Patients with headache and functional dyspepsia present meal–induced hypersensitivity of the stomach

Abstract

IntroductionFunctional gastrointestinal disorders are frequently characterised by the presence of extra-intestinal symptoms. A survey on irritable bowel syndrome showed that gynaecological, urinary, psychological, dermatological and neurological symptoms were significantly more prevalent in patients than in controls [1]. Headache, in particular, was present in more than 30% of patients suffering from this condition. Although there is no similar evaluation for functional dyspepsia, the presence of headache also in patients suffering from this functional disorder is a common finding in day-today clinical practice. To our knowledge no data are available on the responsible pathophysiological mechanism.A new instrument recently became available, the barostat, which allows the evaluation of both tone modifications of large viscera, such as the stomach and colon, and the evaluation of visceral sensitivity, by the study of sensitivity thresholds to mechanical distention [2]. The application of this new technology to the study of the pathophysiology of functional dyspepsia has made it possible to identify several mechanisms at the basis of the onset of dyspeptic symptoms: for example, it was shown that the onset of post-prandial epigastric pain, belching and weight loss is due to gastric hypersensitivity to distention Abstract Headache is a frequent feature of functional gastrointestinal disorders but there is no data on the responsible pathophysiological mechanism. The aim of this study was to verify whether alteration of post-prandial gastric tone or sensitivity might explain this association. Fourteen patients affected by functional dyspepsia (7 migraine without aura) and 7 healthy volunteers (HV) underwent gastric tone measurement in fasting condition and after the administration of a liquid meal by barostat. Gastric volume (GV) and accommodation were calculated as difference between mean post-prandial and mean fasting volume. Mean postprandial GV increase and fasting perception and discomfort threshold (DTh) were similar among the 3 groups. DTh after meal was lower in dyspeptic headache patients than in HV and dyspeptic without headache patients. Patients with migraine and functional dyspepsia may be characterised by mealinduced hypersensitivity of the stomach.

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“…Gastric reflux has been reported to precipitate attack of migraine. 34 Further Autonomic nervous system (ANS) dysfunction can play an important role in the etiology of both disorders. 35 - 36 …”