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Migraine and the gut

Here is an excellent article taken from the Migraine World Summit this year. Enjoy!! The nerves that control the gut are linked to disorders of the vagus nerve, and possibly migraine. Dr. Jay Pasricha, MD, is the chair of medicine at Mayo Clinic, Scottsdale, Arizona. He is the former director of the Johns Hopkins Center for Neurogastroenterology; as well as the founder and co-director of the Amos Food, Body and Mind Center. Dr. Pasricha is the chair of the National Institutes of Health–funded multi-center Gastroparesis Clinical Research Consortium.

How are the gut and the brain connected? Dr. Pasricha: The gut serves a very critical function - it processes materials from the environment to generate energy (digestion) and is carefully controlled by the brain. The gut is also an endocrine organ, like the thyroid, which produces a variety of hormones that signal to the brain directly or indirectly. The most well-known way by which the gut communicates with the brain is through what we call the superhighway, the vagus nerve. The vagus nerve monitors functions in the visceral organs: the heart, the lungs, and gut. Its role is to monitor the environment, monitor the function of these organs, and convey that information back to the brain. The brain receives that signal, and then it provides regulation of those organs through a feedback loop. What is the relationship between the gut, chronic pain, and migraine? Dr. Pasricha: Chronic pain can refer to a specific area, such as an injured joint or nerve. But there is another more generalized type of chronic pain, not limited to one specific region. These are called neuropathic pain syndromes, where the pain is not coming from the organ itself, but rather the nerve. This is like a faulty alarm system - the brain thinks there is an injury to that organ, because it can't tell whether it's the alarm or the organ itself. There are many patients with migraine who also have neuropathic pain. The gut’s connection to migraine via the vagus nerve may be part of a more widespread neuropathic problem. A lot of patients with migraine have problems with the gut, such as nausea, GI upset, and foods that trigger migraine. Drugs to treat migraine like CGRP antagonists have side effects on the gut depending on whether the drug acts against the CGRP receptor or against the CGRP neurotransmitter itself. One way to treat migraine is through vagal nerve stimulation, and some devices have been FDA approved. Can probiotics help with migraine? Dr. Pasricha: Probiotics are a very important pathway to improving our health, but their benefits are still potential rather than proven. Most probiotics have been developed without a clear target. You don't know what you're actually changing in the microbiome or how effective they are in populating your colon. For now, probiotics are a leap of faith.

Watch the full interview for answers to:

  • What parts of the body comprise the gut?

  • How are the gut and brain connected?

  • What is the vagus nerve?

  • What is the enteric nervous system?

  • What role does the gut play in serotonin and GABA production?

  • What is the gut microbiome?

  • Why is the gut considered to be an external organ?

  • How does the gut impact our overall health?

  • Can depression and anxiety originate in the gut?

  • What is neuropathic pain?

  • How does the gut affect chronic pain?

  • How are gut disorders such as nausea and emesis (vomiting) related to migraine?

  • How is the vagus nerve related to gastroparesis and nausea?

  • What is gastroparesis and how is it linked to migraine?

  • What are medications that act as neuromodulators, and how do they work?

  • What are some ways to restore the gut?

If you’ve previously purchased the 2023 Migraine World Summit, you are all set to log in to watch the full interview.

Kind regards, Paula K. Dumas and Carl Cincinnato Email: info@migraineworldsummit.com Web: www.migraineworldsummit.com

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