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Migraine of gastrointestinal origin
I Mavromichalis1, T Zaramboukas, M M Giala
1Second Pediatric Department, Aristotelian University of Thessaloniki, AHEPA General Hospital, Greece.
Insights
Gastrointestinal inflammation is common in children with migraine, suggesting a gut-brain connection. This study found underlying inflammatory lesions in most children, but not strongly linked to Helicobacter pylori infection.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Microbiology
Background:
- Migraine is a common neurological disorder in children.
- Gastrointestinal symptoms are frequently reported by children experiencing migraine.
- The origin of these gastrointestinal complaints in pediatric migraine patients remains unclear.
Purpose of the Study:
- To investigate the gastrointestinal (GI) origins of complaints in children suffering from migraine.
- To determine the prevalence of upper GI inflammatory lesions in pediatric migraine patients.
- To explore the potential role of Helicobacter pylori (H. pylori) in these GI findings.
Main Methods:
- Endoscopic biopsies of the esophagus, stomach, and duodenum were performed on 31 children with migraine.
- Histopathological examination of biopsies was conducted to identify inflammatory changes.
- H. pylori colonization was assessed in all participants.
Main Results:
- A high prevalence of upper GI inflammation was observed: 41.9% had esophagitis, 51.6% had corpus gastritis, 38.7% had antral gastritis, and 87.1% had duodenitis.
- Twenty-nine out of 31 children (93.5%) had an identifiable inflammatory lesion in their upper GI tract.
- H. pylori colonization was detected in only 7 children (22.6%), with no strong association found between H. pylori, antral gastritis, and migraine.
Conclusions:
- The study strongly suggests a gastrointestinal origin for the complaints in children with migraine.
- While H. pylori was present, it did not appear to be the primary cause of the observed inflammatory changes or directly linked to migraine.
- Recurrent abdominal pain may be an early manifestation of migraine, supporting a causal link between GI issues and migraine in children.
Unlabelled:
A consecutive series of 31 children (median age 12 years) suffering from migraine with (n = 21) or without (n = 10) aura underwent endoscopic oesophageal, gastric and duodenal biopsy in order to determine whether the complaints were of gastro-intestinal origin. Of these 31 children, 13 (41.9%) showed oesophagitis, 16 (51.6%) gastritis of corpus, 12 (38.7%) antral gastritis and 27 (87.1%) duodenitis. Thus, 29 of the 31 children studied had an underlying inflammatory lesion explaining their complaints. Helicobacter pylori colonization was found in 7 of the children: one had H. pylori associated antral and corporal gastritis and 6 H. pylori associated antral gastritis only. Gastritis of corpus without H. pylori was present in all these 6 children. Our data do not support that H. pylori is a primary pathogen of inflammatory changes seen in children studied, neither do they establish an association between H. pylori, antral gastritis and migraine. However, our data strongly suggest that there is a gastro-intestinal origin of these patients' complaints.
Conclusion:
Our findings provide further evidence that recurrent abdominal pain is an early expression of migraine and strongly support a causal link between recurrent abdominal pain and migraine.