This is part 2 of a 2 part series on the microbiome-gut-brain axis for migraine. If you haven’t seen the first article which explains the microbiota, the microbiome and how it can affect our health and brain, read it first here >>
Recent findings between the gut microbiota and the brain suggest that our microbiota can deeply influence our health, brain and potentially even our behavior.
The microbiota has been associated with several neurological conditions  and it could be playing a role in your migraine condition.
This article reviews evidence for those gut conditions associated with migraine and what you can do about it.
Below is a review of associations from research studies between migraine and gut conditions.
- 1 Headache and Gastrointestinal Symptoms
- 2 Migraine and Gastroparesis
- 3 Migraine and Colic
- 4 Migraine and Irritable Bowel Syndrome
- 5 Migraine and Celiac Disease
- 6 Migraine and Inflammatory Bowel Disease
- 7 How Important Are Associations Between Migraine and Other Disorders?
- 8 Leaky Gut and Migraine
- 9 How to Improve or Restore Your Microbiome
- 10 Implications for Migraine Patients
Headache and Gastrointestinal Symptoms
A HEAD-hunt study in Norway looked at the relationship between gut or gastrointestinal (GI) symptoms and headache including migraine.  The study included 51,000 people and found a higher prevalence of headache among those who regularly experience GI symptoms compared to the control group without GI complaints.
Researchers found that as the headaches became more frequent so did the number of GI complaints which suggests a correlation between them.
The GI complaints were just as common in those with migraine than in those with headache. Both migraine and other headaches were found to be more common in those who had GI complaints. 
Migraine and Gastroparesis
Gastroparesis is a chronic disorder characterized by a delayed emptying of the stomach. It is a relatively common complication of diabetes.
In a population of patients with this condition, those with recurring symptom patterns had higher incidences of migraine headaches with 47% versus 20%. 
For oral medication like the triptans, migraine associated gastroparesis can hinder absorption in the gut which can reduce or block its effectiveness.  This has been found in another study which associated migraine attacks with delayed gastric emptying. 
Migraine and Colic
Infant colic refers to the inconsolable crying during the first months of a baby’s life. It is defined as crying and fussing for more than 3 hours per day, more than 3 days a week, for more than 3 weeks in an otherwise healthy, well-fed infant. 
It can affect many families with an incidence ranging from 5-19%.  Colic is suspected to be caused by abdominal pain but other causes have not been ruled out.
It has been suggested that colic is an early life expression of migraine. 
In a group of 154 infant and mother pairs, those whose mother had a history of migraine were 2.6 times more likely to have colic as infants than those without a maternal history of migraine. 
It has also been shown that infants with abdominal colic have lower intestinal microbiota diversity and stability compared to other infants in the first week of life. 
Some studies have used probiotics to treat or try to prevent colic with variable results. 
Children with migraine are more likely to have experienced infantile colic compared with controls (findings vary from 1.6 to 6.6 times more likely from different studies).
Clearly, there is an association between migraine and infantile colic. Exactly how they affect each other is yet to be uncovered.
Migraine and Irritable Bowel Syndrome
IBS involves abdominal pain, bloating, discomfort and noticeable changes in bowel habits. It is a functional bowel disorder.
Like migraine, the pathophysiology of IBS is still not fully understood.
Those with IBS tend to have increased intestinal permeability also known as leaky gut.
Intestinal permeability refers to cells lining the wall inside the gut which controls what material passes through into the bloodstream and what doesn’t. Intestinal permeability deteriorates with more severe IBS symptoms. 
A study involving around 125,000 IBS patients from a large national health insurance database found that the chance of being diagnosed with migraine were 60% higher in those with IBS versus those without IBS. 
Other studies found similar associations with 25-50% of IBS patients having migraine versus just 4-19% in control groups (regular population samples). [24, 25] See this article for a definition of control groups >>
A small clinical trial involving 21 patients in an IgG-based elimination diet given to migraine patients with IBS demonstrated promise.
The study was double-blinded, randomized, controlled and a cross-over trial with baseline diet, elimination diet and a provocation diet. Compared to baseline, the elimination diet was associated with a reduction in migraine frequency and severity. 
This study found a significant reduction in IBS complaints, reinforcing the association between the two diseases. 
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Migraine and Celiac Disease
Celiac disease occurs when the immune system has an autoimmune reaction against gliadin, the primary protein in gluten. 
This inflammatory reaction can lead to intestinal damage, dysfunction, and increased intestinal permeability or leaky gut. 
Several studies have found that migraine is 2 to 3 times more common in those with celiac disease versus the control groups. 
Within populations of migraine patients, celiac disease has also been found to be more common. One study found celiac disease in 4.4% of the migraine patients (90 people) versus just 0.4% from the migraine free group (236 people). 
Whilst relatively few people have celiac disease compared to migraine. Many people with migraine may test negative for celiac disease but still find some level of sensitivity or trigger from foods high in gluten.
Those who commonly experience bloating, constipation, fatigue or mental fog after eating gluten may benefit from a gluten free diet or a diet with minimal gluten intake.
Migraine and Inflammatory Bowel Disease
Ulcerative colitis and Crohn’s disease are the most common types of inflammatory bowel disease (IBD). IBD causes defects in the intestinal walls (the epithelial layer) and the gut-based mucus immune system.
Factors that may trigger IBD are antibiotics, NSAIDs, stress and infection. These factors can reduce the mucosal barrier integrity, affect the immune response and change the gut microenvironment making it more vulnerable to inflammation. 
Only two studies could be found that looked at the potential relationship between IBD and migraine. The first, a study facilitated by the Gastroenterology Clinic at the University of North Carolina found that migraine was experienced by 30% of IBD patients.  This is significantly higher than the general population incidence at 18.2% in females and 6.5% in males. 
The study found that migraine was more common amongst Crohn’s disease patients with 36% versus ulcerative colitis patients with 14.8%. 
The second study had IBD patients self-report whether they experienced migraine or not compared to controls. Results from this study found that participants were 2.6 times more likely to have migraine. 
To date however, there has not been any evidence yet to demonstrate that an improvement in IBD also delivers a corresponding improvement in migraine. 
How Important Are Associations Between Migraine and Other Disorders?
Click image or here view TED talk.
In his TED talk, Rob Knight (pictured above) is pioneering the study of human microbes. What he reveals is that with “90% accuracy” we can tell if someone is lean or obese just by looking at the microbes in your gut.
Whilst this may not seem very impressive since we only need to look at someone and simply see whether they are lean or obese. Consider this – when your entire human genome is sequenced and you have provided all your DNA, researchers can only tell with 60% accuracy whether you are lean or obese.
Rob concludes: “The three pounds of microbes that you carry around with you might be more important than every single gene you carry around in your genome…”
Leaky Gut and Migraine
This overview has looked at several gut conditions and there relationship to migraine. Clearly there are significant associations between the gut and migraine. A piece of the puzzle may be our inflammatory immune responses which have been found in intestinal disorders characterized by increased intestinal permeability or leaky gut such as IBS, IBD and celiac disease. 
These enhanced pro-inflammatory immune responses are potentially one of the key links between these inflammatory diseases and migraine. Significant associations have also been reported between migraine and a range of inflammatory disorders such as asthma, obesity, metabolic syndrome, allergies and GI diseases.
Genetic susceptibility can determine where these pro-inflammatory responses occur in the body. For example, in the case of migraine, it may occur on the pain receptors of the trigeminal nerve through the release of inflammatory cytokines (see part 1 for more detail).
Leaky gut and inflammation affect each other. Increased intestinal permeability (leaky gut) can cause inflammation and inflammation can also lead to leaky gut. 
For migraine patients with leaky gut, improving intestinal permeability could improve the migraine condition, although further research is warranted to provide conclusive evidence of this hypothesis.
A group of migraine patients who may particularly benefit are those with food allergies.
Individuals with food allergies have shown to have increased intestinal permeability compared to healthy subjects. 
By contrast, the role of food allergies with migraine is still controversial and according to some researchers there is little evidence showing that avoiding food triggers improves migraines. 
To date, there has been little research interest to study the relationship between migraine and diet. 
After 26 years of migraine and 3 years keeping a diary, I have no doubt that my diet affects my migraine condition. Caution should be taken as I’m only a sample of one and what affects my condition may not necessarily affect someone else.
How to Improve or Restore Your Microbiome
Given the number of associations between migraine and the gut. The evidence is mounting rapidly and whilst the science is still catching up, there ways we can improve our microbiome diversity and health.
1) Get Dirty
There is a ‘hygiene hypothesis’ that suggests over sanitizing your baby; your young child’s environment and preventing exposure to good bacteria and other microorganisms increases susceptibility to allergic diseases. 
There is also a correlation between highly sanitized environments and autoimmune diseases such as diabetes and multiple sclerosis. 
Every parent knows that childcare and daycare centers are breeding grounds for germs. If one child is sick… eventually everyone gets sick. Is this an important part of a child’s immune system development?
Scientists are still working out exactly how important allowing children to get dirty is to the child’s immediate immune development as well as the long term protection later in life from autoimmune diseases.
2) Eat Clean
Diet can regulate the gut microbiome by changing the availability of nutrients.
Mango and avocado may be a migraine trigger for some, but the point is to focus on fresh, heathy and whole (single ingredient) foods. Keep a diary to uncover food triggers.
Researcher Lawrence David, Assistant professor at the Duke Institute for Genome Sciences and Policy found that dietary changes caused variations in different kinds of bacteria and genetic expression within days. 
An average US diet consists of an excess of highly refined foods which are mass produced in sterilized environments.
These types of foods reduce bacteria that help control inflammation and stress in the body. Depending on the food, it may even cause inflammation itself.
Disease and pain follow stress and inflammation. Patients with gastrointestinal disorders are more sensitive to pain than others.  Avoid inflammatory foods and eat healthy with fresh food.
3) Be Aware of Stress
Regulating the microbiome-gut-brain axis is essential to maintain balance in the central nervous system.  Stress upsets this balance or homeostasis.
Our stress responses may also be influenced by our own microbiome, suggesting yet again, another bidirectional relationship at work. 
If your body was a car, then stress is the high speed and aggressive driving of your car. You can drive this way for a short while but not all the time. If you do, over time, you’ll wear out the parts and cause bigger problems down the track.
The same principle applies to stress. We are designed biologically to be in fight or flight for only short discrete periods of time. With extended periods of stress we can wear out our own “parts” which can have very serious health consequences.
Chronic exposure to stress has been well documented as a contributor to disease including osteoporosis, IBS, diabetes, hypertension, dyslipidemia, and neurodegeneration. 
You may be able to exercise away anxiety, depression, and stress.
Exercise releases a cascade of benefits within your body and microbiome. Greater levels of inflammatory protection are released with exercise and the microbiota produces hormonal-neurotransmitter agents including GABA, noradrenaline, dopamine, and serotonin. 
These are powerful, natural feel-good neurotransmitters and protective agents, many of which have been shown to be in short supply in migraine patients.
A study involving professional rugby players found that exercise increased gut microbiota richness and diversity. That is, exercise increased the biodiversity in the gut which is a key indicator of microbiome health. 
For some people exercise might be a trigger. This shouldn’t stop you from starting small and going for a short walk or doing a gentle yoga class. Gradually build up and use common sense. Running 5 kms without prior training is a recipe for disaster.
Without exercise, your life expectancy is shortened. 
5) Use Antibiotics With Caution
Antibotics can upset the balance of our microbiome
Antibiotics affect the gut microbiota. Different antibiotic agents can cause different changes in the gut and alter the profile or equilibrium of the gut microbiome and immune mechanisms.
The microbiota is our first line of defense against infection and disease. Antibiotics have shown potential to reset the default immune and neuro-hormonal status of the microbiome. This may therefore change an individuals predisposition to related disorders.  It can also damage the microbiome and leave it vulnerable to opportunistic microorganisms.
Antibiotics are like fishing with dynamite. It’s a tool which can destroy more than what you intended. It should be used sparingly as a last resort.
If you really need antibiotics, many health practitioners encourage taking probiotics whilst on a course of antibiotics to minimize damage to your intestinal environment. Try not take them right at the exact same time. Taking a pro-botic and an anti-botic at the exact same time will not deliver the desired effect. Speak to your pharmacist about timing each optimally.
Consuming beneficial living bacteria is known as probiotics. It may one day become a therapeutic method of treatment using components of the microbiota for a broad range of conditions.
Today, probiotics are widespread with many unregulated and unsubstantiated health claims. Several probiotic strains have shown to be helpful for specific gastrointenstinal symptoms of IBS. 
The most commonly used probiotics are lactobacilli and bifidobacteria.  The effect of probiotics depends on the species and strain of bacteria.
Certain probiotics have shown to be effective in gut-related diseases but in other clinical trials findings have been inconsistent. This may be due to multiple factors including study population, duration, end-points and the different probiotic strains studied. These multiple factors make conclusive findings for these conditions difficult.
Probiotics have been shown in several studies to improve gut permeability (leaky gut) through different mechanisms.  This can have a beneficial impact for those with migraine. No studies could be found where migraine patients received nutritional therapy solely from probiotics.
An uncontrolled study reported the effects of different probiotics combined with vitamins, mineral, herb and micronutrient supplementation in 40 migraine patients. The research found that 60% of the migraine patients experienced reductions of 50% or more from migraine attacks. 
Caution: When taking probiotics it may actually cause headaches and/or migraine. This is can be an unfortunate side effect of a healthy process underway.
Probiotics may trigger headaches because the good bacteria stimulate the body to eliminate toxins and chemicals such as bad bacteria and yeast residing in the digestive tract. As these toxins exit the body symptoms may be experienced for a few days or a week. Any longer and it may be a sign of more serious infection or candida overgrowth.
To avoid or minimize headaches whilst using probiotics you can lower the dose and gradually build up.
Implications for Migraine Patients
Our gut and brain is more complex and interconnected than we previously thought.
What we eat and are exposed to can ripple across our gut, microbiome, brain and potentially our migraine condition. It can affect us today, but also potentially years into the future.
Whilst the science is still catching up, it makes sense to ensure that our microbiome is as healthy. That we address any leaky gut issues and ensure sustainable and healthy practices like getting dirty, eating clean, regular exercise, minimizing antibiotics and controlling our response to stress.
Most of those activities also help prevent migraines. Coincidence? Time will tell.
Have you made changes to improve your gut and digestion? Has this also helped your migraine condition? Let me know in the comments below.
Get a list of 11 natural and proven treatments from medically published studies sent to you.
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Very interesting. Would like to see more about this as it becomes available.
Unlike migraine, this area is getting plenty of attention and funding. No doubt, more will be coming out as scientists learn more how the gut influences our health.
Important article. My child has migraine and developed first oral food allergy, motion sickness in cars, and as the allergies got worse so did the frequency and severity of the migraine until chronic daily. Google deficitdao.org. They know that infants with colic (she was and so was I as baby) genetically have an SNP which impacts their DAO enzyme- which degrades histamine but also monoamine a and diamines. Including tyramine. Check also your FUT2 gene status, if you are a "non-secretor", you do not secrete in your gut mucous blood factor elements…which feeds and helps colonize clostridium type bacterium which produce butyrate. Read about butyrate on self-hacked website. It is known low butyrate is associated with food allergies and leaky gut. Low butyrate is associated with diabetes and obesity. It is important in the immune modulation and causing "tolerance" for gut comensual bacteria, and causes Treg propagation. You can buy butyrate and take it. I have a friend who healed Colitis after 18 mos of use, she had Colitis for 10 years. Her gastro could not believe it. Zero inflammation.
Also my more recent research came up with full fat bovine colostrum as being excellent for leaky gut repair.
I am interested in polling patients. How many took cipro, avelox, levaquin or any antibiotic in that family before migraine hit you???
Amitryptiline by the way suppresses DAO further. And what they are finding about drugs which block receptors is that your body/cells grows more receptors. The density of receptors increases as the body struggles to get signal through. Amitryptiline blocks histamine receptors. That is why it makes you like a zombie when you first start taking it, until your body "adjusts". Google histamine in the nervous system for a great article.
Yeah amptriplyline is a hard drug I took it before n had to get off of it cause it had me like a zombie crying all the time
The side effects of some of the drugs are pretty significant. At different times, my side effects have made sad, happy, fat, slim and moody amongst other things. I’m just grateful my hair hasn’t fallen out (a potential side effect of a treatment used to take frequently).
What treatment Carl, causes hairfall?
Once of the listed (potential) side effects of some anti seizure medications which are commonly used for migraine prevention is hair loss.
WOW – I just looked at my FUT2 gene snips, as I can’t understand what the colors mean – 4 yellow and 1 green, perhaps I will try taking some butyrate anyway! Any brands or doses to suggest? Amazing information Michelle, and Carl – Thank you.
Oh, you can buy DAO enzyme too. You have to take it every time you eat to be effective.
Have you taken a beta blocker and then if you stopped had more anxiety? You grew more receptors. Beta blockers block adrenaline and noradrenaline…
Very interesting Michelle.
I’ve heard good things about the DAO enzyme but haven’t tried it. It sounds like a potential topic for another article. In addition to the site you mentioned earlier, please share any great resources about it and I’ll dig deeper.
Personally, I’m pretty sure I had antibiotics before I experienced migraine. It started at a young age for me.
I really appreciate these articles! They are very informative and pertinent. Thank you so much for all your research and for sharing it with us. One of my daughters was very colicky and she was diagnosed with migraines when she was a young child. Although they are managed well, she has significant ongoing ‘gut’ issues.
Thank you Janet. I appreciate your feedback.
Hopefully this article gives you a few ideas to discuss with your health care professional about how to address those issues with your daughter.
Carl, your research always amazes me. That list of sources …. where do you find the time to read 49 things for one article? Legend! I have no idea if I had leaky gut before I got migraines … it was so long ago. I do know I have it now!
Buying some butyrate today!
I would try to understand the full effects and consequences of this before deciding.
If I’ve learnt anything from this 2 part series… it’s how connected our organic systems are. We definitely want to seek homeostasis (balance) to achieve optimal functioning… but I suspect many treatments designed to help could actually hinder us (eg. antibotics).
So we just need to check what are the downstream consequences of any new and especially medicinal treatments we take. It would well be a good option… but do your own due diligence first.
Interesting article. Rings true. I had leaky gut issues prior to getting migraines.
Very interesting… I wonder what impact that could have on your migraines if it was addressed?
Something worth addressing.
It will be hard to see how well this works, unless people do their own organized trial. Doubt that research funding is coming – or is it?
Research is being funded by different groups and organisations. Part 1) covers a bunch of the funding that is currently planned or underway.
I decided to consult an allergist before finally going to a neurologist. After various tests to rule out major problems I was put on an illumination diet. That was about 6 years ago, I didn’t need to go to the neurologist after that.
Great results Doni. An elimination diet can be very helpful when under the supervision of a medical professional. For others considering it, you need supervision so that you don’t risk malnutrition.
At last some one is actually making sense. My family has a history of migraine at least back from my Grandfather ( I am 77) and down 3 more generations.
I had a food intolerance test about 35 years ago (not connected to Migraine) and cut down on the foods suggested and my Migraines became a lot less severe and less often.
Great to hear about your results Karne. I was originally very surprised that doctors didn’t know all this stuff and be taking these potential factors into account… but it’s eye opening to discover just how much is still a mystery within our bodies and the interrelationships within.
Reading the two articles have given me much food for thought.
As a child I had frequent so called ‘bilious attacks’. As an adult I developed what was diagnosed as a spastic colon. From time to time I still suffer from this.
Perhaps all this is related to my migraine problem.
Hi Marian, since scientists are only just discovering how strong the connection is between our digestive system and our brain you might need to follow your ‘gut’ on this. If you can improve your condition there it could possibly help your migraine condition.
I have always heard about the connection of our gastrointestinal tract and having an overall healthier body! Eating healthy raw, lightly steamed veggies with olive oil and natural seasonings w/o msg ( which do exist in even pepper) ! But now McCormack Seasons has added an entire line of all natural organic seasonings with no msg, addivitives or artificial colors or flavorings, which can be triggers for a migraineur through their own personal life’s choice of using a simple pepper shaker! Now that I have found this out, I only use these special seasonings which in truth is the only way all of our food supply should be, 100% natural organic with no additional additives and fillers that are not even considered to be in any "foods" group! I am also been easily affected by the change back in the late 1960’s to the current change of our now "Fast Foods!"’Which have too many of these non-food fillers for their own way to make them in a microwave or at a fast food drive through type of eating! Our bodies are also like the same as a very delicate intricate sports car, w/o the proper care, gas, oil changes etc…, it’s not going to run well either! So by taking a little more time to prepare whole, real food that has not been processed for easier/faster cooking than we will also be making our own bodies become more efficient with the food that we are getting to keep us from getting our bodies sick from additives, artificial colors, flavors and seasonings! I feel much better when I give myself the best possible choices of food from the ground or animal, meat products that have not been given any growth hormones, or antibiotics or even kept cooped up together with out being able to run, walk and use their bodies the way they were meant to before being used in our own daily lives as part of the food chain if you want to include protein based meats, not fatty based foods like, bacon, or even using any type of the fat of the animal even though their skin,!there are no nutritional values for you there! I believe in only using Olive oils for sautéing foods and baking foods, never using grease(animal fats) to cook with ever! Also I think drinking the 8 glasses of purified water or real unsweetened Japanese Green Tea every day is also very important for a healthy gut! Using raw probiotics through very good supplements is also very helpful for a healthy body and brain connection!
I like the analogy of your body and the intricate sports car. It you’re not maintaining your car with the right oil, services and fuel… problems will appear. Also true for our body and mind 🙂
It certainly sounds like your benefitting from your changes. Thank you for sharing your tips!
I started taking probiotics about a week ago, carefully following the instructions but halving the dose. I wake each morning feeling hungover – I don’t drink – and have really nasty migraines despite my prophylactic medication for them. I’m hoping this clears up soon because if not I’ll have to stop.