Could migraine increase the risk of inflammatory bowel disease? A new study found a link. Michela Ravasio/Stocksy
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More than 1 billion people around the world have at least one migraine attack each year.
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Previous research shows that migraine can potentially increase a person’s risk for several health issues, including gastrointestinal conditions.
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New research from Seoul National University College of Medicine in South Korea says there may also be a link between migraine and an increased risk for inflammatory bowel disease (IBD)..
Migraine has also been linked to some gastrointestinal conditionsNow, researchers from Seoul National University College of Medicine in South Korea say there may also be a link between migraine and an increased risk for irritable bowel disease (IBD), which is an umbrella term that includes Crohn’s disease and ulcerative colitis.
The study was recently published in the journal Scientific Reports
Migraine and IBD: An unsurprising connection
According to Dr. Brooks D. Cash, professor and chief of the division of Gastroenterology, Hepatology, and Nutrition at UTHealth Houston in Texas, who was not involved in this study, the field of gastroenterology has recognized for many years that migraine has been associated with many chronic gastrointestinal syndromes and diseases.
“The data in this report supports previous reports of an association between migraine headaches and IBD,” Dr. Cash told Medical News Today.
Dr. Rudolph Bedford, a board-certified gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA, who was also not involved in this study, told MNT that the research results were not surprising.
“[With] inflammatory bowel disease we do see some extra-intestinal manifestations including things involving the eye or ocular findings, which may be neurogenic in nature, so it wasn’t surprising,” Dr. Bedford added.
This is not the first study to look at a connection between migraine and IBD.
A study published in March 2021 of people in the United States found a higher prevalenc of migraine or severe headaches among adults with IBD than in those without.
Research published in March 2023 reported an increased prevalence of IBD in people with migraine with and without aura.
Could migraine increase risk of inflammatory bowel disease?
For the current study, researchers analyzed data from more than 10 million people through the nationwide healthcare system for South Korean citizens. About 3% of the study population had IBD.
Through the data, scientists found the incidence of IBD was significantly higher in people who had migraine compared to those who did not.
Scientists also reviewed the data through subgroups of Crohn’s disease and ulcerative colitis incidences. People with migraine in both subgroups had a higher risk of developing either condition when compared to people without migraine.
After a migraine diagnosis, researchers found people were at a higher risk of developing Crohn’s disease, with a significant rise after a 5-year follow-up.
Additionally, within the subgroups, scientists reported that the impact of migraine on the risk of developing ulcerative colitis was more prominent in men than women.
Study results not definitive
Based on these findings, the research team suggests that people with migraine be monitored carefully for the development of IBD.
However, Dr. Cash stated that the data presented do not convincingly support that approach or recommendation.
“The odds ratios that were reported in this study, which can be thought of as the increased odds of an outcome (e.g., developing IBD) with a given exposure (e.g., migraine headaches), were consistently between one to two, which is not far from definitive and can be easily misinterpreted or misrepresented,” he explained.
“The results are, at best, suggestive of an association between migraines and IBD, which we were already aware of based on previous research and deserve to be further evaluated. However, the minimal increase in the odds of developing IBD reported in this study is not sufficient to recommend increased monitoring of patients with migraines for the development of Crohn’s disease or ulcerative colitis.”
– Dr. Brooks D. Cash
Importance of identifying potential IBD triggers
Dr. Bedford said it is important to identify potential health issues that may trigger IBD, as a doctor may be able to mitigate the symptoms of IBD if they know what may be associated with it.
“Migraines can be very debilitating and you may want to identify those people with migraines,” he continued. “We don’t normally question patients with inflammatory bowel disease whether or not they have migraine headaches, so it probably rates as something that should be done more frequently.”
“These results add to an already relatively robust body of research suggesting that chronic pain syndromes are statistically more common in patients with chronic GI syndromes or diseases,” Dr. Cash said.
“We do not have enough information or proof yet to establish a causal relationship either way. But this data can be used to explain some therapeutic approaches that may benefit both GI and neurologic symptoms in patients with migraines,” he added.
Research next steps
Regarding the next steps for this research, Dr. Cash said that mechanistic data evaluating the possible reasons for these consistent observations of association is needed.
“Right now, all we have are hypotheses,” he continued. “Are there changes in the gut-brain communication pathways or sensory perceptions in the enteric and central nervous systems? Is the gut microbiome involved? Are there psychological and stress-mediated factors at play?”
“Once clinical relationships such as these have been identified, we need to move toward trying to explain why those relationships may exist,” Dr. Cash added. “That, in turn, may lead us to develop more targeted and effective therapies that can address multiple symptoms/syndromes.”
Dr. Bedford suggested researchers look for an association between IBD flares and migraine occurring at the same time. As migraine is associated with serotonin release, he encouraged researchers to examine how the serotonin transporters within the GI tract, small bowel, and colon might play a role.
“I think just questioning our patients in terms of quality of life issues — is there any way that we can mitigate their migraine headaches, potentially preventing their inflammatory bowel disease flare, or vice versa, is certainly something to look into,” Dr. Bedford said.
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Pain / AnestheticsBy Corrie Pelc on January 22, 2024 — Fact checked by Ferdinand Lali, Ph.D.
In Conversation: What do we know about the gut microbiome in IBD?
Inflammatory bowel disease (IBD) affects millions of people, often severely impacting their day-to-day lives. What role does the gut microbiome play in IBD, and can we harness dietary interventions to manage symptoms? Medical News Today explores this question In Conversation with a researcher and an expert through lived experience
Inflammatory bowel disease (IBD) is an umbrella-term that encompasses ulcerative colitis and Crohn’s disease, two chronic gastrointestinal conditions characterized by inflammation of the gut.
Some of the symptoms of IBD include nausea and vomiting, blood in stool, diarrhea, abdominal pain, fatigue, and irregularities in the menstrual cycle — all of these are invisible issues that can severely impact a person’s quality of life on a daily basis.IBD affects many people all over the world. In the United States, for example, around 1% of all adults have diagnosed IBD — and while that may seem like a small percentage overall, it actually amounts to approximately 2 million people.
In the United Kingdom, the most recent estimates suggest that IBD affects around 0.8% of the population, or around 131,000 people.
And that figure may be a serious underestimate of the real prevalence of IBD, as both Crohn’s and ulcerative colitis have symptoms that can also be attributed to other chronic conditions, which often makes them difficult to diagnose.
Research from the U.K. published in the Journal of Crohn’s and Colitis in 2020 suggested that an individual could see their doctor in relation to persistent gastrointestinal symptoms for 5 years before they receive the correct diagnosis of IBD.
A different gut microbiome
Yet recent research shows that in people with IBD, the gut microbiome — the community of bacteria and other microorganisms in the gastrointestinal tract — has certain particularities that set it apart from the microbiomes of healthy individuals, and which may offer clues to better treatments.
In this episode of our In Conversation podcast, we speak to Dr. Marcel de Zoete, an associate professor in the Department of Medical Microbiology at UMC Utrecht, The Netherlands.
In January 2023, Dr. de Zoete and his colleagues published a paper in the International Journal of Systematic and Evolutionary Microbiology, showing that people with IBD had two previously unidentified bacterial species in their intestinal tracts — a new species of Allobaculum mucilyticum, and a new species of Allobaculum fili. This finding may offer important clues about the underlying mechanisms in IBD, as well as potential new treatments.
Can diet help manage symptoms?
Joining us in conversation was also Zosia Krajewska, who lives with ulcerative colitis, and received her diagnosis at the age of 14.
Zosia told us about how changing her diet and lifestyle — alongside medical treatments — has helped her manage her ulcerative colitis and feel healthier, overall.
Past research has suggested that, in some people, dietary fiber and high-sugar diets can worsen the symptoms of IBD, while favoring ultra-processed foods can increase the risk of Crohn’s disease.
Conversely, a recent study showed that following a healthy diet and having a healthy lifestyle may help reduce a person’s risk of IBD.
Future research avenues for treatments
Beyond lifestyle interventions, however, it is also important for researchers to find better ways of fighting the underlying mechanisms of IBD.
One promising avenue is research looking at gut immune cells, which play an important role in inflammation and other processes in the gut. Harnessing immune cell activity in the gut may, in the future, help treat different forms of IBD.
Another potential treatment line that has been receiving attention from researchers, but which is currently only rarely used in clinical settings, is fecal microbiota transplantation. This presupposes the transfer of “good bacteria” into the guts of people with gastrointestinal disorders.
Find out more about the current research on IBD causes and treatments, and delve into a candid discussion on the real-life impact of IBD by listening to our podcast in full below, or on your preferred streaming platform.
By Maria Cohut, Ph.D. on October 5, 2023 — Fact checked by Michelle T. yatt, MD
How a poor night's sleep may trigger migraine headaches
Researchers have carried out a study about whether there is a connection between when migraine attacks occur and factors such as sleep quality, energy levels, and mood quality.
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The scientists acknowledged that prior studies already showed a connection between poor sleep and an increased risk of a migraine attack, but they believe that it is possible to narrow the window of timing for attacks.
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The study participants logged daily multiple electronic diary entries about their mood and energy levels as well as logging their sleep and perceived sleep quality.
Migraine attacks affect millions of people every year.
According to the American Migraine Foundation, around 37 million people (including both adults and children) in the United States experience these painful headaches.
Migraine attacks can be quite debilitating for people who experience them and oftentimes certain triggers can contribute to these headaches occurring.
Researchers in the new study took a closer look at potential migraine triggers. Their study required participants to track multiple metrics daily, which set apart the study from prior research.
One of the key study findings showed that participants who perceived a reduced quality of sleep the night before had a 22% increased chance of a migraine attack the following morning.
The study was published in the journal Neurology.
Collecting data from people with migraine
The symptoms of migraine attacks vary from person to person.
According to the National Institutes of Health, some symptoms of a migraine attack include severe pain on one side of the head as well as nausea and sensitivity to light. The attacks can last up to 3 days.
While there are migraine medications such as topiramate (Topamax) and sumatriptan (Imitrex) to help prevent these headaches from occurring or lessen symptoms, they are not 100% effective.
Researchers wanted to learn more about predicting and possibly preventing these attacks through tracking by mobile phone apps and electronic diaries.
The study had a participant pool of 477 people, with the youngest participant being 7 years of age and the oldest participant being 84 years of age. There were 291 female participants and 186 male participants, which the study authors mentioned set their research apart from prior work since other studies typically have mostly female participants.
The participants had to report their emotional state throughout the day in an electronic diary. The emotional states included:
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anxiety
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mood
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energy
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stress
The participants also reported on both their perceived sleep quality and sleep duration with mobile apps. The participants wore actigraphy monitors, which look similar to smartwatches and measure activity (including sleep times, wake-up times, and any sleep disruptions).
Researchers said this allowed them to see how the participants’ actual sleep time and sleep quality compared to how the participants perceived their sleep.
Participants also reported any migraine attacks they experienced as well as the timing of these headaches.
The participants logged the information for 2 weeks. After collecting the information, the researchers performed a statistical analysis of the data.
Poor perceived sleep increases migraine risk
The researchers said the results showed a connection between perceived sleep quality and energy changes and an increased risk of migraine attacks.
People who felt like their sleep quality was lower experienced a 22% increased chance of having migraine the following morning. However, this did not impact afternoon/evening headache chances.
Compared to the sleep results shown in the actigraphy monitor, there was a discrepancy between perceived sleep quality and actual sleep quality.
The researchers also found that lower energy levels the prior day increased the chances of a morning attack the following day by 16%. Conversely, people who experienced a much higher energy level than normal combined with a higher stress level than normal saw a 17% increased chance of migraine the next day in either the afternoon or evening.
The scientists said they did not find any connection between mood issues such as depression or anxiety levels and an increased risk of migraine.
“Surprisingly, we found no link between a person’s anxiety and depression symptoms — either having more symptoms or having higher-than-average levels of symptoms — and their likelihood of having a migraine attack the next day,” said Kathleen Merikangas
, PhD, a study author and National Institutes of Health investigator.
Overall, researchers said the study offers more insight into how sleep and energy patterns can be used to predict migraine and contribute to prevention. Tracking these patterns can give people with a history of migraine the ability to improve both self-awareness and the management of their condition.
Circadian rhythm and migraine
Merikangas mentioned that their findings “highlight the role of circadian rhythms in headache.”
Circadian rhythms refer to the 24-hour cycle of being awake and sleeping. As noted by the Sleep Foundation, circadian rhythms “dictate multiple processes in the body, including alertness or sleepiness, appetite, and body temperature.”
Disruption of circadian rhythms can affect how one feels throughout the day and can even contribute to memory issues.
Dr. Mark Burish, the director of the Will Erwin Headache Research Center with the McGovern Medical School at UTHealth Houston who wasn’t involved in the research, spoke with Medical News Today and addressed the study in regards to circadian rhythms.
“Research suggests that approximately half of patients with migraine have a circadian pattern to their headaches, with the headaches occurring at about the same time each day,” Burish said. “A specific gene variant in patients causes both migraine and a circadian rhythm disorder called advanced sleep phase disorder, where patients go to bed and wake up much earlier than most other people.”
Burish thinks that an increased understanding of how sleep factors into migraine will help with prevention.
“We think circadian rhythms might be important in the prevention of migraine because a circadian-related molecule called melatonin is sometimes used as a preventive treatment for migraine based on positive clinical trial data,” noted Burish.
Burish also thinks the improved understanding can help develop better medication and help people make behavioral changes to reduce the frequency of headaches.
“Aligning our eating, exercise, sleeping, and other behaviors to our individual circadian rhythm [may] help prevent headaches,” he said.
Dr. Joey Gee, a neurologist with Providence Mission Hospital in California who was not involved in the study, also spoke with Medical News Today.
“There are specific patterns of headaches that may come on more frequently and intensely depending on the sleep cycle – this can include migraines,” Gee said.
For people who experience migraine, Gee emphasized the importance of sleep hygiene.
“It is often very important to maintain an adequate sleep schedule,” commented Gee. “Going to sleep when tired and getting the necessary hours to feel rested is very important in all patients with chronic headaches, specifically those with migraine and cluster headaches.”
“The importance of this kind of study will only aid in supporting our knowledge about encouraging patients with headache disorders to improve their overall sleep behavior,” he added.
By Maria Cohut, Ph.D. on October 5, 2023 — Fact checked by Michelle T. Wyatt, MD
By Erika Watts on January 26, 2024 — Fact checked by Jennifer Chesak, MSJ
By Corrie Pelc on January 22, 2024 — Fact checked by Ferdinand Lali, Ph.D.
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