Is Helicobacter pylori the infectious trigger for headache?: A review

The interest that surrounds the bacterium Helicobacter pylori (H. pylori) is due not only to its causal role in several gastroduodenal diseases, but also to its supposed involvement in the pathogenesis of extra-gastric manifestations. This review provides a literature update on the hypothetic correlation between H. pylori and headache. To identify all publications on this issue, a MEDLINE search of all studies published in English from 1965 to 2013 was conducted. The authors examined three aspects of this potential association: epidemiology, intervention trials and pathogenesis. While in the former, the results are contradictory, in the intervention studies, it has been documented that at 6 and 12 months, bacterial eradication is associated to disappearance of symptoms in 23% and 28% of cases, and to a significant decrease of intensity, frequency and duration of acute attacks in the remaining patients. Under a pathogenetic aspect, if H. pylori has a role, it does not act through oxidative stress. In conclusion, the eradication of H. pylori seems efficient at least in a subgroup of patients suffering from migraine. Further investigations should focalize on particular subgroups of patients and, encouraged from data produced by intervention studies, evaluate the long-term benefit of eradication.