Is there an association between migraines and the onset of inflammatory bowel disease?

In a recent article posted to the Research Square* preprint server, researchers used the National Health Insurance Service (NHIS) data of 10,628,070 Koreans aged ≥20 to investigate the link between migraines and the new onset of inflammatory bowel disease (IBD), a chronic gastrointestinal (GI) disorder, including Crohn's disease (CD) and ulcerative colitis (UC).

The NHIS population-based nationwide cohort study started in 2009 with a health examination/screening to determine the presence or absence of migraine in its participants and continued till 2017.

Study: Migraine Is Associated with the Development of Inflammatory Bowel Disease: A Nationwide, Population-Based Study. Image Credit: OrawanPattarawimonchai/Shutterstock.com

*Important notice: Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Background

Studies have shown that the incidence and prevalence of IBD have increased in South Korea. Thus, researchers aim to identify risk factors modifiable before the onset of IBD.

Even though a few studies have reported an increased risk of migraine among IBD patients than in the general population, studies have not assessed the direct effect of migraine on IBD development.

About the study

In the present study, researchers used de-identified NHIS data comprising every 20 years or older participant's sociodemographic data, disease codes, prescriptions/ procedures, and medical records. In the study population of 10,131,193 individuals, 2.8% of the individuals constituted the migraine group, and the remaining formed the control group. 

The people in the migraine group were more likely to be older, female, living in a rural area, with a lower income. A higher proportion of patients with migraine also had metabolic syndrome, hypertension, dyslipidemia, and chronic kidney disease (CKD).

They followed up with these participants for a median of 10.3 years to determine the incidence rates of IBD per 100,000 person-years. The team defined patients with IBD by ICD-10 and a special V code constituting the rare intractable disease (RID) code used by NHIS since 2006.

The researchers used the Cox proportional hazard regression models to evaluate the risks of new-onset IBD, with results presented as hazard ratio (HR) and 95% confidence interval (CI).

They compared patient characteristics between migraine and control groups using t-tests and chi-square tests for continuous and categorical variables.

Finally, the team used Kaplan-Meier curves to showcase the cumulative incidence for each group and the log-rank test for comparisons. For all two-tailed statistical analyses, p<0.05 was considered significant.

Results

The main study finding was that patients with migraine were at an increased risk of developing IBD, including CD and UC. The cumulative risk of IBD, especially CD, showed a steep rise up to five years following a diagnosis of migraine.

Intriguingly, the risk of CD remained unaffected by age, gender, health behaviors, or metabolic syndrome; however, their effect was more pronounced in male UC patients.

The risk for IBD development in migraineurs was 1.3-fold higher compared to the general population, even after adjusting for common risk factors, e.g., female gender, metabolic syndrome, etc.

Conclusions

Migraine is a remitting neurological disorder that affects an individual's daily life yet remains under-recognized and untreated. It is often accompanied by GI disturbances, suggesting that it manifests due to the interference in the gut–brain axis.

There is enough scientific evidence that relationships between neurological and gastrointestinal symptoms are bidirectional. Thus, researchers have proposed multifaceted biological mechanisms describing the link between migraine and IBD development based on the gut–brain axis.

First, they have linked increased proinflammatory cytokines, such as interleukins (IL)-1b/6/8 during a migraine attack, to IBD onset. Second, they found gut dysbiosis a common factor in migraine and IBD pathophysiology.

Third, they have implicated dietary and lifestyle choices with episodic/chronic migraines and IBD onset. Even psychological or physical stress changes the gut microbiota, which alters intestinal permeability triggering IBD.

Furthermore, many experimental studies have shown how decreased gut motility disturbs the gut microbiota to initiate chronic intestinal inflammation, such as IBD. Finally, drugs for treating migraine, e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), likely triggers IBD onset, especially when administered at a higher frequency for a prolonged duration.

Perhaps the answer to the causality of these associations and their direction is hidden in a better understanding of the gut–brain axis. Nonetheless, since the risk of IBD, including CD and UC, in patients with migraine is significantly higher, clinicians should carefully consider these risks when treating migraine.

*Important notice: Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.