Migraine episodes often encompass more than just headaches; they can also bring about nausea, heightened sensitivity to light and sound, and sensations of tingling or numbness in the limbs. Recent research indicates that these medications might be prescribed too frequently, prompting individuals to consider reassessing their usage with their healthcare provider.
Key Points to Note:
- Individuals who use antacid medications such as Prilosec, Prevacid, and Nexium are 70 percent more likely to report experiencing migraine attacks or severe headaches compared to those who do not take these drugs.
- Those who take medications like Pepcid AC and Zantac 360, as well as common antacids like Tums and Alka-Seltzer, face a 40 and 30 percent increased risk, respectively, of severe headaches or migraines.
- The study did not establish that antacids cause or exacerbate headaches or migraines, only that there is an association between their use and the occurrence of these symptoms.
Research indicates a significant connection between migraines and gastrointestinal issues. Individuals suffering from migraines often experience gastrointestinal problems such as acid reflux, gastroesophageal reflux disease (GERD), diarrhea, constipation, and nausea. Conversely, those who frequently face these digestive disturbances are more prone to chronic, debilitating headaches.
This bidirectional relationship between the gut and the brain raises the question of whether treating gastrointestinal disorders might alleviate migraines. Intuitively, one might expect that easing gut symptoms would lead to a reduction in migraine frequency and severity. However, a recent study challenges this assumption. The findings suggest that medications commonly prescribed to address digestive issues may inadvertently increase the likelihood of migraine attacks.
The study’s results underscore the complexity of the gut-brain axis and the intricate ways in which our bodily systems interact. For individuals living with both gastrointestinal disorders and migraines, this insight is crucial. It highlights the need for a careful and nuanced approach to treatment, considering potential unintended consequences.
Healthcare professionals must weigh the benefits of gastrointestinal medications against the potential risk of exacerbating migraines. This balancing act requires personalized treatment plans and a thorough understanding of each patient’s unique medical history. Ongoing research into the gut-brain connection is essential to developing more effective and holistic treatment strategies for those affected by both gastrointestinal and migraine disorders.
“We had heard some anecdotal stories about patients whose migraine symptoms improved when they discontinued their acid-suppressing drugs,” study author Margaret Slavin, PhD, RDN, an associate professor with an expertise in migraine, food, and nutrition at the University of Maryland in College Park, said. “Our study showed an association between their use and the risk of someone having migraine.”
Proton Pump Inhibitors Connected to Headaches
In a study published on April 24, 2024, in the journal Neurology Clinical Practice, Dr. Slavin and his team analyzed data from approximately 12,000 U.S. adults. These participants provided information about their usage of heartburn medications and reported whether they had experienced a migraine attack or severe headache within the past three months.
The study found a significant correlation between the use of proton pump inhibitors (PPIs) and the likelihood of experiencing migraines or severe headaches. Specifically, individuals using PPIs for chronic heartburn were found to be 70 percent more likely to suffer from migraine attacks or severe headaches compared to those who did not use these medications.
Furthermore, the research indicated that the risk of headaches was 40 percent higher among those using H2 blocker drugs and 30 percent higher for those taking common antacids such as Tums or Alka-Seltzer.
Proton pump inhibitors, described in the study as the most effective and frequently used acid reflux medications, function by reducing the production of stomach acid by the glands in the stomach lining. These medications include lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium).
Headaches are a known side effect of PPIs, and previous research has indicated that up to 40 percent of individuals with chronic headaches or migraines who have tried these medications end up discontinuing their use because they can lead to an increase in headache frequency.
In this recent study, 25 percent of participants taking PPIs reported experiencing migraines or severe headaches, compared to 19 percent of those not taking these drugs.
Additionally, prior studies suggest that PPIs may be overprescribed, and long-term use of these medications has been associated with increased risks of infections, bone fractures, nutrient malabsorption, and dementia. This underscores the importance of cautious and judicious use of PPIs, especially considering their potential side effects and the growing evidence linking them to a higher incidence of migraines and severe headaches.
“Many people get on these drugs, and stay on these drugs for too long,” Teshamae Monteith, MD, chief of the headache division at the University of Miami’s Miller School of Medicine, and a fellow of the American Academy of Neurology, said. “These drugs are helpful, but may not take the place of lifestyle interventions for common conditions such as GERD [gastroesophageal reflux disease] and gastritis [inflammation in the stomach lining].”
Other Prescription and OTC Antacids Possibly Can Also Increase Chances of Headaches and Migraine Attacks
The findings revealed that other categories of acid-suppressing medications might also be linked to migraines and severe headaches.
H2 blockers, also known as H2 receptor antagonists, work by reducing the production of histamine, a key chemical responsible for acid secretion in the stomach. Common H2 blockers include cimetidine (Tagamet) and famotidine (Pepcid AC and Zantac 360).
The study found that 25 percent of participants using H2 blockers experienced severe headaches or migraines, compared to 20 percent of those who were not on these medications. Similarly, 22 percent of individuals taking antacid supplements reported severe headaches or migraines, in contrast to 20 percent of those not taking antacids.
The analysis concluded that these results suggest “potential clinical implications for any acid-suppression therapy.”
How Medication May Affect Attacks?
Slavin and her team stress that the findings do not establish a causal relationship between these drugs and increased migraine risk; they only demonstrate an association.
However, there are several plausible mechanisms that might explain why these medications could potentially elevate the risk of migraines.
“Acid-suppression therapies have broad effects on the digestion and absorption of other drugs, as well as nutrients from our food,” Slavin explained. “Over time, they could alter the nutritional status or the health of one’s gut microbiome, which is increasingly recognized to influence our neurological health.”
She notes that part of the observed association in this study may be attributed to the fact that individuals with migraines are already known to have higher rates of gastrointestinal conditions.
Furthermore, pain medications like ibuprofen or those containing caffeine are known to cause stomach upset, potentially leading to increased use of acid-suppressing medications.
Reassessing but Not Necessarily Stopping Meds
Laura Targownik, MD, the division director for gastroenterology and hepatology at the University of Toronto and a spokesperson for the American Gastroenterological Association (AGA), has contributed to writing AGA clinical guidelines on the use of proton pump inhibitors (PPIs), including recommendations for reducing dosages or discontinuing the medications when appropriate.
Dr. Targownik warns that studies like this might prompt some individuals who genuinely benefit from PPIs—such as those at high risk for upper gastrointestinal bleeding or with a history of severe esophagitis or Barrett’s esophagus—to stop taking them.
“There is no obvious biological reason why a drug that primarily inhibits the production of gastric acid would affect one’s likelihood of developing migraines, so it is unlikely that there is a direct causal link between PPI use and the occurrence of migraine,” she said. She also added that findings similar to these have the potential to “promote the inappropriate discontinuation of PPI use.”
Slavin concurs that, despite the findings, acid-suppressing drugs are essential for some patients to manage symptoms and mitigate the risk of serious conditions such as ulcers and esophageal cancer.
“It’s important to note that many people do need acid-reducing medications to manage acid reflux or other conditions, and people with migraine or severe headache who are taking these drugs or supplements should talk with their doctors about whether they should continue,” she stated.
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