Is the Gut-Brain Axis to Blame for Why Your Migraines Won’t Get Better?
Anyone who suffers from migraines knows that it isn’t simply a headache that goes away with an extra glass of water and a quick, over the counter pain killer. Migraines can last for hours to days, and often prevent people from going to work, attending social events, and even making future plans.
Migraine has become the third most common disease in the world, is one of the most prevalent of the neurological disorders, and tends to affect women more than men. While the most recognized symptom of migraine is excruciating pain in the head, many people also tend to experience nausea, vomiting, and other gastrointestinal symptoms. These symptoms are not merely an accompaniment to the headache however, and they may actually reveal true disharmony at play.
During a debilitating migraine attack, it’s hard to imagine that the source of such an episode may have originated far away in another part of your body. The most recent scientific literature has started to solidify previous theories that migraines and headaches may be a result of disruption in the balance of the gut bacteria, which then creates neurological symptoms through what is called the ‘ gut-brain axis’.
While the term “gut-brain axis” has become popular amongst those in the functional medicine community and the health and wellness industry, many people still don’t really understand how it works, and how it might contribute to migraines in particular.
The Gut-Brain Connection
Understanding the gut-brain axis connection to migraines is important for both patients and practitioners as it may influence the course of the disease, decisions around treatment, and even diet and lifestyle choices. Migraines that present with gut symptoms may be less likely to respond to conventional migraine pharmacotherapy, and require a more complex, multifaceted approach.
Due to a compromised gastrointestinal system, oral therapies for migraines may have suboptimal efficacy and even produce additional adverse events as they are not properly metabolized. In this article we will explore the questions, ‘what is the gut-brain axis’, ‘how do gut imbalances lead to migraines’ as well as ‘how to treat migraines’ and potential dietary changes that may restore the balance of bacteria in the gut.
As with any complex disorder, it’s important to work one-on-one with your doctor or functional medicine practitioner in order to make sure that the migraine treatment approach taken is the right one for you.
Let’s dive in!
Understanding the Gut-Brain Axis
The intestines house more microorganisms than all of the cells in the whole body. They are also the location of the majority of human microbiota including fungi, viruses, and bacteria which are known to protect the body against pathogens and to regulate our immune systems. These organisms are also responsible for producing essential vitamins and for metabolizing carbohydrates into short-chain fatty acids, which play an important role in neurological health.
Besides the other more commonly known functions of the gut, such as digestion and nutrient absorption, the gut’s connection to the brain is being increasingly observed in scientific studies, and its implications in neurological diseases is becoming more recognized in the functional medicine community.
The relationship between the brain and the gut is ‘bidirectional’ meaning that they both influence each other, and changes in one may create changes in the other. The brain, and more broadly the Central Nervous System (CNS), controls neural, hormonal, nutrient, and immunological signals which help to regulate gut functions and connect emotional centers in the brain with intestinal mechanisms. From the other direction, the microbiota in the gut influences the CNS with neurotransmitters, hormones, and inflammatory molecules as well as through connection with the end terminals of the vagus nerve.
Over half of the variation in the gut microbiome is regulated by the diet, compared to only about 10% from genetic variations. This means that diet and lifestyle factors play an important role in creating a balanced variety of gut bacteria, which in turn leads to improved neurological conditions. We will explore the dietary factors with the most evidence for their effect on migraines and headaches in just a moment! In order to make more sense of the potential treatment options, let’s take a closer look at the gut-brain axis’s role in migraines specifically.
How Migraines are Affected by the Gut-Brain Axis
We now know that those suffering from both episodic and chronic migraines have altered gut microbiota compared to those without migraines. These findings, along with those that show migraine and gastrointestinal comorbidities, point to the close association that exists between our gut microbiome and neurological disorders in humans. This is becoming less surprising as we know that the gut microbiota plays a major regulatory role in neurotransmission, cognition, and cerebral vascular physiology.
Many people who have migraines will also experience gut conditions such as cyclical vomiting syndrome, functional dyspepsia, and gastroparesis. It’s also very common to have G.I. symptoms like nausea, vomiting, constipation, diarrhea, bloating, and fullness either just before, after, or during migraine attacks. Migraine sufferers who present with these gastrointestinal symptoms also seem to have longer migraine attacks that are more severe than those with gut imbalance symptoms..
Another interesting link between the gut and the brain, and specifically migraines, is that several drug therapies that are prescribed for migraines are also independently prescribed for gastrointestinal disorders. These include antiemetics, antiepileptics, tricyclic antidepressants, metoclopramide, and a noninvasive therapy that stimulates the vagus nerve.
Unfortunately, it appears that excessive use of medication may speed up the course of the migraine condition so it’s important to explore treatment strategies that do not simply block the pain experience of the migraine, but address the imbalance in the gut bacteria and the integrity of the intestinal microbiome.
Issues With Migraine Treatment and Dietary Strategies that Address the Underlying Cause
If you are one of those migraine sufferers who doesn’t get much relief from oral medications, or you find yourself cycling through the various drug therapies without satisfying results, it’s very possible that the gut-brain axis is at play.
Imagine if your gut bacteria is way out of balance and unable to do its job properly, it’s going to have trouble metabolizing and absorbing medications and sending the right signals up to the brain.
If you have accompanying gut symptoms with your migraines, as many people do, then it’s almost certain that the gut is involved in the overall mechanism. In addition to that, if you are experiencing nausea and vomiting during an attack, it will be difficult to take medication or other helpful treatments for the acute presentation.
Some people turn to nasal sprays for better absorption, but even these have issues as they administer the drug to the lower nasal space which has high likelihood of drug clearance through post nasal drip and swallowing, as well as targeting the type of epithelium that does not promote proper absorption.
Ultimately, a treatment strategy that actually corrects the dysbiosis, or imbalance in the gut bacteria, is likely to have much better and longer lasting results when it comes to reducing migraine frequency and severity. Since the diet has such a pronounced influence on the gut bacteria, that is an important place to begin making some changes.
This is best done with the guidance of your functional medicine practitioner who can request the appropriate testing to determine your specific needs.
Migraine Food Triggers
The most common food triggers for migraine sufferers include:
- alcohol (specifically red wine)
- caffeine
- MSG
- nuts
- aspartame
- aged cheese
- chocolate
- some fruit
- and nitrates
Those with celiac disease also tend to have a higher occurrence of migraines.
Food triggers may be related to pro-inflammatory cytokines and increased sensitivity of the nervous system, but those with compromised intestinal biodiversity may also have deficiencies in vital vitamins and nutrients that contribute to the overall disease presentation.
How to Treat Migraines?
It is common for migraine patients to try elimination diets in order to discover which foods and substances seem to trigger their migraine attacks. While this can be helpful in finding some relief, it is not ultimately correcting the underlying issues in the gut bacteria, but rather avoiding them.
Over time, disrupted gut bacteria will cause problems whether a specific food trigger is consumed or not, as nothing will be properly assimilated, including supplements and medications that would otherwise provide some assistance.
One of the diets that has some evidence for helping those with migraines is the ketogenic diet, or one that is lower in carbohydrates, higher in fat, and moderate in protein.
The lack of glucose in this diet prompts the liver to produce ketone bodies which later contribute to the generation of ATP in the Krebs cycle. This is involved in cellular signaling and those on keto diets report milder migraine episodes that occur less frequently. They also report less medication intake after one month on the diet.
However, it’s important to work with your functional medicine practitioner to make sure this type of dietary change is appropriate for your hormones and overall health goals. A low carbohydrate diet is not appropriate for everyone.
Some study participants found relief on a low-glycemic index diet as well as incorporating a variety of nutrients, fiber, and vitamins and minerals. Your functional medicine practitioner can help you determine which changes will be most helpful for your particular bacterial imbalances.
Other potentially effective dietary changes for treating migraines include: B2 and B9 supplements for oxidative metabolism and DNA methylation, magnesium, increase in omega-3 fatty acids and decrease in omega-6, and reduction in highly processed foods and sugars. Prebiotics are fermentable foods that feed probiotics and seem to be helpful alongside adequate fiber intake for producing normal gut flora.
Probiotics have a lot of hype in the mainstream health and wellness industry, but there is still inconclusive evidence for their effect on migraines in particular. Supplements in general will be most helpful once dietary changes have already corrected some of the gut dysbiosis, which will allow proper absorption and assimilation of the additional nutrients.
It has also been observed that antibiotics and proton pump inhibitors reduce the diversity of gut bacteria and can increase potential pathogens and “bad” bacteria. SSRIs also seem to affect the motility in the gut and lower bacterial diversity. The dysbiosis that results from these medications damages the intestinal flora and can increase the likelihood of migraines. It’s important to work with a practitioner to repair the gut during and after these types of treatments.
How to Treat Migraines Considering the Gut-Brain Axis
We have covered so much on the gut-brain axis today and its effect on migraines!
Now that you have a better understanding of the importance of a healthy balance and diversity in gut bacteria for treating migraines, you can begin making some changes in your diet and lifestyle rather than cycling through potentially ineffective migraine medications and delaying addressing the root cause of your condition.
It’s really important to note that while it may be tempting to go out and buy a bunch of supplements mentioned above, or go on an extreme keto diet, everyone with a migraine will have a different underlying presentation in the gut.
Tailored migraine care is extremely important in order to get real and lasting relief, and to avoid making the situation worse. Make sure to contact your doctor and ideally a functional medicine practitioner who can do a personalized investigation into the presentation in your gut and its potential implication in your migraines.
Check out the recent studies in the sources below, and get in touch to start repairing your gut and start getting relief from your migraines.
Dr. Jenny Bisset
Founder of The Bisset Method
JB Wellness
Chinese + Functional Medicine
Sources:
Arzani, M., Jahromi, S.R., Ghorbani, Z. et al. Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain 21, 15 (2020). https://doi.org/10.1186/s10194-020-1078-9
Aurora, S., Shrewsbury, S., Ray, S., Hindiyeh, N, & Nguyen, L.. A link between gastrointestinal disorders and migraine: Insights into the gut-brain connection. Headache: The Journal of Head and Face Pain. 2021, Apr. https://doi.org/10.1111/head.14099
Crawford J, Liu S, Tao F. Gut microbiota and migraine. Neurobiol Pain. 2022 Apr 9;11:100090. doi: 10.1016/j.ynpai.2022.100090. PMID: 35464185; PMCID: PMC9018445.
Crawford, J., Liu, S., & Tao, F. Gut microbiota and migraine. Neurobiology of Pain. 2022. https://doi.org/10.1016/j.ynpai.2022.100090.
Kappéter Á, Sipos D, Varga A, Vigvári S, Halda-Kiss B, Péterfi Z. Migraine as a Disease Associated with Dysbiosis and Possible Therapy with Fecal Microbiota Transplantation. Microorganisms. 2023; 11(8):2083. https://doi.org/10.3390/microorganisms11082083
Nguyen, L., Hindiyeh, N., Ray, S. et al. The Gut-brain Connection and Episodic Migraine: an Update. Curr Pain Headache Rep (2023). https://doi.org/10.1007/s11916-023-01175-6
Spekker E, Nagy-Grócz G. All Roads Lead to the Gut: The Importance of the Microbiota and Diet in Migraine. Neurology International. 2023; 15(3):1174-1190. https://doi.org/10.3390/neurolint15030073
Suganya K, Koo BS. Gut-Brain Axis: Role of Gut Microbiota on Neurological Disorders and How Probiotics/Prebiotics Beneficially Modulate Microbial and Immune Pathways to Improve Brain Functions. Int J Mol Sci. 2020 Oct 13;21(20):7551. doi: 10.3390/ijms21207551. PMID: 33066156; PMCID: PMC7589356.
Yong, D., Lee, H., Min, HG. et al. Altered gut microbiota in individuals with episodic and chronic migraine. Sci Rep 13, 626 (2023). https://doi.org/10.1038/s41598-023-27586-4