Survey Highlights Relationship Between IBS and Migraine

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