Gastric stasis in migraineurs: etiology, characteristics, and clinical and therapeutic implications

Abstract

Background: Migraine is a disabling neurological disorder often complicated by gastrointestinal conditions such as gastric stasis. The association between migraine and gastric stasis has received very little attention in the literature, but the existing evidence suggests that they may share a common etiology.

Results: Patients with migraine and those with gastric stasis exhibit abnormal autonomic nervous system function. Furthermore, empirical studies demonstrate that migraineurs experience significant delays in gastric emptying, both during and outside of attacks, when compared to non-migrainous controls.

Conclusion: More research is needed to establish the relationship between gastric stasis and migraine burden and to determine the impact of gastric stasis on migraine treatment.

Conflict of interest statement

Dr. Kedar reports no disclosures.

Figures

Figure 1

Neuronal control of headache pain Scenario A: (1) Hyperexcitable neurons trigger cortical spreading depression. Cortical spreading depression stimulates the release of neurotransmitters and ions. (2) These neurotransmitters and ions relay pain signals to the trigeminal nucleus in the brain stem, which (3) sends a pain signal to the thalamus, ultimately resulting in the sensation of pain. Scenario B: (1) The raphe nucleus, the locus coeruleus, and the periaqueductal gray function abnormally. (2) Dysfunction of the brain stem leads to spreading depression in the cortex or subcortex, and through signals transmitted by neurotransmitters and ions, subsequently activates the trigeminal system. (3) Alternatively, brain stem dysfunction can directly activate pain pathways. Reprinted with permission.

Figure 2

Control of gastrointestinal function by the brain. Sympathetic and parasympathetic innervation of gut modulates gastrointestinal function. Neurotransmitters released from the enteric neurons control peristalsis. The major neurotransmitters involved are acetylcholine (ACh), substance P (SubP), vasoactive intestinal polypeptide (VIP) and nitric oxide. NOS: nitric oxide synthase; SubK: substance K. Adapted with permission.