The relationship between episodic migraine headache and chronic constipation in adults

Abstract

Aims: There might be a potential relationship between headaches and constipation. This study aimed to observe the benefits of treating chronic constipation in disease management in patients with episodic migraine (EM). Methods: Patients diagnosed with EM according to ICHD-3 were recorded according to aura presence/absence, disease duration, frequency of attacks/day/month, severity of attacks (Visual Analog Scale (VAS) assessment) and detailed demographic information and clinical parameters. Of these patients, those with Bowel habit abnormalities (discomfort and bloating in the abdomen, abdominal pain, hard feces, excessive strain during defecation, infrequent defecation and feeling of incomplete emptying) were diagnosed with chronic constipation according to the Rome IV diagnostic criteria during the interiktal period. All participants underwent abdominal ultrasonography and assessed constipation index (CI). Daily 15 cc lactulose syrup and a nutrition program were administered to the EM group with chronic constipation, simple analgesic+prophylactic treatment was administered to EM patients without chronic constipation in severe attacks, and simple analgesic/triptan+symptomatic treatment was administered to patients with mild-moderate attacks. Results: A total of 106 patients with EM (n=54, 50.9%) chronic constipation and (n=52, 49.1%) non-chronically constipated participated in the study. The relationship between nausea and vomiting (p=0.000), vitamin D levels (p=0.036) and chronic constipation was found to be statistically significant. The difference between pre-and post-treatment USG/CI values, average VAS scores, and pain frequency (day/month) in chronically constipated patients was statistically significant (p=0.000). Conclusion: This study is important because it shows that medical treatment targeting intestinal transit in patients with EM who have chronic constipation and additional supportive supplements that change dietary habits significantly reduce intestinal volume, which in turn relieves the severity of migraine headaches and reduces their frequency.

Keywords

• Chronic constipation
• episodic migraine
• headache
• constipation index

References

1. Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020;14(1):39-46. doi:10.1080/17474124.2020.1708718
2. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(9):1582-1592. doi:10.1038/ajg. 2011.164
3. Vazquez Roque M, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015;10(2):919-930. doi:10.2147/CIA.S54304
4. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation.Gastroenterology. 2013;144(1):218-238. doi:10.1053/j.gastro. 2012.10.028
5. Chang JY, Locke GR 3rd, McNally MA, et al. Impact of functional gastrointestinal disorders on survival in the community. Am J Gastroenterol. 2010;105(4):822-832. doi:10.1038/ajg.2010.40
6. Sun SX, Dibonaventura M, Purayidathil FW, Wagner JS, Dabbous O, Mody R. Impact of chronic constipation on health-related quality of life, work productivity, and healthcare resource use: an analysis of the National Health and Wellness Survey. Dig Dis Sci. 2011;56(9):2688-2695. doi:10.1007/s10620-011-1639-5
7. Shore WS, DeLateur BJ. Prevention and treatment of frailty in the postmenopausal woman. Phys Med Rehabil Clin N Am. 2007;18(3):609-xii. doi:10.1016/j.pmr.2007.04.004
8. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016; 19(16):223-227. doi:10.1053/j.gastro.2016.02.032

9. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-924. doi:10.3109/ 00365529709011203
10. Jani B, Marsicano E. Constipation: Evaluation and management. Mo Med. 2018;115(3):236-240.
11. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202
12. Rezaeiashtiani A, Jadidi A, Khanmohammadi-Hezaveh A, et al. Is the treatment of constipation can relieve the migraine symptoms? A Randomized clinical trial study. J Pediatr Neurosci. 2019;14(4):186-190. doi:10.4103/jpn.JPN_19_19
13. Begasse de Dhaem O, Sakai F. Migraine in the workplace. eNeurologicalSci. 2022;27:100408. doi:10.1016/j.ensci.2022.100408
14. Ebrahimi-Monfared M, Sharafkhah M, Abdolrazaghnejad A, Mohammadbeigi A, Faraji F. Use of melatonin versus valproic acid in prophylaxis of migraine patients: a double-blind randomized clinical trial. Restor Neurol Neurosci. 2017;35(4):385-393. doi:10.3233/RNN-160704
15. Inaloo S, Dehghani SM, Hashemi SM, Heydari M, Heydari ST. Comorbidity of headache and functional constipation in children: a cross-sectional survey. Turk J Gastroenterol. 2014;25(5):508-511. doi:10. 5152/tjg.2014.6183
16. Park MN, Choi MG, You SJ. The relationship between primary headache and constipation in children and adolescents. Korean J Pediatr. 2015; 58(2):60-63. doi:10.3345/kjp.2015.58.2.60
17. Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013; 33(9):629-808. doi:10.1177/ 0333102413485658
18. Katsarava Z, Buse DC, Manack AN, Lipton RB. Defining the differences between episodic migraine and chronic migraine. Curr Pain Headache Rep. 2012;16(1):86-92. doi:10.1007/s11916-011-0233-z
19. Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016;18(16):222-225. doi:10.1053/j.gastro.2016.02.031
20. Manabe N, Kamada T, Hata J, Haruma K. New ultrasonographic evaluation of stool and/or gas distribution for treatment of chronic constipation. Int J Colorectal Dis. 2018;33(3):345-348. doi:10.1007/s00384-018-2964-3
21. Dodick DW. A Phase-by-phase review of migraine pathophysiology. Headache. 2018;58(Suppl 1):4-16. doi:10.1111/head.13300
22. Mayer EA, Tillisch K, Gupta A. Gut/brain axis and the microbiota. J Clin Invest. 2015;125(3):926-938. doi:10.1172/JCI76304
23. Hindiyeh N, Aurora SK. What the gut can teach us about migraine. Curr Pain Headache Rep. 2015;19(7):33. doi:10.1007/s11916-015-0501-4
24. Kim J, Lee S, Rhew K. Association between gastrointestinal diseases and migraine. Int J Environ Res Public Health. 2022;19(7):4018. doi:10.3390/ijerph19074018
25. Arzani M, Jahromi SR, Ghorbani Z, et al. Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain. 2020;21(1):15. doi: 10.1186/s10194-020-1078-9
26. Aurora SK, Shrewsbury SB, Ray S, Hindiyeh N, Nguyen L. A link between gastrointestinal disorders and migraine: Insights into the gut-brain connection. Headache. 2021;61(4):576-589. doi:10.1111/head. 14099
27. Akasaka K, Akasaka F, Akasaka T, Okada K, Sadahiro S. Relationship between mental disorders, psychotropic drugs, and constipation in psychiatric outpatients. Medicine (Baltimore). 2022;101(37):e30369. doi: 10.1097/MD.0000000000030369
28. Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gut-enteric microbiota axis. Nat Rev Gastroenterol Hepatol. 2009;6(5):306-314. doi:10.1038/nrgastro.2009.35
29. Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000;47(6):861-869. doi:10.1136/gut.47.6.861
30. Urban MO, Gebhart GF. Central mechanisms in pain. Med Clin North Am. 1999;83(3):585-596. doi:10.1016/s0025-7125(05)70125-5
31. Panarese A, Pesce F, Porcelli P, et al. Chronic functional constipation is strongly linked to vitamin D deficiency. World J Gastroenterol. 2019; 25(14):1729-1740. doi:10.3748/wjg.v25.i14.1729
32. Togha M, Razeghi Jahromi S, Ghorbani Z, Martami F, Seifishahpar M. Serum vitamin D status in a group of migraine patients compared with healthy controls: a case-control study. Headache. 2018;58(10):1530-1540. doi:10.1111/head.13423.33
33. Ghorbani Z, Togha M, Rafiee P, et al. Vitamin D in migraine headache: a comprehensive review on literature. Neurol Sci. 2019;40(12):2459-2477. doi:10.1007/s10072-019-04021-z