Comorbidity of gastrointestinal disorders, migraine, and tension-type headache: a cross-sectional study in Iran

DOI: https://doi.org/10.1007/s10072- 017- 3141- 0

Abstract-Summary Migraine can be accompanied by some gastrointestinal (GI) disorders.

We aimed to investigate the relationship between migraine and tension-type headache (TTH) and different lower and upper GI disorders as well as non- alcoholic fatty liver (NAFLD) and cholelithiasis.

The diagnosis of migraine and TTH was made by an expert neurologist based on

the international classification of headache disorders-III β (ICHD III β).

GI disorders, including irritable bowel syndrome (IBS), constipation, heartburn, dyspepsia, non-alcoholic fatty liver (NAFLD), and cholelithiasis, were diagnosed by a gastroenterology specialist.

These findings show an association between GI disorders and primary headaches especially migraine and are, therefore, of value to the management of migraine and TTH.

Further studies should investigate the etiology of the relationship between all

subtypes of primary headaches and GI disorders.

Extended: The diagnosis of GI disorders was made by an expert gastroenterology

specialist.

The diagnosis of cholelithiasis and NAFLD was based on abdominal ultrasono-

graphic findings as well as recent blood tests for aminotransferases.

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2 Mechanisms

Introduction According to a cross-sectional study in Tehran, Iran, the most prevalent types of headaches were TTH (48.6%) and migraine (18.2%) in the general population which reflects a fairly high prevalence rate [405].

Primary headache, including migraine and TTH, was described as a major public health problem by the WHO because of their prevalence and socioeconomic burden [406–408].

This gut-brain axis has a major role in the association between GI disorders and

migraine [409].

Although some GI complaints have been studied in migraine patients, further investigations about the association between migraine and GI disorders are needed. In the present cross-sectional study, we assessed the relationship between migraine and TTH and different lower and upper GI discomforts as well as non- alcoholic fatty liver (NAFLD) and cholelithiasis in a population that might be at more risk of experiencing headache, i.e., overweight and obese adults.

Materials and Methods The diagnostic criteria for migraine without aura were as follows: (A) a minimum of five attacks (fulfilling B–D as follows); (B) headache lasting 4–72 h; (C) head- ache characterized by at least two of the following: (1) unilateral location, (2) pul- sating quality, (3) moderate or severe intensity (inhibiting daily activities), and (4) aggravated by climbing stairs or similar routine physical activity; and (D) headache accompanied by at least one of the following: (1) nausea or vomiting or both (2) photophobia and phonophobia.

Based on ICHD III β, diagnostic criteria for TTH were as follows: (A) experienc- ing at least ten episodes (fulfilling B–D as follows); (B) headache lasting from a half hour to 7 days; (C) headache with at least two of the subsequent characteristics: (1) bilateral location, (2) pressing/tightening (non-pulsating) quality, (3) mild or mod- erate intensity, and (4) not provoked by usual physical activity such as walking or climbing stairs; and (D) both of the subsequent characteristics: (1) no nausea or vomiting and (2) no more than one episode of photophobia or phonophobia.

Results The mean age of the TTH group was significantly higher than the headache-free subjects (p = 0.007).

In the migraine group, the prevalence of GI disorders was 4.4% for IBS, 11% for constipation, 18.8% for dyspepsia, 7.2% for heartburn, 6.1% for fatty liver, and 1.7% for cholelithiasis, while in the TTH group, the prevalence was 1.3% for IBS, 3.8% for constipation, 21.8% for dyspepsia, 3.8% for heartburn, 10.3% for fatty liver, and 1.3% for cholelithiasis.

Among headache-free subjects, the prevalence of GI disorders was 0.9% for IBS, 3.1% for constipation, 4.5% for dyspepsia, 1.4% for heartburn, 2.7% for fatty liver, and 0.4% for cholelithiasis.

Migraine had significant association with IBS (p = 0.000), constipation (p =

0.000), dyspepsia (p = 0.000), heartburn (p = 0.000), and fatty liver (p = 0.048).

2.3 Comorbidities

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Discussion This is the first study that investigated the relationship between two subtypes of primary headache (migraine and TTH) and various GI disorders, NAFLD, and cho- lelithiasis in overweight and obese adults.

In this cross-sectional study, we observed higher prevalence of GI disorders including IBS, constipation, dyspepsia, and heartburn in patients suffering from migraine than headache-free participants.

Dyspepsia was the most prevalent GI disorder among migraineurs (18.8%) and

TTH patients (21.8%).

The prevalence of IBS was 4.4, 1.3, and 0.9% in migraineurs, TTH patients, and

headache-free subjects, respectively.

In our study, the prevalence of fatty liver and dyspepsia was significantly higher

in the TTH patients than the headache-free group.

Since this study investigated the association of GI disorders with migraine and TTH in overweight and obese people, the results may not represent the general population.

Conclusion The present study has shown that GI disorders are associated with primary headache especially migraine.

Further research should be undertaken with regard to the etiology of the relation-

ship between all subtypes of primary headaches and GI disorders.

Acknowledgement A machine generated summary based on the work of Martami, Fahimeh; Ghorbani, Zeinab; Abolhasani, Maryam; Togha, Mansoureh; Meysamie, Alipasha; Sharifi, Alireza; Razeghi Jahromi, Soodeh. 2017 in Neurological Sciences.

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