Migraine in young females with irritable bowel syndrome: still a challenge

Abstract

Migraine without aura is frequently reported in female patients with irritable bowel syndrome (IBS), but knowledge about the relationship between these two conditions is still lacking. This study was aimed to explore the particularities of migraine without aura in young female patients with IBS in order to establish a possible link between them. From a cohort of young female patients hospitalized with IBS in the Internal Medicine Department, 30 joined this pilot study, and they were assigned into two groups on the basis of presence or absence of migraine. In this sample, 15 patients have mild to moderate migraine without aura, with a recently taken normal brain scan, and 15 were without migraine. Diseases and conditions not related to migraine and other possible specific female comorbidities were ruled out. Patients undertook a thorough clinical examination in order to assess fibromyalgia (FM) and chronic pelvic pain (CPP), Questionnaires for migraine disability assessment (MIDAS) and generalized anxiety disorder (GAD) were performed. Laboratory testing of blood, urine, and stool were also performed. Optimized lymphocyte proliferation test for food allergy (FA) and a fecal microbiota (microbiological semiquantitative method) for dysbiosis (DB) assessment were performed. Based on the results, migraine-positive group displayed more severe comorbidities: FM (p=0.0002), FA (p=0.0006), CPP (p=0.026), higher scores of anxiety (GAD, p=0.0008), and more severe DB (p=0.0009). We noticed a strong positive correlation between MIDAS and GAD (r=0.83), a good positive correlation between MIDAS and DB (r=0.56), and a moderate positive correlation between MIDAS, FM, and FA (r=0.46 and 0.41). In conclusion, young female patients with IBS and migraine without aura displayed more severe associated issues – anxiety, intestinal DB, FM, FA, and CPP. The severity of migraine correlated well with anxiety range and DB magnitude and moderately with FM and FA.

Sex-Gender Differences in Irritable Bowel Syndrome

“…That is, women reported more severe abdominal pain following menopause than before menopause. 32 However, another study demonstrated that there was no significant difference (P > 0.05) in IBS severity score system (IBS-SSS) between pre-and postmenopausal women. 34 However, there are several limitations in the qualities, methods, and numbers of studies evaluating the effect of menstrual cycle, hormone supplementation, and menopausal status on IBS symptoms.…”

“…16 In addition, the prevalences of chronic pain disorders that often overlap with IBS, such as fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, and migraine headache, are higher in women with IBS, suggesting an association between their symptoms and hormonal statuses. 25,27,[29][30][31][32] Women report more frequent and severe IBS symptoms during menstruation such as loose stools, bloating, and worsening of abdominal pain, increases that are likely related to changes in the menstrual cycle. 25 In a population-based postal study performed in Iceland, women with dysmenorrhea were revealed to experience IBS symptoms more frequently than those without dysmenorrhea.…”

Gut-brain Axis and migraine headache: a comprehensive review

“…Similar to migraine, IBS can alter gut microflora composition and thereby may affect the gut-brain axis and inflammatory status [13,[89][90][91][92][93]. Moreover, food allergies/intolerances that seem to cause migraine attack initiation and relapse of IBS may also explain the association between the disorders [92]. With respect to this, food elimination diets based on IgG antibodies may effectively reduce symptoms in migraine patients with concomitant IBS [94].…”

Chronic Pelvic Pain and Irritable Bowel Syndrome: Is Subclinical Inflammation Bridging the Gap?

“…IBS is well known as intestinal disorder often associated to other functional pain conditions and various extraintestinal co-morbidities [14][15][16] Several pelvic floor conditions are reported by multiple studies as comorbidities associated to IBS: pelvic organ prolapse, urinary urgency, latency or incontinence…”