Stanford University, Palo Alto, CA, USA.
Metrodora Institute, West Valley City, UT, USA.
Curr Pain Headache Rep. 2023 Nov;27(11):765-774. doi: 10.1007/s11916-023-01175-6. Epub 2023 Oct 4.
Historical evidence suggests a shared underlying etiology for migraine and gastrointestinal (GI) disorders that involves the gut-brain axis. Here we provide narrative review of recent literature on the gut-brain connection and migraine to emphasize the importance of tailoring treatment plans for patients with episodic migraine who experience GI comorbidities and symptoms.
Recent population-based studies report the prevalence of migraine and GI disorders as comorbidities as well as overlapping symptomology. American Headache Society (AHS) guidelines have integrated GI symptoms as part of migraine diagnostic criteria and recommend nonoral therapies for patients with GI symptoms or conditions. Nasal delivery is a recommended nonoral alternative; however, it is important to understand potential adverse events that may cause or worsen GI symptoms in some patients due to the site of drug deposition within the nasal cavity with some nasal therapies. Lastly, clinical perspectives emphasize the importance of identifying GI symptoms and comorbidities in patients with episodic migraine to best individualize migraine management. Support for an association between the gut-brain axis and migraine continues to prevail in recent literature; however, the relationship remains complex and not well elucidated. The presence of GI comorbidities and symptoms must be carefully considered when making treatment decisions for patients with episodic migraine.
历史证据表明，偏头痛和胃肠道（GI）疾病之间存在共同的潜在病因，涉及肠-脑轴。本文对近年来关于肠-脑联系与偏头痛的文献进行综述，强调为伴有 GI 共病和症状的发作性偏头痛患者制定治疗计划的重要性。
最近的基于人群的研究报告偏头痛和 GI 疾病作为共病以及重叠症状的患病率。美国头痛协会（AHS）指南已将 GI 症状纳入偏头痛诊断标准的一部分，并为有 GI 症状或疾病的患者推荐非口服治疗。鼻腔给药是一种推荐的非口服替代方案；然而，由于某些鼻腔治疗药物在鼻腔内的沉积部位，了解可能导致或加重某些患者 GI 症状的潜在不良反应非常重要。最后，临床观点强调了在发作性偏头痛患者中识别 GI 症状和共病的重要性，以便更好地个体化偏头痛管理。最近的文献继续支持肠-脑轴与偏头痛之间的关联，但这种关系仍然很复杂，尚未得到很好的阐明。在为发作性偏头痛患者做出治疗决策时，必须仔细考虑 GI 共病和症状的存在。
