Dr. Ahmed
Despite being two distinct pain-related diseases, irritable bowel syndrome (IBS) and migraine share some characteristics.
Additionally, IBS sufferers get migraines more frequently than the general public, and the reverse is also true. It implies a potentially shared reason.
In fact, many medical professionals believe that IBS and migraine both fall under the umbrella term of central sensitivity disorders.
What do we know about IBS?
Irritable bowel syndrome (IBS) is a functional digestive disorder characterized by bloating, constipation, diarrhea, and abdominal discomfort.
Although it is so widespread that you probably know at least one person with it, individuals seldom talk about having IBS since digestive problems are considered taboo.
Chronic and sometimes challenging to treat IBS symptoms can have an impact on many facets of a person’s life, including physical and mental health, social activities, and employment.
Features | IBS |
| Prevalence | 5 – 10% |
| Age Predilection | IBS affects younger age groups. It is more prevalent in less than 35 years of age. The incidence of IBS drops by 25% after the age of 50 |
| Characterized by pain | 75% of IBS patients have abdominal pain. Pain is visceral in nature arising from sensory nerves supplying the smooth muscles and blood vessels of the intestines. |
| Females: Male | 2.5: 1 (Women are 2.5 times more likely to develop IBS than men) Women have more severe migraine symptoms than men. |
| Association | 17% of patients with IBS have a concomitant migraine headache |
| Diagnosis | Diagnosis is made using symptoms score and excluding other causes. Typically the ROME IV criteria are used. |
| Improvement with diet | 26% of patients noted improvement with Immunoglobulin G –eliminated from the diet |
| Improvement with a placebo | 40 – 50% |
| Acupuncture | 41% noted improvement in IBS symptoms (9% more than sham treatment). |
| Antidepressants | 55% of people with IBS get relief using antidepressants (TCAs or SSRIs) |
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What do we know about migraines?
Migraine headache is a neurological disorder that causes excruciating headaches with pulsating pain.
These recurrent episodes usually only affect one side of the brain and are moderate to severely painful.
The majority of people also feel nausea, vomiting, dizziness, and sensitivity to light and sound in addition to the migraine headache.
From a few hours to many days, a migraine might endure. Similar to how IBS may have an impact on all aspects of life, migraines can cause people to miss work and social engagements.
Features | Migraine |
| Prevalence | 1 – 3% |
| Age Predilection | Migraine affects people around 35 and 50 years of age. |
| Characterized by pain | 85% of migraine patients have headaches. Pain arises from the trigeminal nerve as a result of vascular dilation |
| Females: Male | 2 – 3: 1 (Women are two to three times more likely to have migraine headaches than men) 1 in 8 women with migraine develops aura compared to 1 in 3 men with migraine. |
| Association | 24% of patients with migraine have concomitant IBS |
| Diagnosis | Diagnosis is made via symptoms and excluding other causes. |
| Improvement with diet | An average of 3 headache days and 3 migraine attacks per month were lessened with Immunoglobulin G – eliminated from the diet |
| Improvement with a placebo | 25 – 30% |
| Acupuncture | 53% noted improvement in migraine headache (9% more than sham treatment) |
| Antidepressants | 50% of patients with migraine get relief using antidepressants |
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Role of central sensitivity
There is no lab or imaging test to validate the diagnosis of the class of disorders known as central sensitivity syndromes, including chronic headaches and IBS; instead, the diagnosis is made based only on the symptoms.
The term “central” describes discomfort that results from a disturbance in your brain or spinal cord, which together make up your central nervous system.
“Sensitivity” refers to the fact that individuals with central sensitivity disorders, such as migraine and IBS, have an increased sensitivity to both painful and painless stimuli.
For instance, individuals experience more pain than usual from a needle stick or even discomfort from simple contact.
How central sensitivity is similar in migraine and IBS
Pain in migraine | Pain in IBS |
| Nobody is really certain of what causes migraines. It’s probable that one of the reasons underlying it is the activation of the trigeminal nerve, a cranial nerve, which releases peptides like calcitonin gene-related peptides when migraines alter your brain’s physiology. The trigeminovascular pain pathway is the process by which this causes inflammation and sends pain signals to your brain. Over time, your brain gets more sensitive to your triggers, which allows the nerve cells to communicate across the trigeminovascular pain pathway more quickly since they have already done so. This is how central sensitization in migraine may function, potentially causing migraine episodes to occur more frequently after exposure. | IBS is characterized by visceral hypersensitivity, which means that your internal organs make you feel pain more intensely. Because of this, even slight stomach bloating or distension can be agonizing and incapacitating if you have IBS. According to experts, cerebral sensitization eventually results from the visceral hypersensitivity of IBS. This might explain why some IBS sufferers have symptoms associated with extraintestinal discomforts, such as migraines and joint and muscular pain, while others do not.
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In both conditions, there is a heightened sensitivity to pain which is why these fall under the term ‘central sensitivity syndromes.
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Role of serotonin in IBS and migraine
According to research, changes to the gut-brain axis may be the cause of the association between IBS and migraines.
Serotonin levels being out of balance is one potential cause. Previous studies suggest that chronically low serotonin levels that rise during active migraines may be connected to migraine.
Selective serotonin reuptake inhibitors can be a successful therapeutic option for people with IBS since it’s also plausible that certain cases of IBS may result from low levels of serotonin in the stomach.
Additionally, IBS and migraines are more frequent in women than in males, suggesting that female hormones (which also include estrogen) may potentially be involved.
Medications to treat migraine and IBS
Your doctor may test one of the antidepressants to see if it helps both diseases since antidepressants, especially tricyclic antidepressants, are used as therapy in both cases. (Ref)
Elavil (amitriptyline), Pamelor (Nortriptyline), and Tofranil (imipramine) are a few examples of tricyclic antidepressants.
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Alternate treatments for IBS and migraine
Following are some alternative treatments that you can use to treat both of these conditions.
- Another kind of psychotherapy that has shown some potential in treating both disorders is cognitive-behavioral therapy.
- By taking probiotic supplements daily, you can assist your gut’s population of beneficial bacteria in rebuilding. It may help with some of your IBS symptoms.
- Probiotics can lessen inflammation and enhance gut flow, thus it’s feasible that they may also help lower the frequency and/or severity of migraines due to the probable function of the brain-gut axis.
- As you learn to relax, the biofeedback approach employs sensors to help you become aware of and manage the specific responses your body has to stress.
- Acupuncture may be beneficial for both illnesses, according to research. [Ref]
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In Conclusion:
IBS and migraines are very similar conditions. Both manifest primarily with pain and discomfort. Both migraine and IBS patients are more common in women and get aggravated during the menstrual cycles.
People with IBS and migraines usually get relief using nerve-soothing drugs like TCAs (tricyclic antidepressants).
The following table summarizes the similarities between the two conditions:
Features | IBS | Migraine |
| Prevalence | 5 – 10% | 1 – 3% |
| Age Predilection | IBS affects younger age groups. It is more prevalent in less than 35 years of age. The incidence of IBS drops by 25% after the age of 50 | Migraine affects people around 35 and 50 years of age. |
| Characterized by pain | 75% of IBS patients have abdominal pain. Pain is visceral in nature arising from sensory nerves supplying the smooth muscles and blood vessels of the intestines. | 85% of migraine patients have headaches. Pain arises from the trigeminal nerve as a result of vascular dilation. |
| Females: Male | 2.5: 1 (Women are 2.5 times more likely to develop IBS than men) Women have more severe migraine symptoms than men. Aggravated during periods. | 2 – 3: 1 (Women are two to three times more likely to have migraine headaches than men) 1 in 8 women with migraine develops aura compared to 1 in 3 men with migraine. Aggravated during periods. |
| Association | 17% of patients with IBS have a concomitant migraine headache | 24% of patients with migraine have concomitant IBS |
| Diagnosis | Diagnosis is made using symptoms score and excluding other causes. Typically the ROME IV criteria are used. | Diagnosis is made via symptoms and excluding other causes. |
| Improvement with diet | 26% of patients noted improvement with Immunoglobulin G –eliminated from the diet | An average of 3 headache days and 3 migraine attacks per month were lessened with Immunoglobulin G – eliminated from the diet |
| Improvement with a placebo | 40 – 50% | 25 – 30% |
| Acupuncture | 41% noted improvement in IBS symptoms (9% more than sham treatment). | 53% noted improvement in migraine headache (9% more than sham treatment) |
| Antidepressants | 55% of people with IBS get relief using antidepressants (TCAs or SSRIs) | 50% of patients with migraine get relief using antidepressants |
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