What do migraine and gut disorders have in common?

Nausea, vomiting, and delayed gastric emptying are symptoms of migraine and certain disorders of gut-brain interaction (DGBI) that are also migraine comorbidities. Could migraine and DGBI have a shared pathophysiology? Professor Linda Nguyen, Stanford University, Palo Alto, CA, highlighted their shared physiologic links at AAN 2021.

What are disorders of gut-brain interaction?

Previously known as functional gastrointestinal (GI) disorders, disorders of gut-brain interaction (DGBI) are characterized by GI symptoms related to any combination of:

Disorders of gut-brain interaction manifest as many different syndromes

  • Motility disturbance
  • Visceral hypersensitivity
  • Altered mucosal and immune function,
  • Altered gut microbiota
  • Central nervous system processing1

They affect all parts of the GI tract and manifest as many different syndromes.1

 

What are the overlaps between DGBI and migraine?

Gastroparesis, functional dyspepsia, and cyclic vomiting syndrome are migraine comorbidities

"Three DGBI—gastroparesis, functional dyspepsia, and cyclic vomiting syndrome—are comorbid conditions of migraine",2,3 explained Professor Nguyen, "and some of their symptoms—nausea, vomiting and delayed gastric emptying—are also symptoms of migraine".2

"It is thought that the nausea, vomiting and delayed gastric emptying result from autonomic dysfunction2 and that migraine and DGBI might have a shared pathophysiology",4 said Professor Nguyen.

Gut microbiota, serotonin, proinflammatory mediators, and CGRP may play a role in the pathophysiology

Other pathophysiologic overlaps between migraine and DGBI were also highlighted by Professor Nguyen and include:

  • Altered serotonin signalling, which may play a role in the initiation of a migraine and GI dysfunction
  • Involvement of proinflammatory mediators, which may be linked to altered gut microbiota
  • Involvement of calcitonin gene-related peptide (CGRP)4

 

What is the impact of GI symptoms on treatment of patients with migraine?

GI symptoms may decrease the efficacy of oral therapies

"When treating patients with migraine, it is important to take into account any GI symptoms because nausea, gastric motility dysfunction, and vomiting may decrease the efficacy of oral medications and result in a lack of response to therapy", noted Professor Nguyen. For example:

  • Nausea may mean a patient avoids or delays taking an oral medication5
  • Gastric stasis and vomiting may interfere with and impair drug absorption5

This Industry Therapeutic Update was funded by Impel NeuroPharma.

 

DGBI : disorders of gut-brain interaction 
CA : California 
AAN : American Academy of Neurology
GI : gastrointestinal 
CGRP : Calcitonin Gene-Related Peptide

BE-NOTPR-0182, approval date : 07.2022

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Schmulson MJ, Drossman DA. What is new in Rome IV? J Neurogastroenterol Motil 2017; 23:151–63.
  2. Aurora SK, et al. A link between gastrointestinal disorders and migraine: Insights into the gut–brain connection. Headache 2021;61:576–89.
  3. Pareek N, et al. Cyclic vomiting syndrome: what a gastroenterologist needs to know. Am J Gastroenterol 2007;102:2832–40.
  4. Arzani M, et al. Gut-brain axis and migraine headache: a comprehensive review. The J Headache Pain 2020;21:15.
  5. Rapoport AM, et al. Innovative delivery systems for migraine: the clinical utility of a transdermal patch for the acute treatment of migraine. CNS Drugs 2010;24:929–40.
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