The relationship between Helicobacter infection and endoscopic upper gastrointestinal diseases and migraine

Abstract

Objectives: Migraine is often associated with various gastrointestinal (GI) symptoms and disorders, including Helicobacter pylori (Hp) infection. The aim of this study was to investigate both the relationship between migraine and Hp infection and the relationship between migraine and endoscopic upper GI diseases.

Methods: This prospective observational case-control study involved 91 migraine patients and 80 control individuals with no history of migraines presenting with upper GI symptoms. Both groups underwent upper GI endoscopy, and gastric biopsy specimens were histopathologically examined. Headache frequency, duration and pain intensity (measured by VAS) were re-evaluated in the Hp-positive migraine group at week 8 post-eradication.

Results: There was no statistically significant difference between migraine and control groups regarding Hp prevalence (p=0.117). Gastroesophageal reflux disease (GERD) was the most prevalent endoscopic upper GI condition in migraine patients (52.7%) than control group. It was statistically significant (p < 0.001). There was no statistically significant association detected between GERD and Hp in migraine subgroups (p =0.966), indicating independence of GERD from Hp. 40.7% of migraine patients had moderate chronic inflammation in the gastric antrum, while this rate was 25.0% in the control group (p=0.037). 30.8% of migraine patients had moderate acute inflammation in the gastric antrum, while this rate was 28.7% in the control group (p=0.036). While moderate acute inflammation was 45.3% in Hp-positive migraine patıents, it was 10.5% in Hp-negative migraineurs( p <0.001). While severe chronic inflammation was present in 7.5% of Hp-positive migraine patients, it was absent in Hp-negative migraineurs. Moderate chronic inflammation was observed in 52.8% of Hp-positive and 23.7% of Hp-negative migraine patients, with a significant positive relationship between chronic inflammation and Hp in migraine patients (p<0.001).Although no significant differences in attack frequency and average attack duration was detected between the Hp-positive and Hp-negative migraine subgroups. The pain intensity between migraine subgroups exhibited a significant difference being higher in Hp-positive migraine patients (p= 0.044). In addition, in the Hp-positive migraine group, significant differences were observed in attack frequency(day/month), attack intensity(visual analog scale) and average attack duration(hours) at the 8th week post-eradication compared to the pre-eradication period.The attack frequency in the Hp-positive migraine group who have been treated was 10.0 before treatment and 6.0 after treatment(p<0.001). The attack intensity was 8.0 before treatment and 5.0 after treatment(p<0.001). The average attack duration was 5.0 before treatment and 4.0 after treatment(p<0.001).

Conclusion: We conclude that Hp causes more chronic active inflammation in migraine sufferers than in individuals with upper GI symptoms without a history of migraine. In addition, migraine sufferers infected with Hp experienced more severe levels of inflammation compared to those not infected with the bacterium. In Hp-infected migraine patients, the presence of the bacteria may be related to the severity of the pain attacks. Hp eradication therapy may potentially play an important role in headache management in Hp-positive migraineurs with upper GI symptoms in addition to conventional migraine treatments. A positive association was also found between GERD and migraine patients independent of Hp status.