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      Gut-brain Axis and migraine headache: a comprehensive review

      review-article
      1 , 2 , 3 , 1 , 4 , 5 , 6 , 7 , , 1 , 4 , , On behalf of the School of Advanced Studies of the European Headache Federation (EHF-SAS)
      The Journal of Headache and Pain
      Springer Milan

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          Abstract

          The terminology “gut-brain axis “points out a bidirectional relationship between the GI system and the central nervous system (CNS). To date, several researches have shown that migraine is associated with some gastrointestinal (GI) disorders such as Helicobacter pylori (HP) infection, irritable bowel syndrome (IBS), and celiac disease (CD). The present review article aims to discuss the direct and indirect evidence suggesting relationships between migraine and the gut-brain axis. However, the mechanisms explaining how the gut and the brain may interact in patients with migraine are not entirely clear. Studies suggest that this interaction seems to be influenced by multiple factors such as inflammatory mediators (IL-1β, IL-6, IL-8, and TNF-α), gut microbiota profile, neuropeptides and serotonin pathway, stress hormones and nutritional substances. Neuropeptides including CGRP, SP, VIP, NPY are thought to have antimicrobial impact on a variety of the gut bacterial strains and thus speculated to be involved in the bidirectional relationship between the gut and the brain. According to the current knowledge, migraine headache in patients harboring HP might be improved following the bacteria eradication. Migraineurs with long headache history and high headache frequency have a higher chance of being diagnosed with IBS. IBS and migraine share some similarities and can alter gut microflora composition and thereby may affect the gut-brain axis and inflammatory status. Migraine has been also associated with CD and the condition should be searched particularly in patients with migraine with occipital and parieto-occipital calcification at brain neuroimaging. In those patients, gluten-free diet can also be effective in reducing migraine frequency. It has also been proposed that migraine may be improved by dietary approaches with beneficial effects on gut microbiota and gut-brain axis including appropriate consumption of fiber per day, adhering to a low glycemic index diet, supplementation with vitamin D, omega-3 and probiotics as well as weight loss dietary plans for overweight and obese patients.

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          Most cited references116

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          Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

          Summary Background Through the Global Burden of Diseases, Injuries, and Risk Factors (GBD) studies, headache has emerged as a major global public health concern. We aimed to use data from the GBD 2016 study to provide new estimates for prevalence and years of life lived with disability (YLDs) for migraine and tension-type headache and to present the methods and results in an accessible way for clinicians and researchers of headache disorders. Methods Data were derived from population-based cross-sectional surveys on migraine and tension-type headache. Prevalence for each sex and 5-year age group interval (ie, age 5 years to ≥95 years) at different time points from 1990 and 2016 in all countries and GBD regions were estimated using a Bayesian meta-regression model. Disease burden measured in YLDs was calculated from prevalence and average time spent with headache multiplied by disability weights (a measure of the relative severity of the disabling consequence of a disease). The burden stemming from medication overuse headache, which was included in earlier iterations of GBD as a separate cause, was subsumed as a sequela of either migraine or tension-type headache. Because no deaths were assigned to headaches as the underlying cause, YLDs equate to disability-adjusted life-years (DALYs). We also analysed results on the basis of the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility. Findings Almost three billion individuals were estimated to have a migraine or tension-type headache in 2016: 1·89 billion (95% uncertainty interval [UI] 1·71–2·10) with tension-type headache and 1·04 billion (95% UI 1·00–1·09) with migraine. However, because migraine had a much higher disability weight than tension-type headache, migraine caused 45·1 million (95% UI 29·0–62·8) and tension-type headache only 7·2 million (95% UI 4·6–10·5) YLDs globally in 2016. The headaches were most burdensome in women between ages 15 and 49 years, with migraine causing 20·3 million (95% UI 12·9–28·5) and tension-type headache 2·9 million (95% UI 1·8–4·2) YLDs in 2016, which was 11·2% of all YLDs in this age group and sex. Age-standardised DALYs for each headache type showed a small increase as SDI increased. Interpretation Although current estimates are based on limited data, our study shows that headache disorders, and migraine in particular, are important causes of disability worldwide, and deserve greater attention in health policy debates and research resource allocation. Future iterations of this study, based on sources from additional countries and with less methodological heterogeneity, should help to provide stronger evidence of the need for action. Funding Bill & Melinda Gates Foundation.
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            Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis

            Celiac disease is a major public health problem worldwide. Although initially it was reported from countries with predominant Caucasian populations, it now has been reported from other parts of the world. The exact global prevalence of celiac disease is not known. We conducted a systematic review and meta-analysis to estimate the global prevalence of celiac disease.
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              Diet and the intestinal microbiome: associations, functions, and implications for health and disease.

              The mutual relationship between the intestinal microbiota and its mammalian host is influenced by diet. Consumption of various nutrients affects the structure of the microbial community and provides substrates for microbial metabolism. The microbiota can produce small molecules that are absorbed by the host and affect many important physiological processes. Age-dependent and societal differences in the intestinal microbiota could result from differences in diet. Examples include differences in the intestinal microbiota of breastfed vs formula-fed infants or differences in microbial richness in people who consume an agrarian plant-based vs a Western diet, which is high in meat and fat. We review how diet affects the structure and metabolome of the human intestinal microbiome and may contribute to health or the pathogenesis of disorders such as coronary vascular disease and inflammatory bowel disease. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                simona.sacco@univaq.it
                togha1961@gmail.com
                Journal
                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                Springer Milan (Milan )
                1129-2369
                1129-2377
                13 February 2020
                13 February 2020
                2020
                : 21
                : 1
                : 15
                Affiliations
                [1 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, , Tehran University of Medical Sciences, ; Tehran, Iran
                [2 ]GRID grid.411600.2, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, , Shahid Beheshti University of Medical Sciences, ; Tehran, Iran
                [3 ]GRID grid.411874.f, ISNI 0000 0004 0571 1549, Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, , Guilan University of Medical Sciences, ; Rasht, Iran
                [4 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, , Tehran University of Medical Sciences, ; Tehran, Iran
                [5 ]GRID grid.7841.a, Department of Clinical and Molecular Medicine, , Sapienza University of Rome, ; Rome, Italy
                [6 ]GRID grid.420169.8, ISNI 0000 0000 9562 2611, Department of Virology, , Pasteur Institute of Iran, ; Tehran, Iran
                [7 ]GRID grid.158820.6, ISNI 0000 0004 1757 2611, Neuroscience section – Department of Applied Clinical Sciences and Biotechnology, , University of L’Aquila, ; L’Aquila, Italy
                Author information
                https://orcid.org/0000-0002-9368-6835
                Article
                1078
                10.1186/s10194-020-1078-9
                7020496
                32054443
                3c79b4fc-ad00-4d8b-b0dc-fb74ffc0de63
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 12 October 2019
                : 23 January 2020
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2020

                Anesthesiology & Pain management
                Anesthesiology & Pain management

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