The role of the gut microbiome in migraine
Many health problems are linked to the gut microbiome, even if these problems are located elsewhere in the body and one does not suspect a link with the gut. Migraine is an example of such a health problem, and the fact that IBS is 2-4 times more prevalent in migraineurs than in healthy controls indeed is a first clue that the gut microbiome is involved (1,2).
One mechanism that seems to play a role in migraine and that is linked to the gut microbiome, is failure of various anatomical barriers, including the gut-blood, blood-brain, and blood-cerebrospinal fluid barriers. The microbiome can affect all three of these anatomical barriers (3,4). Interestingly, the blood-brain barrier consists of endothelial cells, and research in pediatric patients has found endothelial dysfunction in migraineurs (5). Given the influence of the microbiome on the blood-cerebrospinal fluid barrier, it is noteworthy that migraine is characterized by meningeal inflammation and the inflammatory signals are thought to be spread through cerebrospinal fluid (6).
The most important pharmaceutical treatments of migraine are serotonin-agonists, which is based on convincing mechanistic research since the 1950’s that has shown how serotonin plays a role in migraine (7). Serotonin is synthesized in our body from the amino acid tryptophane and it is known that the gut microbiome influences tryptophane metabolism (8,9). Disturbed balance of other tryptophane metabolites such as kynurenine is linked to migraine and has been associated with IBS as well (9).
Overgrowth of Heliobacter pylori and other pathogens have also been associated with migraine (8-10). These and the aforementioned factors can be positively influenced by probiotics, and indeed a small number of RCTs have shown that specific probiotics can be effective in the treatment of migraine (11).
Together, these insights show that it is worthwhile to consider a potential role of the gut microbiome when treating patients with migraine. An easy way to quickly get a clue whether or not the a disturbed microbiome may be involved in an individual migraineur, is to use Bristol Stool Chart (BSC) and GI question list. It is often necessary to be a bit persistent with the questions, as many patients are reluctant to talk about their stools and do not connect the gut with migraine. If you are interested in this simple tool, you can receive the BSC and question list for free in Dutch, German, or English by replying to this e-mail. If there are GI complaints, a fecal analysis can give insights into which microbiome functions are disturbed (e.g. leaky gut, pathogens, inflammation, etc.). Based on that, an evidence-based way to treat these individual disturbances is to use personalized microbiome treatment.
References:
- https://doi.org/10.1002/brb3.2291
- https://doi.org/10.1155/2022/8690562
- https://doi.org/10.1177/1535370217743766
- https://doi.org/10.1111/ejn.15878
- https://doi.org/10.1111/ped.14946
- https://doi.org/10.1186/s10194-021-01353-0
- https://doi.org/10.1152/physrev.00034.2015
- https://doi.org/10.1186/s10194-020-1078-9
- https://doi.org/10.3390/ijms221810134
- https://doi.org/10.2147/NDT.S144955
- https://doi.org10.1080/1028415X.2020.1764292