Use of acid reflux drugs associated with higher risk of migraine

NATION — Researchers say there may be a link between acid reflux and migraine. Researchers are reporting that taking acid-reducing drugs could increase the chance of severe headaches.
They note that acid-reducing drugs are often considered to be overprescribed.
They acknowledge that the study doesn’t prove acid-reducers cause migraine, only that there could be an association.
People who take acid-reducing drugs to help their stomach might be increasing their risk of severe headaches.
A study published today in the journal Neurology Clinical Practice reports that people who take acid-reducing drugs could have a higher risk of migraine and other severe headaches than those who don’t take them.
Researchers said headaches could be associated with acid reducing proton pump inhibitors, such as esomeprazole, omeprazole, and histamine H2-receptor antagonists as well as H2 blockers, such as cimetidine and famotidine, and antacid supplements.
Acid reflux is caused by stomach acid flowing into the esophagus, usually after a meal or when lying down. Acid reflux frequently causes heartburn and ulcers.
People with more frequent episodes of acid reflux can develop gastroesophageal reflux disease (GERD), which can lead to cancer of the esophagus.
“Given the wide usage of acid-reducing drugs and these potential implications with migraine, these results warrant further investigation,” said Margaret Slavin, PhD, a study author and an associate professor at the University of Maryland in College Park, in a statement.
“These drugs are often considered to be overprescribed and new research has shown other risks tied to long-term use of proton pump inhibitors, such as an increased risk of dementia,” she added.
The study authors said their work doesn’t prove migraine is caused by acid-reducing drugs. Only that there could be an association.
Details from the migraine and acid reflux drugs study
Researchers examined data from 11,818 people who reported on whether they took acid-reducing drugs and whether they had migraine or severe headache the previous 90 days.
The study authors said 25% of subjects using proton pump inhibitors, one of the most commonly prescribed antacids, experienced migraine or severe headache, compared to 19% of subjects not taking the drugs. They also reported that 25% of subjects taking H2 blockers had severe headache compared to 20% of those not taking the drugs.
The study also revealed that 22% of subjects taking any form of acid reflux drug experienced severe headache, compared to 20% of those not taking antacids.
Researchers found that people taking proton pump inhibitors were 70% more likely to develop migraine than those who didn’t take proton pump inhibitors after adjusting for other factors that could affect the risk of migraine, such as gender, age, and whether a person used alcohol and caffeine.
Subjects taking H2 blockers were 40% more likely to have migraine headaches and those taking antacid supplements were 30% more likely.
Limitations of the acid reflux medication study
Authors said one study limitation was that only a small number of people were taking the acid reflux drugs, especially the H2 blockers.
“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,” Slavin said.
The study only looked at prescription drugs. During the study, some of the medications became available for over-the-counter use at non-prescription strength, but the use of these particular medications was not included in this study.
The authors said other studies have shown people with gastrointestinal conditions may be more likely to develop migraine, but Slavin said that correlation isn’t likely to fully explain the connection between migraine and acid-reducing drugs found in the study. It is unclear if reducing acid levels in the stomach has a clear effect on the incidence of migraines.
The potential links between migraine and acid reflux
Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California, told Medical News Today that the research “is a good study; however the conclusion’s outcome was known and the number of patients taking PPI medications or antacids were small.”
“However, the study does raise awareness and concerns about the use of such class of drugs in migraine patients since there is a major association between patients that suffer from GERD, hyperacidity and migraine headache,” said Mikhael, who wasn’t involved in the study.
He added that acid reflux can occur alongside headaches, but researchers don’t know the nature of the link between these conditions.
“One theory is that it is a problem with the person’s [central nervous system] or glutamate level, which is one of the pain pathway facilitators and that might link acid reflux disease and headaches, which both can be part of an inflammatory process,” Mikhael said.
Stress and migraine headaches
Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Center in California, told Medical News Today that stress may be a factor in both acid reflux and migraine.
“In my clinical practice, I see countless patients with increased life stress causing disabling headaches and many of these patients’ increased life stress also causes disabling GERD,” said Segil, who was not involved in the study.
He added that neurologists find it challenging to explain why any stomach acid level changing medications would cause a change in someone’s brain to increase or decrease the frequency of headaches or migraine.
“But it’s easy as a neurologist to blame increased life stress on causing patients to have migraine headaches and GERD,” Segil said. “Proton pump inhibitors are the most potent acid decreasing medications available and are newer and work better than old H2 (histamine) blocking medications and antacids.”
Segil noted that people with increased life stress would be expected to produce more acid as a stress response, which is what he sees in clinical practice.
“Patients with increased life stress would also be expected to have more frequent headaches,” Segil said. “I am not surprised to see the treatment group requiring the strongest acid decreasing family of medications, PPIs, to have the most frequent headaches as a comorbidity.”
“I was surprised to see the placebo group in the weakest of the stomach acid producing medications to have the highest number of migraine [headaches], which was 20% of the placebo group versus 22% of the patients taking antacid supplements,” he noted
— By Tony Hicks on April 24, 2024 — Fact checked by Kevin Cyr, MD