of migraine, at 37.5%, compared with 18.2% in males.
  • Females also had a higher prevalence of IBS, at 20. 9%, compared with 12.4% for males.
  • 34.8% of respondents had IBS-mixed, followed by IBS-predominant constipation (33%), IBS-diarrhea (24.6%), and IBS-unsubtyped (7.6%).
  • Odds of having IBS in migraineurs were much higher than in those without migraine (odds ratio [OR], 4.127; 95% CI, 3.325-5.121; P < .001).
  • Those with IBS had an increased likelihood of having migraines (OR, 3.304; 95% CI, 2.632-4.147; P < .001).
  • Migraineurs with severe symptoms were more likely to have IBS than migraineurs with moderate or lower migraine symptoms (P = .015).

“A standard theory for the sex discrepancy in migraine and IBS is hormonal factors, especially sex hormones,” researchers noted. However, “more research is needed to investigate sex-related vulnerability to migraine headaches and IBS, including genetic and biological determinants and other environmental factors influencing migraine and IBS prevalence in females.”

One potential explanation for the relationship seen between migraine and IBS is the role of defective serotonin, which modulates gut motility, secretion, and sensation, and serves as an essential neurotransmitter in the central nervous system.

Diet can also influence the gut-brain axis, and evidence has shown that “an IgG-based elimination diet drastically improves the symptoms of both conditions, implying a relationship between the 2 via the enteric-nervous system mediated by serotonin and other inflammatory components.”

Due to the nature of the study, no causal effects can be determined, marking a limitation. Recall bias may also have been present.

“National surveillance of migraine and IBS prevalence can bring awareness to the cost on the health and social care systems, mainly as both disorders have been attributed to a lower quality of life,” authors concluded. “Measuring the severity of one disorder may aid in predicting the likelihood of developing the other,” but ultimately, more research is needed.

Reference

Bin Abdulrahman KA, Alenazi NS, Albishri SB, Alshehri FF. Association of migraine and irritable bowel syndrome in Saudi Arabia: a nationwide survey. Biomed Res Int. Published online January 18, 2022. doi:10.1155/2022/8690562

Migraine is a risk factor for most cardiovascular diseases

Migraine and associated pathologies

Migraine is a primary neurological disease characterized by recurrent episodes of headache, gastrointestinal and autonomic symptoms (singly or in combination). This disease is detected in almost 15% of the population (about 1 billion people worldwide). The lifetime prevalence of migraine is 10-20% depending on sex, age (after puberty) and the population studied, but it is more common in women. Approx 90% of all first migraine attacks occur before age 50. The disease significantly reduces the quality of life and puts a significant burden on the healthcare system.

Among the most frequent associations of migraine, especially in patients with migraine aura, are ischemic stroke and coronary heart disease. Major potential mechanisms for these conditions include endothelial dysfunction, hypercoagulability, platelet aggregation, vasospasm, cardiovascular risk factors, paradoxical embolism, depolarization spread, genetic predisposition, nonsteroidal drug use, and immobilization. Most of these causes may also be associated with an increased risk of other cardiovascular events.

New data from population-based studies

A recent study from Stanford University, USA, and Aarhus University Hospital, Denmark, focuses on improving understanding of the relationship between cardiovascular disease and migraine. The results were published in BMJ in January 2018. The study was funded by the University of Aarhus, the Lundbeck Foundation’s Program for Clinical Research Infrastructure, and the Novo Nordisk Foundation. In patients with newly diagnosed migraine, a risk assessment was performed (in comparison with the general population): myocardial infarction, ischemic and hemorrhagic stroke, peripheral arterial disease, venous thromboembolism, atrial fibrillation or flutter, and heart failure. Additionally, the dependence of the association of the listed conditions with the gender of patients and the presence of migraine aura was assessed. The data obtained can serve as a guide for targeted therapeutic intervention in order to reduce cardiovascular risks.

This population-based comparative cohort study included 51,032 people with migraine and 510,320 people in the matched group. The average age of participants is 35 years (interquadrate range 22-47), 71% are women. In the migraine cohort (2451 patients), a higher baseline level of cardiovascular risk factors and comorbidity was noted. Of these, 575 patients had more than one cardiovascular event. Cumulative rate of cardiovascular events in the migraine cohort per 1000 people after 19years of follow-up compared with the general population was 25 versus 17 for myocardial infarction, 45 versus 25 for ischemic stroke, 11 versus 6 for hemorrhagic stroke, 13 versus 11 for peripheral arterial disease, 27 versus 18 for venous thromboembolism; 47 vs 34 for atrial fibrillation or flutter and 19 vs 18 for heart failure.

The highest risk of cardiovascular disease was observed during the first year: an eight-fold increase in the risk of ischemic and hemorrhagic stroke and an approximately two-fold increase in the risk of myocardial infarction, venous thromboembolism, atrial fibrillation or flutter. For >1–5 years and >5–19years, a strong association of migraine with an increase in the incidence of myocardial infarction (by 1.5 times), ischemic stroke (by 1.6–2.1 times), hemorrhagic stroke (by 1.4 times), venous thromboembolism (by 1.3– 2.0 times) and atrial fibrillation or flutter (1.2 times). Information on the presence of migraine aura was available for 30,069 patients (59% of the migraine cohort). Overall, adjusted hazard ratios for migraine with aura were higher than for migraine without aura for all outcomes except for venous thromboembolism and heart failure. Migraine with aura has been associated with long-term risks of myocardial infarction, ischemic stroke, hemorrhagic stroke, and venous thromboembolism.

Conclusions

The absolute risks of cardiovascular outcomes in the study, given the young age of the population, were, as expected, low. However, the authors propose to consider migraine as a powerful and persistent risk factor for most cardiovascular diseases in both men and women. It remains an open question whether strategies to prevent cardiovascular disease are effective in patients with migraine.

Alexander Guziy

causes, symptoms, diagnosis, treatment (pills), prophylaxis in women, men, children

Causes

Classification

Symptoms

Diagnosis

Treatment

Prevention

Migraine is a neurological disease, the main symptom of which is periodic attacks of headache of varying intensity, and the causes of the disease are associated with hereditary predisposition and adverse environmental factors.

Women experience migraines several times more often than men. According to statistics, about 20% of the total population suffers from this neurological pathology in the world, and this is one of the most common causes of disability.

The debut falls on the period of puberty, but the most severe disease occurs when the age of 35-45 years is reached.

Causes of development

To date, there is no exact information about what is the cause of the disease. The hereditary theory is considered the most popular, since close relatives of patients on the mother’s or father’s side also suffer from this neurological pathology.

Migraine headache can be provoked by the following factors:

  • psychological – stress, strong emotions, sudden mood changes;
  • hormones – the beginning of menstruation, the period of ovulation;
  • environment – bright light, loud noise, frosty or windy weather, extreme heat, closeness in the room, strong smell;
  • foodstuffs or drinks, especially alcohol, chocolate and cheese, and meals containing monosodium glutamate;
  • Taking certain medications.

Hunger, lack of sleep, severe fatigue, elevated body temperature, flights and jet lag can also provoke a migraine attack. It is important to know that each patient always has his own specific factors that can give impetus to the development of an attack. This is important to remember when diagnosing and treating the disease. In other words, any deviation of the state of the body from the current status quo is capable of provoking the development of a migraine attack.

One should not think that it is the disease that is inherited. Only the peculiarity of the response of the central nervous system and blood vessels to one or another type of stimulus is inherited. However, this is enough for dysregulation of the vascular tone of the brain and increased excitability of its neurons to manifest the same symptoms as in the parents.

Classification

Most often, migraine in women has three phases. The first is prodromal. A few hours before the attack, drowsiness appears, sensitivity to light or sounds increases, mood changes. However, sometimes this phase does not occur, and the attack begins immediately with the onset of pain – this is the second phase. Usually pain is pulsating, manifests itself in the forehead, eye socket and temple. Their duration is from several hours to 2-3 days. Other symptoms include nausea, vomiting, and pale skin.

The attack ends with a recovery period or the third phase. There are increased fatigue, loss of appetite. Gradually, the state of health is restored to normal, but it takes several days.

Migraine with aura, or classic, occurs in 30% of all patients. Its peculiarity is that it does not consist of three, but of five phases, each of which has its own characteristics:

  1. The prodrome phase fully corresponds to that described above for migraine without aura.
  2. The second phase is the appearance of the aura. Each person has its own, and is associated with a decrease in blood flow to the brain for a short time. Lasts about an hour.
  3. The third is the classic version of pain in half of the head, which in medicine is called hemicrania.
  4. The fourth is the resolution phase. Here there is a decrease in pain, vomiting or nausea stops, and the patient falls asleep.
  5. Fifth – restorative, with complete normalization of well-being.

Chronic migraine is characterized by a headache that is atypical for this pathology, which occurs between attacks. The attacks themselves occur more than 15 times a month and greatly prevent a person from leading a normal life.

Main manifestations

Migraine symptoms will appear depending on what phase the attack is in.

During the prodrome period, which lasts from 4 to 48 hours, the main manifestations will be weakness, decreased concentration, irritability, anxiety, prolonged yawning, decreased skin temperature, loss of appetite.

In the second phase, called the aura, there are visual, sensory and emotional disturbances. Its duration is from 5 minutes to an hour. The aura does not appear in all patients, and sometimes the prodrome phase immediately passes into the third – painful.

The duration of the pain phase can be 4-72 hours. A throbbing headache appears, and with it there may be nausea or vomiting, weakness, increased sensitivity to sounds, smells and light.

A migraine attack ends with weakness, a feeling of heaviness in the head, emotional disturbances, and sometimes diarrhea. The fifth phase lasts from 1 to 3 days. Then the patient considers himself completely healthy before the development of the next attack.

The aura before the onset of a headache may differ from person to person. To date, neurologists distinguish its following types:

  1. Classic or typical. Manifested by visual, sensory and speech, completely reversible disorders. Flickering spots appear before the eyes, visual fields fall out, complaints of a feeling of numbness and tingling in the limbs, speech becomes slurred, or difficulties appear in the selection of certain words.
  2. Motor. To the symptoms described above is added a complete or partial loss of strength in half of the body.
  3. Stem or basilar. There is a violation of articulation, dizziness, tinnitus, double vision, a feeling of “crawling”, sometimes – a violation of consciousness.
  4. Retinal. It is expressed in unilateral visual impairment.

Symptoms and manifestations of aura in migraine in women and men are always identical. However, the latter suffer from this disease much less often and attacks occur between the ages of 18 and 25.

Diagnosis

A neurologist’s consultation begins with a patient interview. Since migraine pain is accompanied by certain symptoms, the doctor, when taking an anamnesis, will ask if nausea accompanies it, if there is an increased sensitivity to sounds and light at that moment, and if such an attack caused a disruption of the usual way of life for one, two or three days. .

Examination does not provide any significant data for making an accurate diagnosis. However, the nature of the pain, namely the presence of pulsation, is the leading diagnostic criterion. This allows you to distinguish migraine from other types of headaches.

Most of the instrumental methods used in the diagnosis of migraine in children or adults are not informative. This includes not only EEG, dopplerography and duplex, but also CT, MRI or X-ray. This is due to the fact that these methods cannot detect changes in the central nervous system that are characteristic of pathology.

It is very important to see a doctor when the first attack occurs. This will allow the patient to start taking the right medications and prevent serious complications from developing.

Therapies

Migraine treatment is carried out by a neurologist. Drug treatment is prescribed strictly individually.

You should not use traditional methods of treatment in the treatment of this disease, since their effectiveness has not been proven, and taking certain herbs, aromatic oils, infusions and decoctions can sometimes cause allergies and worsen the patient’s condition.

Also, self-medication should not be done – this often becomes the cause of the development of a chronic course of the disease. In severe cases, narcotic analgesics are prescribed, as well as combined agents.

Specialized drugs for migraine are called triptans. Today, several types of these medicines are produced, so the selection of the drug is carried out only by a doctor.

There is no one size fits all migraine pill. Therapy is always carried out individually and depends on both the severity of the course and the frequency of the attack, the age of the patient and the presence of concomitant diseases.

Migraine during pregnancy requires special attention. In this case, drugs should be taken only as a last resort and only after consultation with a neurologist, gynecologist, leading the pregnancy.

Prophylaxis

With a timely visit to the doctor and the appointment of the correct treatment, it is possible to improve the patient’s quality of life and reduce the frequency of seizures. To prevent migraines, it is recommended to lead an active lifestyle, observe a sleep schedule, and take medications prescribed by a doctor on a regular basis.

Also, patients should avoid precipitating factors and situations that could cause the development of another attack. These are stress, fasting, drinking alcohol, lack of sleep, overeating, eating foods from certain groups.

The author of the article:

Markelov Gleb Vladimirovich

neurologist, online consultations

work experience 4 years

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