UK Biobank Study Reveals IBS, Peptic Ulcers Linked With Migraine

Migraine is significantly associated with irritable bowel syndrome (IBS) and peptic ulcers among middle-aged and older patients, according to results of a UK Biobank study. Findings were published in Brain and Behavior.

Findings of previous studies have indicated a potential link between migraine and disruptions in the gut-brain-axis, “which entails that there are bidirectional relationships between neurological and gastrointestinal (GI) symptoms,” authors explained.

Several mechanisms have been proposed to explain this link, including disruptions to the serotonergic system and increased gut permeability and inflammatory processes.

In an effort to map the associations between migraine and IBS, peptic ulcers, Helicobacter pylori (HP) infection, celiac disease, Crohn disease, and ulcerative colitis in middle-aged and older individuals, researchers obtained data from the UK Biobank resource. The large prospective cohort study includes health-related information from over 500,000 participants aged between 37 and 69 years at the time of recruitment.

Baseline assessments, including physical measurements, questionnaires, and verbal interviews, were carried out between 2006 and 2010.

Due to missing information, data from 489,753 individuals were included in the final analysis. Results were adjusted for potentially confounding conditions—such as cardiovascular diseases (CVD) and neurological or GI conditions other than those studied—and for use of nonsteroidal anti-inflammatory drugs (NSAIDs). Adjustments were also made for gender, age, and other factors.

Among the individuals included, total prevalence of migraine was 2.9%, and prevalence was higher among women (4.2%) than men (1.4%). Migraineurs were also more likely to be younger, have a lower body mass index, and have a college or university degree.

Analyses revealed:

• Migraine was significantly associated with IBS (odds ratio [OR], 2.24; 95% CI, 2.08-2.40; P < .001) and peptic ulcers (OR, 1.55; 95% CI, 1.35-1.77; P < .001).
• Migraine was not associated with HP infection (OR, 1.34; 95% CI, 1.04-1.73; P = .024), celiac disease (OR, 1.29; 95% CI, 1.04-1.60; P = .023), Crohn disease (OR, 1.08; 95% CI, 0.80-1.45; P = .617), or ulcerative colitis (OR, 1.00; 95% CI, 0.79-1.27; P = .979) after adjusting for multiple testing.
• The percentage of participants with CVD was lower in the migraine group.
• The use of NSAIDs indicated for the treatment of migraine was twice as common in the migraine group as in the control group.
• Among the GI disorders studied, IBS was the most common diagnosis (2.3%) in the full sample, followed by peptic ulcers (1.2%), ulcerative colitis (0.5%), celiac disease (0.4%), Crohn disease (0.3%), and HP infection (0.3%).

The research indicates that lifestyle factors appear to play a role in IBS and peptic ulcers. Because of this, “future studies may wish to evaluate whether the same lifestyle interventions could affect both GI and migraine symptoms in patients with comorbidity,” authors explained.

As there were limited participants with Crohn disease and ulcerative colitis in the current sample, researchers suggested the low prevalence of these conditions may have limited their power to detect potential associations and noted future ad hoc studies may be warranted.

Low prevalence rates for all conditions studied and the age range of those included also mark limitations to the generalizability of findings.

Overall, results indicate “the link between migraine and autoimmune GI conditions is weaker than that of migraine and IBS and peptic ulcers,” authors concluded.

Reference

Welander NZ, Olivo G, Pisanu C, Rukh G, Schiöth HB, and Mwinyi J. Migraine and gastrointestinal disorders in middle and old age: a UK biobank study. Brain Behav. Published online July 21, 2021. doi:10.1002/brb3.2291