Gut-brain Axis and migraine headache: a comprehensive review

Abstract

The terminology "gut-brain axis "points out a bidirectional relationship between the GI system and the central nervous system (CNS). To date, several researches have shown that migraine is associated with some gastrointestinal (GI) disorders such as Helicobacter pylori (HP) infection, irritable bowel syndrome (IBS), and celiac disease (CD). The present review article aims to discuss the direct and indirect evidence suggesting relationships between migraine and the gut-brain axis. However, the mechanisms explaining how the gut and the brain may interact in patients with migraine are not entirely clear. Studies suggest that this interaction seems to be influenced by multiple factors such as inflammatory mediators (IL-1β, IL-6, IL-8, and TNF-α), gut microbiota profile, neuropeptides and serotonin pathway, stress hormones and nutritional substances. Neuropeptides including CGRP, SP, VIP, NPY are thought to have antimicrobial impact on a variety of the gut bacterial strains and thus speculated to be involved in the bidirectional relationship between the gut and the brain. According to the current knowledge, migraine headache in patients harboring HP might be improved following the bacteria eradication. Migraineurs with long headache history and high headache frequency have a higher chance of being diagnosed with IBS. IBS and migraine share some similarities and can alter gut microflora composition and thereby may affect the gut-brain axis and inflammatory status. Migraine has been also associated with CD and the condition should be searched particularly in patients with migraine with occipital and parieto-occipital calcification at brain neuroimaging. In those patients, gluten-free diet can also be effective in reducing migraine frequency. It has also been proposed that migraine may be improved by dietary approaches with beneficial effects on gut microbiota and gut-brain axis including appropriate consumption of fiber per day, adhering to a low glycemic index diet, supplementation with vitamin D, omega-3 and probiotics as well as weight loss dietary plans for overweight and obese patients.

The association between dietary acid load and the migraine odds

“…Third, gut microbiota could be in uenced by dietary acid load due to less intake of fruits and vegetables, which may lead to low microbial diversity in gastrointestinal systems then the adverse effects on human microbiomes (51). Recent shreds of evidence suggested the existence of a link between gut microbiota and migraine (7). Besides, studies have reported that there might be potential bene cial effects following probiotics supplementation in subjects with migraine headache (15,52,53).…”

“…Some of these mechanisms include changes in cerebral blood ow, mitochondrial and hormonal dysfunction, genetic factors, obesity, neuroin ammation, in addition to increased levels of a number of neuropeptides especially nitric oxide (NO), and calcitonin gene-related peptide (CGRP) which are thought to be involved in the function of trigeminovascular system. On the other hand, activation of the trigeminovascular system could lead to excretion of substances such as CGRP, substance P and NO (5)(6)(7)(8). These agents are associated with in ammation and vasodilation in cranial vessels, which lead to intense pain (5,6,8).…”

Chang-Kang-Fang Ameliorates Experimental Diarrhea Predominant Irritable Bowel Syndrome by Regulating Gut Microbiota and Gut -Brain Axis

“…Compared with healthy controls, IBS patients have shown the lower abundance in Lactobacillus, Bi dobacterium, and Faecalibacterium prausnitzii [2,11]. Furthermore, disturbed microbiota structure is linked to co-morbidities of IBS, such as anxiety, depression and migraine [12,13]. On clinical trials, Lactobacillus probiotics [14,15] and multispecies probiotics [16], which contains the SCFAs-producing bacteria, have shown improvement symptoms in IBS patients.…”

Migraine and Diet

“…Evidence in the literature has demonstrated that the application of probiotics might be useful for some neurological disorders, such as Parkinson’s disease [ 60 ]. Evidence, however, is limited for migraine, and large-scale randomized, placebo-controlled studies are required to evaluate whether the gut microbiota is involved in migraine pathogenesis [ 61 ] and whether probiotics are efficient and safe for patients with migraine headaches [ 60 ]. In addition, if the gut–brain axis can influence migraine, the underlying mechanisms remain unexplored.…”