Join Waitlist

Migraines and Irritable Bowel Syndrome (IBS)

As if migraines weren’t enough, many sufferers also deal with irritable bowel syndrome (IBS). But why does this happen, and what can be done about it?

Reading time: 11 minutes

Last updated: February 6, 2024

What you will learn in this article

Migraines are often misunderstood as just severe headaches. In reality, migraines are a complex neurological condition accompanied by diverse and debilitating symptoms. These can include pulsating, one-sided headaches, weakness, nausea, vomiting, and heightened sensitivity to light, sound, and smells. For those with migraines accompanied by aura, additional symptoms such as visual and speech disturbances, numbness, or other neurological impairments may occur.

Because of this complexity, migraines often require more than painkillers. A combination of acute and preventive treatments—both medical and non-medical—is frequently necessary. While migraines are not curable, proper management can extend pain-free periods and reduce the intensity of attacks.

But as the saying goes, “Misfortunes never come singly!” Many migraine sufferers also report coexisting conditions, known as comorbidities.

What Are Comorbidities?

Comorbidities refer to one or more distinct medical conditions occurring alongside a primary illness (in this case, migraines). Migraine sufferers often face cardiovascular diseases like hypertension or coronary artery disease, chronic pain conditions like back pain, or psychiatric conditions such as depression and anxiety.

Gastrointestinal issues, such as IBS, are also common comorbidities. Recognizing these overlapping conditions is crucial for tailoring treatment plans, as some medications may be unsuitable for patients with certain comorbidities.

Migraines and IBS: The Connection

Studies have shown that people with migraines are up to 42% more likely to develop IBS. But why?

Both conditions are thought to involve neurological dysfunctions linked to the central nervous system. Genetic, hormonal, inflammatory, and psychological factors are suspected to play a role. While the exact relationship is still unclear, research suggests a significant connection between migraines and IBS.

What Is IBS?

IBS is a functional digestive disorder characterized by symptoms such as abdominal pain and cramping, without any identifiable physical cause. Approximately 7.1% of Europeans suffer from IBS, with women being more frequently affected than men.

Common Symptoms of IBS

Symptoms vary from person to person but may include:

  • Abdominal pain and cramps: Typically relieved after bowel movements.
  • Changes in bowel habits: Diarrhea, constipation, or alternating patterns.
  • Bloating and gas: Many experience excessive gas and a swollen abdomen.
  • Other symptoms: Fatigue, muscle pain, or frequent urination.

 

These symptoms alone are disruptive, and when combined with migraines, the impact on quality of life is profound.

Migraine Relief through Personalized Nutrition
  • Medication Free
  • Side Effect Free
  • Based on Science
Learn More

Causes of Migraines and IBS

The causes of IBS are multifactorial, similar to migraines, and not entirely understood. Possible factors include:

  • Genetics
  • Disruptions in serotonin metabolism
  • Altered gut microbiota
  • Metabolic issues like glucose dysregulation
  • Psychological stress

 

Conditions like the “leaky gut syndrome,” where the gut lining becomes overly permeable, may also contribute to both IBS and migraines by triggering inflammation.

Managing Both Migraines and IBS

There are various treatment approaches for migraines and irritable bowel syndrome (IBS) that combine lifestyle changes, dietary adjustments, and medication. The good news for those affected by both migraines and IBS: Some treatment strategies overlap and contribute to an overall healthier lifestyle, such as:

  • Cognitive behavioral therapy (to develop better coping mechanisms for these highly limiting conditions)
  • Stress reduction through relaxation techniques or meditation (relaxation)
  • Regular physical activity such as moderate endurance training (exercise for migraines)
  • Adequate hydration (around 1.5 to 2 liters of still water or unsweetened herbal teas) (headaches from dehydration?)
  • A healthy diet with fresh, minimally processed foods¹⁰,²¹
  • Supporting gut flora (directly or indirectly)

 

This means that with some approaches, you can tackle two issues at once. That’s why understanding your comorbidities is so important! When it comes to nutrition, there are both similarities and differences in the treatment of these two conditions. In the following, I will discuss both aspects.

Supporting Gut Flora

Individuals with IBS and migraines can support their gut flora with probiotics (microorganisms) and prebiotics (fibers that serve as food for microorganisms) in the form of tablets, capsules, liquid supplements, and/or food. A combination of probiotics and prebiotics can promote the growth and diversity of the gut microbiome—the totality of all gut bacteria.

Probiotics are preparations that contain live microorganisms, such as lactic acid bacteria and yeasts. Prebiotics, on the other hand, are indigestible food components that support the growth and activity of bacteria in the colon—such as fiber like inulin and oligofructose. Synbiotics combine both.

However, probiotic bacteria don’t have to be taken in capsule form—they are also found in fermented foods such as fresh sauerkraut, kefir, yogurt, or fermented grain drinks. Prebiotic effects can be achieved with foods like psyllium husks or flaxseeds¹².

Nutrition for Migraine & IBS Patients

To support gut health, a healthy, balanced, and low-glycemic diet is recommended. In relation to migraines, recent studies suggest that glucose metabolism and particularly strong blood sugar fluctuations play a significant role in triggering migraine attacks¹³-¹⁶. A low-glycemic diet, which keeps blood sugar levels stable and low, can be an effective migraine prevention strategy¹⁷,¹⁸. You can read more about how stable blood sugar reduces migraines in our dedicated article.

The migraine app Ebby Migraine Prevention provides an opportunity to monitor how your blood sugar responds to meals using a continuous glucose monitor (CGM). This allows you to proactively prevent migraines by adjusting your food choices. It’s not about following a restrictive migraine diet—which doesn’t really exist—since every person reacts differently to foods (blood sugar & migraines).

FODMAP-Reduced Diet for IBS Patients

For those with IBS, a FODMAP-reduced diet is specifically recommended.

FODMAP is an acronym for:

  • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • And
  • Polyols

 

These are all fermentable (fermenting) carbohydrates, found in sweets, bread (especially wheat), dairy products, stone fruits, and cabbage. Polyols (sugar alcohols) are often added as sweeteners or moisture-retaining agents in many processed foods.

For IBS patients, this means avoiding many processed foods and sugary items—at least for an extended period, if not permanently. However, those who consistently follow a FODMAP-reduced diet can often significantly improve both their digestive issues and migraine symptoms¹⁰,¹⁷,¹⁸,²¹.

Medication Options

For IBS, treatments include:

  • Plant-based remedies (e.g., peppermint oil or lemon balm extracts).
  • Medications targeting specific symptoms like diarrhea, constipation, or cramps.
  • Antibiotics like rifaximin or antidepressants, which may also benefit migraine sufferers.

 

For migraines, treatments include a range of acute and preventive medications, as detailed in articles on managing migraines.

Conclusion

Understanding and addressing comorbidities like IBS in migraine sufferers is vital for effective treatment. Lifestyle modifications, gut health support, and tailored medical interventions can help manage both conditions, improving overall quality of life.

The Ebby app, a digital health tool, offers personalized dietary guidance and monitoring to help stabilize blood sugar levels and potentially reduce migraine attacks.

Sources
  1. Pescador, Ruschel, M. A. & De Jesus, O. Migraine Headache. in StatPearls (StatPearls Publishing, 2022).
  2. Diener H.-C., Gaul C., Kropp P. et al. (2022): Therapie der Migräneattacke und Prophylaxe der Migräne, S1-Leitlinie. in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie
  3. Kaspar 2013: https://www.headache.ch/Komorbiditaet_Und_Migraene
  4. Müller, D. et al 2013. Komorbiditäten der Migräne: praktische Behandlungskonsequenzen. In: Aktuelle Neurologie, Volume 40, Issue 04, 2013, pp. 213-223. DOI: 10.1055/s-0033-1341517
  5. Lau et al. (2014): Migränepatienten entwickeln häufiger ein Reizdarmsyndrom. In: Journal Club Schmerzmedizin 2014; 3(4): 211. DOI: 10.1055/s-0034-1544150
  6. Buse DC, Reed ML, Fanning KM, Bostic R, Dodick DW, Schwedt TJ, et al.. Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. J Headache Pain. (2020) 21:23. 10.1186/s10194-020-1084-y
  7. Shahrami, A., Assadi, M., & Khatami, M. (2012). The prevalence of migraine in patients with irritable bowel syndrome. Annals of Saudi Medicine, 32(6), 560-563.
  8. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-721.e4. doi: 10.1016/j.cgh.2012.02.029. Epub 2012 Mar 15. PMID: 22426087.
  9. Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., … & Whitehead, W. E. (2017). The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut, 66(6), 1075-1082.
  10. Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014 Jun 14;20(22):6759-73. doi: 10.3748/wjg.v20.i22.6759. PMID: 24944467; PMCID: PMC4051916.
  11. Crawford, J. et al. (2022): Gut microbiota and migraine. In: Neurobiology of Pain,Volume 11, 2022.
  12. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61; quiz 1546, 1562. doi: 10.1038/ajg.2014.202. Epub 2014 Jul 29. PMID: 25070051.
  13. Siva, Z.O. et al. (2018): Determinants of Glucose Metabolism and the Role of NPY in the Progression of Insulin Resistance in Chronic Migraine. In: Cephalalgia 38 (11), S. 1773–81. https://doi.org/10.1177/0333102417748928.
  14. Yilmaz, N. et al. (2011): Impaired Oxidative Balance and Association of Blood Glucose, Insulin and HOMA-IR Index in Migraine. In: Biochem. Med., 21, S. 145–151.
  15. Bernecker C. et al. (2011): Oxidative stress is associated with migraine and migraine-related metabolic risk in females. In: European Journal of Neurology, 18(10), S.1233-9.
  16. Gruber, H.-J. et al. (2010): Hyperinsulinaemia in Migraineurs Is Associated with Nitric Oxide Stress. In: Cephalalgia 30 (5), S. 593–98. https://doi.org/10.1111/j.1468-2982.2009.02012.x.
  17. Razeghi, J. S. et al. (2019): Association of diet and headache. In: Journal of Headache and Pain, 20(1), S. 106. doi:10.1186/s10194-019-1057-1.
  18. Evcili, G. et al. (2018): Early and long period follow-up results of low glycemic index diet for migraine prophylaxis. In: Agri.30(1), S. 8-11. doi: 10.5505/agri.2017.62443.
  19. Bongiovanni, D. et al. (2021): Effectiveness of Ketogenic Diet in Treatment of Patients with Refractory Chronic Migraine. In: Neurol Sci, doi:10.1007/s10072-021-05078-5.
  20. Probol, Britt & Lambernd, Stefanie (2023): Probiotika und Präbiotika: Gesunde Darmflora aufbauen. In: https://www.ndr.de/ratgeber/gesundheit/Probiotika-und-Praebiotika-Darmflora-aufbauen,darmgesundheit100.html#:~:text=Probiotika%20sind%20Zubereitungen%2C%20die%20lebensf%C3%A4hige,Ballaststoffe%20wie%20Inulin%20und%20Oligofruktose.
  21. S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie des Reizdarmsyndroms der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) 2021
  22. Wongtrakul W, Charoenngam N, Ungprasert P. Increased prevalence of irritable bowel syndrome in migraine patients: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2022 Jan 1;34(1):56-63. doi: 10.1097/MEG.0000000000002065. PMID: 33470704.

About the Author

Picture of Jutta Drewes

Jutta Drewes

Jutta works as a freelance illustrator and graphic designer in Hamburg. Since she was diagnosed with ulcerative colitis 10 years ago, the theoretical study of chronic diseases has also been part of her life. She finds the exchange of experiences with other sufferers particularly valuable.