Gut Brain Axis and Migraine

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

The gut-brain axis (GBA) is defined by the communication between the central nervous system (CNS)  and the enteric nervous system (ENS) [1]. The CNS consists of the brain and spinal cord, and is responsible for receiving, processing, and responding to sensory information [2]. The tissues of the CNS are extremely delicate. The ENS innervates the gastrointestinal (GI) tract, and is an extensive neuronal network [3]. The ENS has roles in the propulsion of food, nutrient processing, blood flow regulation, immunological defense, and more [3]. The bidirectional interaction between the CNS and ENS has been of recent interest in migraine research, as migraine is a disease that can be complicated by GI conditions including functional dyspepsia and cyclic vomiting syndrome (CVS) [4].

Functional dyspepsia and CVS are members of a spectrum of disorders that are now classified as disorders of the gut-brain interaction (DGBI) [4]. Functional dyspepsia is a common, benign gastrointestinal disorder that affects more than 20% of the population [5]. Factors like anxiety and depression can negatively impact the gut-brain axis, suggesting that there is a CNS component in the GI tract [4]. CVS involves recurrent episodes of nausea and vomiting without identifiable pathology [6]. There are known relationships between CVS and migraine, menstrual cycle, autonomic dysfunction, and mitochondrial disease; however, these relationships are not fully understood [6]. Gastric disorders such as functional dyspepsia and CVS are frequently reported by patients with migraine as comorbidities [4]. 

A 2023 study investigating whether the composition of gut microbiota in participants with episodic migraine and chronic migraine was altered in comparison to that of controls found a significant difference in the composition between groups [7]. The microbial composition differences were evaluated via fecal samples provided by the participants. In addition, the study reported that some clinical characteristics and comorbidities revealed significant association with the relative abundance of microbiota at the genus level (group of species). However, there was no significant difference observed in the microbiota composition dissimilarity between samples and microbial community richness and evenness in the episodic migraine, chronic migraine, and control groups [7]. A study in a hospital-wide population of migraine patients reported that 70% of patients met criteria for concurrent functional gastrointestinal disorders (FGID) [8]. This study also reported a link between FGID symptoms and psychological comorbidities in this patient population [8]. Serotonin, a neurotransmitter involved in behavior, mood, and memory, has been proposed as a factor in both migraine and FGID as well [8].

In conclusion, there is evidence of a link between migraine and GI comorbidities. This research further illustrates the need to illuminate the role of the GBA in migraine and other neurological conditions.

 

References:

  1. Carabotti M, Scirocco A, Maselli MA, Severi C (2015) The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol 28:203–209
  2. Thau L, Reddy V, Singh P (2023) Anatomy, Central Nervous System. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  3. Fleming MA, Ehsan L, Moore SR, Levin DE (2020) The Enteric Nervous System and Its Emerging Role as a Therapeutic Target. Gastroenterol Res Pract 2020:8024171. https://doi.org/10.1155/2020/8024171
  4. Aurora SK, Shrewsbury SB, Ray S, et al (2021) A link between gastrointestinal disorders and migraine: Insights into the gut–brain connection. Headache: The Journal of Head and Face Pain 61:576–589. https://doi.org/10.1111/head.14099
  5. Francis P, Zavala SR (2023) Functional Dyspepsia. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  6. Davis A, Bryant JH. Cyclic Vomiting Syndrome. (2023). In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  7. Yong D, Lee H, Min H-G, et al (2023) Altered gut microbiota in individuals with episodic and chronic migraine. Sci Rep 13:626. https://doi.org/10.1038/s41598-023-27586-4
  8. Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A (2016) Gastrointestinal disorders associated with migraine: A comprehensive review. World J Gastroenterol 22:8149–8160. https://doi.org/10.3748/wjg.v22.i36.8149
Published On: August 19th, 2023