Potential IBS-Migraine Association Seen in Nationwide Survey

©Inna/adobe stock

Patients with irritable bowel syndrome (IBS) are more likely to have migraine headaches, and those living with migraine are more likely to have IBS, according to results of a nationwide survey.

Saudi Arabian investigators, publishing in BioMed Research International, found that the odds of individuals with migraine in the general Saudi population having IBS were much higher than in those without migraine.

Migraine affects 11.6% of people globally, the researchers noted, while IBS has a prevalence of 9.2% worldwide. Study authors cite research that shows a “significant” link between migraine and IBS worldwide as well. A cohort study that looked at the prevalence of migraine in IBS patients using data from a major United States health plan found a 60% higher risk of migraine among those with IBS than among those without the disease.

Using Taiwan's National Health Insurance Research Database, another retrospective cohort study found that IBS incidence was nearly 2 times higher in the migraine cohort than in the comparator cohort.

According to the investigators’ review of studies on both conditions in Saudi Arabia, findings vary significantly and, in particular, a nationwide prevalence of IBS cannot be inferred from the available data.

The authors, a team of 4 from the College of Medicine at Imam Mohammad Ibn Saud Islamic University, designed the current study with 2 aims: to measure the prevalence of both migraine and IBS in Saudi Arabia and to observe the association between the 2 conditions in the country.

The observational cross-sectional study was conducted among the Saudi general population aged ≥15 years between March and June 2021.

Participants completed an online self-administered survey divided into 3 sections. The first collected personal and demographic data. The second used the Migraine Screen Questionnaire (MS-Q) to assess symptoms and the MIGSEV scale to assess headache severity. The third section used the IBS module of the Rome IV Diagnostic Questionnaire (R4DQ) for IBS symptoms and their subtype.

Of the 2802 participants who returned the survey, all were eligible and accounted for in the analysis. Just more than half were men (52.5%); the majority (46.7%) were aged 20-29 years; more than half (54.9%) reported never being married.

Migraine, IBS and migraine-IBS

Migraine prevalence across the cohort was 27.4% and for IBS, prevalence was 16.4%.

Women were more likely to report migraine than men (37.5% and 18.2%) and prevalence of IBS was found to be higher among women than men (20.9% and 12.4%).

The researchers found in bivariate analysis that women were significantly more likely to have both migraine and IBS (p<.001).

Overall, study participants with migraine were found to be significantly more likely to have IBS (p<.001); similarly, those with IBS showed a significant probability of having migraine (p<.001).

These findings were confirmed in regression analysis, according to the investigators, who report that participants with migraine had higher odds (OR 4.127) of having IBS (95% CI 3.325-5.121; p<.001), and that those with IBS had an increased likelihood of having migraines (OR 3.304; 95% CI 2.632-4.147; p<.001).

Migraineurs with severe symptoms were more likely to have IBS than migraineurs with moderate or lower migraine symptoms (p = 0.015). The analysis showed no correlation between IBS subtypes and migraine.

“A standard theory for the sex discrepancy in migraine and IBS is hormonal factors, especially sex hormones,” noted authors. "Ultimately, more research is needed to investigate sex-related vulnerability to migraine headaches and IBS, including genetic and biological determinants and other environmental factors influencing migraine and IBS prevalence in females.”

While the cause of the migraine-IBS link is not yet fully understood, an explanation gaining favor focuses on “defective serotonin, “which has been linked to the pathophysiology of IBS and migraine since it modulates gut motility, secretion, and sensation and is an essential neurotransmitter in the central nervous system,” wrote study authors.

“This theory is supported by the similar management of both conditions, as 5-HT agonists and antagonists are beneficial in managing chronic hyperalgesic illnesses such as IBS, migraine, and fibromyalgia,” they added.

Reference: Bin Abdulrahman KA, Alenazi NS, Albishri SB, Alsheri FF. Association of migraine and irritable bowel syndrome in Saudi Arabia: A nationwide survey. Biomed Res Int. Published online January 18, 2022. Doi:10.1155/2022/8690562