Migraine: a gut feeling?

Gut-brain axis

The gut microbiota

Migraines affect both the head and the gut, with the gut microbiota of individuals with migraine differing from that of healthy controls. Some bacteria may even predict the intensity and frequency of headaches. The gut-brain axis under the spotlight.¹

About this article

Created 29 March 2023

Updated 11 April 2023

Those who suffer from migraines are known to be more prone to gastrointestinal disorders such as diarrhea, constipation, and gastroesophageal reflux. A South Korean study published at the beginning of 2023 shows that they also have an altered gut microbiota.

What is a migraine?

Migraines are headaches of varying intensity, which are often severe (known as migraine attacks), and which commonly begin at puberty. Attacks can last from a few hours to two or three days and can occur anything from once a week to once a year. They are sometimes accompanied by nausea or an intolerance to noise or light. Migraines can become chronic and alter patient’s quality of life.²

Prevalence

Migraines affect 15% of the world’s population.³
Migraines affect 20% of women.⁴
Migraines affect 10% of men.
Due to hormonal influences, migraines are twice as common in women as in men.⁵

Altered gut flora in individuals with migraine

By analyzing the bacteria present in the stools of 87 individuals with migraine (42 with episodic migraine and 45 with chronic migraine (sidenote: Chronic form of migraine Headache for ≥ 15 days per month with ≥ 8 migraine features (increased sensitivity to light, sound or smells, nausea, vomiting…) for > 3 months. Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015 May;6(3):115-23. ) ) and 43 healthy controls, the researchers observed differences in their gut microbiota composition: in those suffering from migraine, bacteria of the genera Roseburia, Eubacterium, Agathobacter, PAC000195 (a previously undescribed bacterium), and Catenibacterium were more abundant than in people not affected by the disorder. There were also differences in certain gut bacteria according to the type of migraine (episodic or chronic): PAC001212 were characteristic of the chronic migraine group, while Prevotella, Holdemanella, Olsenella, Adlercreutzia, and Coprococcus were associated with episodic migraines.

Approximately 2.5% of individuals who suffer from episodic migraines will develop a chronic form of migraine.

1-2% Chronic migraines affect 1-2% of the world’s population.

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(sidenote:

Burch RC, Buse DC, Lipton RB. Migraine: Epidemiology, Burden, and Comorbidity. Neurol Clin. 2019 Nov;37(4):631-649.

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Bacteria as an indicator of headache severity

Furthermore, the presence of certain bacteria may predict key parameters of migraines. A higher content of PAC000195 was significantly associated with lower headache frequency, whereas Agathobacter revealed a significant negative association with severe headache intensity.

The gut microbiota

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Microbiota and migraine: chicken or egg?

However, this does not mean that these bacteria protect against migraines and prevent their recurrence, or that others exacerbate migraines. The results of this study merely show that individuals with migraine suffer from a gut dysbiosis. We cannot say for sure whether this imbalance is the cause or consequence of the migraine. The only way to find out is by performing longitudinal studies that follow the patients over time and look for variations in the microbiota that precede or follow migraine attacks, thus showing whether one factor triggers the other. This may in turn lead to the development of treatments for this disease.