The Frequency of Gastroesophageal Reflux Disease (GERD) in Migraineurs and the Impact of GERD Treatment on Migraine Attacks
Year 2025,
Volume: 17 Issue: 1, 1 - 9, 27.03.2025
Merve Pozlu Çifçi
,
Ozden Gokdemır
,
Olgu Aygün
,
İsmail Çifçi
,
Dilek Güldal
Abstract
Objective: To determine the frequency of gastroesophageal reflux disease (GERD) in migraine patients and investigate the impact of adherence to gastroesophageal reflux treatment on migraine attack frequency.
Method: A total of 757 people aged 18-45 years who applied to the Dokuz Eylul University (DEU) Neurology-Headache Clinic and the DEU Family Health Centers and met the inclusion criteria were included in the study. Exclusion criteria were pregnancy, cancer or alarming findings, and any mental disability that would prevent understanding of the questionnaire. The Migraine Diagnostic Questionnaire, including International Headache Society (IHS) criteria, was used to diagnose migraine, the Gastroesophageal Reflux Disease Questionnaire (GERDQ) to diagnose GERD, and the Modified Morisky Scale to assess medication compliance. SPSS 22 package was used for statistical analysis. Chi-square, t-test and ANOVA were used for statistical evaluation of the data, and p<0.05 was considered significant.
Results: Of the 757 people who participated in the study, 428 patients were diagnosed with migraine and followed up in the neurology outpatient clinic. Of the 329 patients who applied for family health centers, 122 were diagnosed with migraine and 108 with non-migraine headaches. 99 did not complain of headache. When the GERDQ scores of the patients participating in the study were evaluated, there were 183 people (33.3%) with a GERDQ score of 8 and above among the migraineurs, 19 people (17.6%) with non-migraine headaches and 8 people (8.1%) without headaches. The GERDQ reflux score of migraineurs was found to be higher than in the other groups and this level was statistically significant (p<0.001). When the migraine attack frequency of migraine patients treated for GERD was evaluated, no significant relationship was found between treatment adherence and migraine attack frequency.
Conclusion: The incidence of GERD in patients with migraine was found to be higher than in patients without migraine, and the compliance of these patients with treatment was found to be lower. It may be useful to ask patients with migraine about GERD when they come to the outpatient clinic and to support their motivation for treatment.
Ethical Statement
Dokuz Eylul University has approved
Supporting Institution
None
Thanks
All the authors would like to thank Simon Edward Mumford, MSc. TESOL, Writing Centre Advisor at the Izmir University of Economics for his great contribution in editing the language of the manuscript.
References
- 1. Altamura C, Corbelli I, de Tommaso M, Di Lorenzo C, Di Lorenzo G, Di Renzo A, et al. Pathophysiological bases of comorbidity in migraine. Front Hum Neurosci. 2021;15:1-12.
- 2. Domitrz I, Cegielska J. Magnesium as an important factor in the pathogenesis and treatment of migraine-From theory to practice. Nutrients. 2022;14(5):1-16.
- 3. Gallai V, Sarchielli P, Albeni A, Floridi A. Nitrites, prostaglandins, and trigeminal vasoactive peptides in internal jugular venous blood in migraine patients during spontaneous attacks. Neurol Sci. 2000;21.
- 4. Goadsby PJ, Karsan N. Molecular mechanisms of migraine: Nitric oxide synthase and neuropeptides. Int J Mol Sci. 2023;24(15):11993.
- 5. Mauskop A, Varughese J. Why all migraine patients should be treated with magnesium. J Neural Transm. 2012;119(5):575-9.
- 6. Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: A comprehensive review. World J Gastroenterol. 2016;22(36):8149-60.
- 7. Ponce J, Garrigues V, Agréus L, Tabaglio E, Gschwantler M, Guallar E, et al. Structured management strategy based on the Gastro-oesophageal Reflux Disease (GERD) Questionnaire (GerdQ) vs. usual primary care for GERD: Pooled analysis of five cluster-randomised European studies. Int J Clin Pract. 2012;66(9):897-905.
- 8. Shen Z, Bian Y, Huang Y, Zhou W, Chen H, Zhou X, et al. Migraine and gastroesophageal reflux disease: disentangling the complex connection with depression as a mediator. PLOS ONE. 2024;19(7)
- 9. Hormati A, Bian Y, Huang Y, Zhou W, Chen H, Zhou X, et al. Higher risk of migraines among patients with GERD. PLOS ONE. 2023;18(5).
- 10. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808.
- 11. Jones R, Junghard O, Dent J, Wiklund I. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009;30(10):1030-8.
- 12. Hançerlioğlu S, Bor S. Turkish validation of the reflux disease questionnaire. J Gastrointest Liver Dis. 2021;30(2):193-7.
- 13. Vural UB, Özgür U, Acar T, Topsever DP, Filiz DTM. Modifiye Morisky Ölçeğinin Türkçe Geçerlilik Güvenilirlik Çalışması. Turkish Fam Physician. 2012;4:17-20.
- 14. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-54.
- 15. Pescador Ruschel MA, De Jesus O. Migraine headache. NCBI Bookshelf [Internet]. National Library of Medicine; 2023. [cited:2024 Nov 13] Available from: https://www.ncbi.nlm.nih.gov/books/NBK582491/
- 16. Bıçakçı Ş, Bozdemir N, Over F, Saatçi E, Sarıca Y. Prevalence of migraine diagnosis using ID Migraine among university students in southern Turkey. J Headache Pain. 2008;9:159-63.
- 17. Wacogne C, Lacoste JP, Guillibert E, Hugues FC, Le Jeunne C. Stress, anxiety, depression and migraine. J Headache Pain. 2003;4:451-5.
- 18. Ertas M, Baykan B, Orhan EK, Zarifoglu M, Karli N, Saip S, et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: A nationwide home-based study in adults. J Headache Pain. 2012;13:147-57.
- 19. Aamodt AH, Stovner LJ, Hagen K, Zwart JA. Comorbidity of headache and gastrointestinal complaints. The Head-HUNT Study. Cephalalgia. 2008;28(2):144-51.
- 20. Al-Hassany L, Haas J, Piccininni M, Kurth T, Maassen Van Den Brink A, Rohann JL. Giving researchers a headache – Sex and gender differences in migraine. Front Neurol. 2020;11:1-16.
- 21. Chalmer MA, Kogelman LJA, Callesen I, Christensen CG, Techlo TR, Møller PL, et al. Sex differences in clinical characteristics of migraine and its burden: A population-based study. Eur J Neurol. 2023;30(7):1774-84.
- 22. Lee SH, Lee JJ, Kwon Y, Kim JH, Sohn JH. Clinical implications of associations between headache and gastrointestinal disorders: A study using the Hallym smart clinical data warehouse. Front Neurol. 2017;8:1-8.
- 23. Peşkersoy C, Peker Ş, Kaya A, Ünalp A, Gökay N. Evaluation of the relationship between migraine disorder and oral comorbidities: Multicenter randomized clinical trial. Turk J Med Sci. 2016;46(3):712-8.
- 24. Peroutka SJ. What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep. 2014;18(10):454.
- 25. Heitkemper M, Jarrett M, Cain KC, Burr R, Levy RL, Feld A, et al. Autonomic nervous system function in women with irritable bowel syndrome. Dig Dis Sci. 2001;46(6):1276-84.
- 26. Shechter A, Stewart WF, Silberstein SD, Lipton RB. Migraine and autonomic nervous system function: A population-based, case-control study. Neurology. 2002;58(3):422-7.
- 27. Kurth T, Holtmann G, Neufang-Hüber J, Gerken G, Diener HC. Prevalence of unexplained upper abdominal symptoms in patients with migraine. Cephalalgia. 2006;26(5):506-10.
- 28. Craske MG, Wolitzky-Taylor KB, Labus J, Wu S, Frese M, Mayer EA, et al. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther. 2011;49(6-7):413-21.
29. Katić BJ, Golden W, Cady RK, Hu XH. GERD prevalence in migraine patients and the implication for acute migraine treatment. J Headache Pain. 2009;10(1):35-43.
30. Basavannaiah S. A comparative study of laryngopharyngeal reflux disease and migraine: Insights from a hospital-based analysis. Tr-ENT. 2024;34(1):13-7.
Migren Hastalarında Gastroözofageal Reflü Hastalığı (GÖRH) Sıklığı ve GÖRH Tedavisinin Migren Atakları Üzerindeki Etkisi
Year 2025,
Volume: 17 Issue: 1, 1 - 9, 27.03.2025
Merve Pozlu Çifçi
,
Ozden Gokdemır
,
Olgu Aygün
,
İsmail Çifçi
,
Dilek Güldal
Abstract
Amaç: Migren hastalarında gastroözofageal reflü hastalığı (GÖRH) sıklığını belirlemek ve GÖRH tedavisine uyumun migren atak sıklığı üzerindeki etkisini araştırmak.
Yöntem: Dokuz Eylül Üniversitesi (DEÜ) Nöroloji-Baş Ağrısı Kliniği ve DEÜ Aile Sağlığı Merkezlerine başvuran ve dahil etme kriterlerini karşılayan 18-45 yaş arası toplam 757 kişi çalışmaya dahil edildi. Dışlama kriterleri gebelik, kanser, alarm bulguları ve anketin anlaşılmasını engelleyecek herhangi bir zihinsel engeldi. Migreni teşhis etmek için Uluslararası Baş Ağrısı Derneği (IHS) kriterlerini içeren Migren Tanı Anketi, GÖRH' yi teşhis etmek için Gastroözofageal Reflü Hastalığı Anketi (GERDQ) ve ilaç uyumunu değerlendirmek için Modifiye Morisky Ölçeği kullanıldı. İstatistiksel analiz için SPSS 22 paketi kullanıldı. Verilerin istatistiksel değerlendirilmesinde ki-kare, t-testi ve ANOVA kullanıldı ve p<0,05 anlamlı kabul edildi.
Bulgular: Çalışmaya katılan 757 kişiden 428'i migren tanısı almış ve nöroloji polikliniğinde takip ediliyordu. Aile sağlığı merkezlerine başvuran 329 hastadan 122'si migren tanısı almış ve 108'i migren dışı baş ağrısı tanısı almıştı. 99'unun baş ağrısı şikâyeti yoktu. Çalışmaya katılan hastaların GERDQ skorları değerlendirildiğinde migrenlilerde GERDQ skoru 8 ve üzeri olan 183 kişi (%33,3), migren dışı baş ağrısı olan 19 kişi (%17,6) ve baş ağrısı olmayan 8 kişi (%8,1) vardı. Migrenlilerin GERDQ reflü skorunun diğer gruplara göre yüksek olduğu ve bu düzeyin istatistiksel olarak anlamlı olduğu bulundu (p<0,001). GÖRH tedavisi alan migren hastalarında tedaviye uyumun migren atak sıklığı ile anlamlı bir ilişkisinin olmadığı görüldü.
Sonuç: Migrenli hastalarda GÖRH insidansı migreni olmayan hastalara göre daha yüksek bulunmuş ve bu hastaların tedaviye uyumunun daha düşük olduğu görülmüştür. Migrenli hastalara poliklinik başvurularında GÖRH varlığı araştırılması ve tedavi motivasyonlarının desteklenmesi faydalı olabilir.
References
- 1. Altamura C, Corbelli I, de Tommaso M, Di Lorenzo C, Di Lorenzo G, Di Renzo A, et al. Pathophysiological bases of comorbidity in migraine. Front Hum Neurosci. 2021;15:1-12.
- 2. Domitrz I, Cegielska J. Magnesium as an important factor in the pathogenesis and treatment of migraine-From theory to practice. Nutrients. 2022;14(5):1-16.
- 3. Gallai V, Sarchielli P, Albeni A, Floridi A. Nitrites, prostaglandins, and trigeminal vasoactive peptides in internal jugular venous blood in migraine patients during spontaneous attacks. Neurol Sci. 2000;21.
- 4. Goadsby PJ, Karsan N. Molecular mechanisms of migraine: Nitric oxide synthase and neuropeptides. Int J Mol Sci. 2023;24(15):11993.
- 5. Mauskop A, Varughese J. Why all migraine patients should be treated with magnesium. J Neural Transm. 2012;119(5):575-9.
- 6. Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: A comprehensive review. World J Gastroenterol. 2016;22(36):8149-60.
- 7. Ponce J, Garrigues V, Agréus L, Tabaglio E, Gschwantler M, Guallar E, et al. Structured management strategy based on the Gastro-oesophageal Reflux Disease (GERD) Questionnaire (GerdQ) vs. usual primary care for GERD: Pooled analysis of five cluster-randomised European studies. Int J Clin Pract. 2012;66(9):897-905.
- 8. Shen Z, Bian Y, Huang Y, Zhou W, Chen H, Zhou X, et al. Migraine and gastroesophageal reflux disease: disentangling the complex connection with depression as a mediator. PLOS ONE. 2024;19(7)
- 9. Hormati A, Bian Y, Huang Y, Zhou W, Chen H, Zhou X, et al. Higher risk of migraines among patients with GERD. PLOS ONE. 2023;18(5).
- 10. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808.
- 11. Jones R, Junghard O, Dent J, Wiklund I. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009;30(10):1030-8.
- 12. Hançerlioğlu S, Bor S. Turkish validation of the reflux disease questionnaire. J Gastrointest Liver Dis. 2021;30(2):193-7.
- 13. Vural UB, Özgür U, Acar T, Topsever DP, Filiz DTM. Modifiye Morisky Ölçeğinin Türkçe Geçerlilik Güvenilirlik Çalışması. Turkish Fam Physician. 2012;4:17-20.
- 14. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-54.
- 15. Pescador Ruschel MA, De Jesus O. Migraine headache. NCBI Bookshelf [Internet]. National Library of Medicine; 2023. [cited:2024 Nov 13] Available from: https://www.ncbi.nlm.nih.gov/books/NBK582491/
- 16. Bıçakçı Ş, Bozdemir N, Over F, Saatçi E, Sarıca Y. Prevalence of migraine diagnosis using ID Migraine among university students in southern Turkey. J Headache Pain. 2008;9:159-63.
- 17. Wacogne C, Lacoste JP, Guillibert E, Hugues FC, Le Jeunne C. Stress, anxiety, depression and migraine. J Headache Pain. 2003;4:451-5.
- 18. Ertas M, Baykan B, Orhan EK, Zarifoglu M, Karli N, Saip S, et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: A nationwide home-based study in adults. J Headache Pain. 2012;13:147-57.
- 19. Aamodt AH, Stovner LJ, Hagen K, Zwart JA. Comorbidity of headache and gastrointestinal complaints. The Head-HUNT Study. Cephalalgia. 2008;28(2):144-51.
- 20. Al-Hassany L, Haas J, Piccininni M, Kurth T, Maassen Van Den Brink A, Rohann JL. Giving researchers a headache – Sex and gender differences in migraine. Front Neurol. 2020;11:1-16.
- 21. Chalmer MA, Kogelman LJA, Callesen I, Christensen CG, Techlo TR, Møller PL, et al. Sex differences in clinical characteristics of migraine and its burden: A population-based study. Eur J Neurol. 2023;30(7):1774-84.
- 22. Lee SH, Lee JJ, Kwon Y, Kim JH, Sohn JH. Clinical implications of associations between headache and gastrointestinal disorders: A study using the Hallym smart clinical data warehouse. Front Neurol. 2017;8:1-8.
- 23. Peşkersoy C, Peker Ş, Kaya A, Ünalp A, Gökay N. Evaluation of the relationship between migraine disorder and oral comorbidities: Multicenter randomized clinical trial. Turk J Med Sci. 2016;46(3):712-8.
- 24. Peroutka SJ. What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep. 2014;18(10):454.
- 25. Heitkemper M, Jarrett M, Cain KC, Burr R, Levy RL, Feld A, et al. Autonomic nervous system function in women with irritable bowel syndrome. Dig Dis Sci. 2001;46(6):1276-84.
- 26. Shechter A, Stewart WF, Silberstein SD, Lipton RB. Migraine and autonomic nervous system function: A population-based, case-control study. Neurology. 2002;58(3):422-7.
- 27. Kurth T, Holtmann G, Neufang-Hüber J, Gerken G, Diener HC. Prevalence of unexplained upper abdominal symptoms in patients with migraine. Cephalalgia. 2006;26(5):506-10.
- 28. Craske MG, Wolitzky-Taylor KB, Labus J, Wu S, Frese M, Mayer EA, et al. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther. 2011;49(6-7):413-21.
29. Katić BJ, Golden W, Cady RK, Hu XH. GERD prevalence in migraine patients and the implication for acute migraine treatment. J Headache Pain. 2009;10(1):35-43.
30. Basavannaiah S. A comparative study of laryngopharyngeal reflux disease and migraine: Insights from a hospital-based analysis. Tr-ENT. 2024;34(1):13-7.