The Gut, the Brain and Migraine: When Pills Don’t Work

Poster presented at the International Headache Congress HIS and EHF Joint Congress 2021, 8-12 September, 2021

Authors: Aurora S., Shrewsbury S., Nguyen L., Hindiyeh N.

Objective: Migraine is often complicated by GI conditions such as gastroparesis, functional dyspepsia – both associated with delayed gastric emptying, and cyclic vomiting syndrome. For example, GI comorbidity was reported in 38.4% of 354 subjects enrolled in STOP 301, with 20.3% reporting GERD. Here we review the current state of scientific evidence that exists linking migraine and gastric stasis.

Methods: Key words, gastric stasis, migraine, autonomic dysfunction were used to obtain relevant studies in a literature search of EMBASE and PubMED.

Results: Delayed aspirin absorption was reported in 19 out of 42 patients during a spontaneous attack, but not interictally. However, scintigraphy studies showed that gastric emptying after an induced migraine attack was delayed 78% ictally, and 80% interictally. Delayed emptying during spontaneous migraine attacks was reported as well but others have reported contradictory results. Compared to migraine patients, subjects with functional dyspepsia had more delayed emptying and others reported delayed ictal, but not interictal, emptying in patients compared to controls. An NIH Gastroparesis consortium survey reported migraine as the most common extra-GI comorbidity (36.6%) and was associated with more severe gastroparesis symptoms.

Conclusion: The association between gastroparesis and migraine may be important if patients have GI symptoms and do not experience migraine relief with oral abortive treatment.


Aurora S, Shrewsbury S., Nguyen L., Hindiyeh N., The Gut, the Brain and Migraine: When Pills Don’t Work. International Headache Congress 8–12 September 2021. Cephalalgia. 2021;41(1_suppl):1-228. doi:10.1177/03331024211034005