“Even though these conditions are benign in the sense that they don’t lead to death, they cause a lot of disability and can negatively impact your quality of life,” says Roderick Spears, MD, a neurologist and headache specialist at Penn Medicine in Philadelphia. IBS is a common chronic disorder characterized by abdominal pain or discomfort, along with diarrhea, constipation, or both. For some people, other symptoms are connected as well. “Many IBS patients, especially women, also report symptoms unrelated to digestion, such as fatigue, muscle pain, sleep disturbances, and sexual dysfunction,” says Bethany DeVito, MD, a gastroenterologist at Northwell Health in Great Neck, New York. Migraine is a neurological disease that usually causes recurrent headaches, but migraine attacks frequently bring other symptoms, including nausea, vomiting, and extreme sensitivity to light, sound, touch, and smell. For many people with migraine, these attacks are debilitating.
The Relationship Between IBS and Migraine
The relationship between IBS and migraine would be described as a correlation, says Dr. Spears. “If you have migraine, it seems you’re more likely to have IBS, and vice versa, but they don’t seem to cause one or the other,” he says. Numerous studies have found an elevated incidence of migraine or headache among people who have IBS, and an increased incidence of IBS among people with migraine.
A study published in the Polish Journal of Neurology and Neurosurgery found that 23 to 53 percent of people with IBS experienced frequent headaches, and the authors noted that “[f]unctional gastrointestinal disorders, such as irritable bowel syndrome (IBS), are reported in migraine patients in periods between the attacks [of migraine].”Another study, published in BMC Gastroenterology, found that people with IBS were 40 to 80 percent more likely to also have migraine, fibromyalgia, or depression than people without IBS.And a study published in the May–June 2017 issue of the Pakistan Journal of Medical Sciences found that people with migraine who had a long headache history, recurrent headache attacks, and anxiety were more likely to have IBS.A meta-analysis of 11 studies, published in January 2022 in the European Journal of Gastroenterology & Hepatology, found a “significantly increased rate” in IBS in patients with migraines, when the data was pooled.
There are a few possible reasons why many people have both conditions. A study published in Current Pain and Headache Reports that explored the connection between migraine, IBS, and celiac disease traced the link to a “genetically sensitive nervous system transformed into one that is hypervigilant,” which can, over time, lead to chronic pain conditions like IBS and migraine. Stress also factors into the connection between the head and the gut. “This mind-body connection is real and can greatly influence health,” says Maxwell Chait, MD, a gastroenterologist at the ColumbiaDoctors medical group in Hartsdale, New York. A study published in April 2022 in the International Journal of Environmental Research and Public Health points to other theories, as well. Study authors note that “evidence from a number of GI diseases showed that nerve fibers become more sensitive to pain by nerve signals, endocrine signals, or the immune system, thereby increasing the risk of migraine.” Inflammatory signals interacting between the gut-brain axis may be causing both migraine and gastrointestinal diseases. And certain neurotransmitters in the gut-brain axis may play a role in both migraine and development of GI diseases. RELATED: The Link Between Your Gut Microbiome and Your Health
Neurotransmitter Serotonin Is Prominent in Both Migraine and IBS
One specific player in both migraine and IBS is the brain chemical serotonin. “Serotonin is a major neurotransmitter of the gastrointestinal tract that plays a relevant part in IBS as well as migraine,” Dr. Chait says. Because of that common denominator, “any medication prescribed to improve migraine that targets serotonin — and that’s typically an antidepressant — may have a positive or negative impact on the IBS,” says Spears. “This would work the other way around, too: If someone has IBS and is put on a medication with a serotonin target, it would have an impact on migraine,” he says. Very often, the effects of the medication track together; that is, both conditions will improve, or both conditions will worsen, as a result of the drug, says Spears.
GI Symptoms of Migraine and IBS Have Key Differences
“The GI symptoms of migraine are typically associated with head pain, and the person is usually disabled by the attack — they’re missing work or social activities,” says Spears. Another difference is that the GI symptoms of migraine typically don’t last as long as the GI symptoms in IBS, he adds. “IBS is more chronic in most cases. People are having either diarrhea, constipation, or abdominal bloating going on most of the time, and they can cycle between those different phases,” says Spears. “The nausea and vomiting that some people experience with a migraine attack would not be all the time; even in chronic migraine, you wouldn’t have a lot of patients in that category,” he says. Chronic migraine is when a person has 15 or more headache days per month. RELATED: The Link Between Migraine, Nausea, and Vomiting
Strategies to Improve Migraine and IBS
As stress and anxiety increase, so do episodes of IBS and migraine, Dr. DeVito says. To help reduce stress, try to identify and defuse its sources, such as finances, work, or relationships. Avoid unhealthy coping mechanisms like smoking, drinking alcohol, using drugs, and overeating. Instead, eat healthfully, get enough sleep, exercise regularly, and drink plenty of water. There are also some natural options that can sometimes benefit both disorders, says Spears. “Often people who have both may try these approaches with their migraine and find that their IBS responds, too,” he says.
Acupuncture
“I’ve had patients who have successfully used acupuncture to help with migraine and IBS,” says Spears. The American Migraine Foundation states that acupuncture can be a valuable treatment option for some people with migraine. A review published in the World Journal of Gastroenterology found that acupuncture “exhibits clinically and statistically significant control of IBS symptoms.”
Cognitive Behavioral Therapy (CBT)
Many studies, such as one published in 2017 in Psychology Research and Behavior Management, have shown that cognitive behavioral therapy (CBT) — a type of short-term psychological therapy that focuses on modifying behaviors and altering dysfunctional thinking patterns — can have significant and lasting symptom improvements in IBS. A type of therapy called mindfulness-based cognitive therapy for migraine (MBCT-M), which integrates cognitive and behavioral therapy techniques with mindfulness-based intervention strategies, was found to be a promising treatment for people with episodic and chronic migraine in a study published in September 2019 in the journal Headache. RELATED: Can Cognitive Behavioral Therapy Help Alleviate IBS Symptoms?
Yoga
A study published in the European Journal of Integrative Medicine found that one hour of yoga three days a week for 12 weeks significantly improved symptoms for people with IBS. Research suggests that many types of yoga can help improve headaches as well. A review published in the Journal of Physical Therapy Science found that yoga may be beneficial for some types of headaches, including tension-type headaches.
Peppermint Oil
“I’ve had patients use peppermint oil during a migraine attack and have it also help with gas and bloating,” says Spears. Typically, diluted peppermint oil is massaged into the forehead and temples to relieve headache symptoms.
Diet Can Influence Both Conditions
For both migraine and IBS, foods and beverages can trigger symptoms. “For IBS, dietary advice includes avoiding dairy products, fatty foods, caffeine, and gas-producing foods such as beans and cruciferous vegetables,” DeVito says. For migraine, common triggers include meats and cheeses with added preservatives and the food additive MSG, according to the American Migraine Foundation. Trigger foods can have a domino effect, warns Spears. “Often, if someone has IBS and consumes foods that trigger an attack — for example, spicy food — it will often lead to a migraine attack as well,” says Spears. Keep a detailed record of what you eat and how you feel afterward to help yourself pinpoint food triggers for migraine and IBS symptoms. While more research is needed when it comes to specific dietary recommendations for people with both IBS and migraine, a study of 100 patients, published in May 2022 in BMC Neurology, found that “the severity scores for migraine and IBS were positively correlated with fat and copper and negatively correlated with fiber and zinc intake.” RELATED: Migraine Diet Modifications: What Really Works?
IBS Symptoms Should Be Considered When Choosing Migraine Medications
“When I have a person with symptoms that sound like IBS, I usually recommend that they see a gastroenterologist to be evaluated,” says Spears. If you see two different specialists for your migraine and IBS, make sure to tell each doctor about the medications you are taking and the symptoms you are experiencing, he says. There are some medications used for migraine that may exacerbate IBS symptoms, such as constipation or diarrhea. The treatment plan for migraine can depend on the symptoms of the IBS, says Spears. “If constipation is a symptom, I’ll try to stay away from migraine preventives that are going to promote that, such as some of the tricyclic antidepressants or calcium channel blockers. If the person is prone to diarrhea and has a hard time keeping things down, I’ll stay away from certain antidepressants such as SNRIs [serotonin-norepinephrine reuptake inhibitors], which tend to speed the gut up,” he says.
Get Educated About IBS and Migraine
When it comes to controlling migraine and IBS, different treatments work for different people. As a first step toward finding relief for your IBS and migraine symptoms, talk to your healthcare professional. You can also learn more about IBS online at the website of the National Institute of Diabetes and Digestive and Kidney Diseases and at AboutIBS, the website of the International Foundation for Gastrointestinal Disorders. And you can learn more about migraine from the National Headache Foundation, the American Migraine Foundation, the Association of Migraine Disorders, and Migraine Again. Additional reporting by Ashley Welch and Becky Upham.
