In the Journals

Migraine associated with functional GI disorders in children, adolescents

In children and adolescents, migraine headaches are positively associated with functional dyspepsia, irritable bowel syndrome and abdominal migraine, and negatively associated with functional constipation, investigators from a European case-control study found.

“The disorders were not more common in children with tension-type headache, confirming the specificity of the association between specific functional gastrointestinal disorders and migraine,” the investigators wrote.

From November 2014 through January 2015, researchers evaluated 257 patients with migraine, 167 with tension-type headache and 648 controls with minor trauma and no history of recurrent headache. All patients were aged 6 to 17 years and were enrolled from the emergency department of four tertiary hospitals in France and Italy.

Researchers unaware of the patients’ headache diagnoses used Rome III criteria to diagnose functional gastrointestinal disorders (FGIDs), then univariable and multivariable analyses were performed to determine associations between headaches and specific FGIDs or baseline variables.

FGIDs were diagnosed in 32% of patients with migraine compared with 18% of controls (P < .0001). Migraine was positively associated with functional dyspepsia (OR = 10.76; 95% CI, 3.52-32.85; P < .0001), IBS (OR = 3.47; 95% CI, 1.81-6.62; P = .0002) and abdominal migraine (OR = 5.87; 95% CI, 1.95-17.69; P = .002), and inversely associated with functional constipation (OR = 0.34; 95% CI, 0.14-0.84; P = .02).

Moreover, 25% of patients with tension-type headache were diagnosed with FGIDs, the prevalence of which was comparable to that in controls. No significant associations were observed between individual FGIDs and tension-type headaches.

“Our findings of a positive association between migraine and three abdominal-pain-related functional gastrointestinal disorders, and the growing evidence of common pathophysiological features, support the idea that both diseases are intertwined,” the investigators wrote. “Therefore, a global approach could be beneficial for early diagnosis and management of both diseases.”

The pattern of these results “clearly indicate[s] that a specific relationship exists between migraine and functional gastrointestinal disorders that cannot be explained by a general propensity towards symptom experience and reporting, since one type of headache showed substantial association with functional gastrointestinal disorders but another type of headache showed no such relationship,” Olafur S. Palsson, PsyD, from the division of gastroenterology and hepatology at University of North Carolina at Chapel Hill, wrote in a related editorial. “Furthermore, the results strongly suggest that the reason for this specific relationship is a common pathophysiological mechanism that is centered on pain genesis, since only functional gastrointestinal disorders involving pain had any association with migraine. Unfortunately, the study cannot provide any further clues about the exact nature of that mechanism.” – by Adam Leitenberger

Disclosures: The researchers and Palsson report no relevant financial disclosures.

In children and adolescents, migraine headaches are positively associated with functional dyspepsia, irritable bowel syndrome and abdominal migraine, and negatively associated with functional constipation, investigators from a European case-control study found.

“The disorders were not more common in children with tension-type headache, confirming the specificity of the association between specific functional gastrointestinal disorders and migraine,” the investigators wrote.

From November 2014 through January 2015, researchers evaluated 257 patients with migraine, 167 with tension-type headache and 648 controls with minor trauma and no history of recurrent headache. All patients were aged 6 to 17 years and were enrolled from the emergency department of four tertiary hospitals in France and Italy.

Researchers unaware of the patients’ headache diagnoses used Rome III criteria to diagnose functional gastrointestinal disorders (FGIDs), then univariable and multivariable analyses were performed to determine associations between headaches and specific FGIDs or baseline variables.

FGIDs were diagnosed in 32% of patients with migraine compared with 18% of controls (P < .0001). Migraine was positively associated with functional dyspepsia (OR = 10.76; 95% CI, 3.52-32.85; P < .0001), IBS (OR = 3.47; 95% CI, 1.81-6.62; P = .0002) and abdominal migraine (OR = 5.87; 95% CI, 1.95-17.69; P = .002), and inversely associated with functional constipation (OR = 0.34; 95% CI, 0.14-0.84; P = .02).

Moreover, 25% of patients with tension-type headache were diagnosed with FGIDs, the prevalence of which was comparable to that in controls. No significant associations were observed between individual FGIDs and tension-type headaches.

“Our findings of a positive association between migraine and three abdominal-pain-related functional gastrointestinal disorders, and the growing evidence of common pathophysiological features, support the idea that both diseases are intertwined,” the investigators wrote. “Therefore, a global approach could be beneficial for early diagnosis and management of both diseases.”

The pattern of these results “clearly indicate[s] that a specific relationship exists between migraine and functional gastrointestinal disorders that cannot be explained by a general propensity towards symptom experience and reporting, since one type of headache showed substantial association with functional gastrointestinal disorders but another type of headache showed no such relationship,” Olafur S. Palsson, PsyD, from the division of gastroenterology and hepatology at University of North Carolina at Chapel Hill, wrote in a related editorial. “Furthermore, the results strongly suggest that the reason for this specific relationship is a common pathophysiological mechanism that is centered on pain genesis, since only functional gastrointestinal disorders involving pain had any association with migraine. Unfortunately, the study cannot provide any further clues about the exact nature of that mechanism.” – by Adam Leitenberger

Disclosures: The researchers and Palsson report no relevant financial disclosures.