Researchers say there may be a link between acid reflux and migraine.
- Researchers are reporting that taking
acid-reducing drugs could increase the chance of severe headaches.
- They note that acid-reducing drugs are
often considered to be overprescribed.
- They acknowledge that the study doesn’t
prove acid-reducers cause migraine, only that there could be an
association.
People who take
acid-reducing drugs to help their stomach might be increasing their risk of
severe headaches.
A study published today in the journal Neurology
Clinical Practice reports that people who take acid-reducing drugs
could have a higher risk of migraine and
other severe headaches than those who don’t take them.
Researchers said
headaches could be associated with acid reducing proton
pump inhibitors, such as esomeprazole, omeprazole, and histamine
H2-receptor antagonists as well as H2
blockers, such as cimetidine and famotidine, and antacid supplements.
Acid reflux is caused by stomach acid flowing into the
esophagus, usually after a meal or when lying down. Acid reflux frequently
causes heartburn and ulcers.
People with more
frequent episodes of acid reflux can develop gastroesophageal reflux disease (GERD), which can
lead to cancer of the esophagus.
“Given the wide usage of
acid-reducing drugs and these potential implications with migraine, these
results warrant further investigation,” said Margaret
Slavin, PhD, a study author and an associate professor at the University of
Maryland in College Park, in a statement.
“These drugs are often
considered to be overprescribed and new research has shown other risks tied to
long-term use of proton pump inhibitors, such as an increased risk of
dementia,” she added.
The study authors said
their work doesn’t prove migraine is caused by acid-reducing drugs. Only that
there could be an association.
Details
from the migraine and acid reflux drugs study
Researchers examined
data from 11,818 people who reported on whether they took acid-reducing drugs
and whether they had migraine or severe headache the previous 90 days.
The study authors said
25% of subjects using proton pump inhibitors, one of the most commonly
prescribed antacids, experienced migraine or severe headache, compared to 19%
of subjects not taking the drugs. They also reported that 25% of subjects
taking H2 blockers had severe headache compared to 20% of those not taking the
drugs.
The study also revealed
that 22% of subjects taking any form of acid reflux drug experienced severe
headache, compared to 20% of those not taking antacids.
Researchers found that
people taking proton pump inhibitors were 70% more likely to develop
migraine than those who didn’t take proton pump inhibitors after adjusting for
other factors that could affect the risk of migraine, such as gender, age, and
whether a person used alcohol and caffeine.
Subjects taking H2
blockers were 40% more likely to have migraine headaches and those taking
antacid supplements were 30% more likely.
Limitations
of the acid reflux medication study
Authors said one study
limitation was that only a small number of people were taking the acid reflux
drugs, especially the H2 blockers.
“It’s important to note
that many people do need acid-reducing medications to manage acid reflux or
other conditions, and people with migraine or severe headache who are taking
these drugs or supplements should talk with their doctors about whether they
should continue,” Slavin said.
The study only looked at
prescription drugs. During the study, some of the medications became available
for over-the-counter use at non-prescription strength, but the use of these
particular medications was not included in this study.
The authors said other
studies have shown people with gastrointestinal conditions may be more likely
to develop migraine, but Slavin said that correlation isn’t likely to fully
explain the connection between migraine and acid-reducing drugs found in the
study. It is unclear if reducing acid levels in the stomach has a clear effect
on the incidence of migraines.
The
potential links between migraine and acid reflux
Dr.
Medhat Mikhael, a pain management specialist and medical director of the
non-operative program at the Spine Health Center at MemorialCare Orange Coast
Medical Center in California, told Medical News Today that
the research “is a good study; however the conclusion’s outcome was known and
the number of patients taking PPI medications or antacids were small.”
“However, the study does
raise awareness and concerns about the use of such class of drugs in migraine
patients since there is a major association between patients that suffer from
GERD, hyperacidity and migraine headache,” said Mikhael, who wasn’t involved in
the study.
He added that acid
reflux can occur alongside headaches, but researchers don’t know the nature of
the link between these conditions.
“One theory is that it
is a problem with the person’s [central nervous system] or glutamate level,
which is one of the pain pathway facilitators and that might link acid reflux
disease and headaches, which both can be part of an inflammatory process,”
Mikhael said.
Stress and
migraine headaches
Dr. Clifford Segil, a neurologist at Providence Saint
John’s Health Center in California, told Medical News Today that
stress may be a factor in both acid reflux and migraine.
“In my clinical practice,
I see countless patients with increased life stress causing disabling headaches
and many of these patients’ increased life stress also causes disabling GERD,”
said Segil, who was not involved in the study.
He added that
neurologists find it challenging to explain why any stomach acid level changing
medications would cause a change in someone’s brain to increase or decrease the
frequency of headaches or migraine.
“But it’s easy as a
neurologist to blame increased life stress on causing patients to have migraine
headaches and GERD,” Segil said. “Proton pump inhibitors are the most potent
acid decreasing medications available and are newer and work better than old H2
(histamine) blocking medications and antacids.”
Segil noted that people
with increased life stress would be expected to produce more acid as a stress
response, which is what he sees in clinical practice.
“Patients with increased
life stress would also be expected to have more frequent headaches,” Segil
said. “I am not surprised to see the treatment group requiring the strongest
acid decreasing family of medications, PPIs, to have the most frequent
headaches as a comorbidity.”
“I was surprised to see
the placebo group in the weakest of the stomach acid producing medications to
have the highest number of migraine [headaches], which was 20% of the placebo
group versus 22% of the patients taking antacid supplements,” he noted.
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