Risk for developing inflammatory bowel disease was 30% higher in people with migraine than in those without, according to a new study based on more than 10 million Korean adults. But more research is needed to understand what’s driving this association.

It’s been well documented that migraine is more common in IBD patients than the general population, but this is the first study to look at the potential involvement of migraine on the subsequent diagnosis of the gastrointestinal disease.

For the study, the researchers analyzed patient data from the Korean National Health Insurance Service database on individuals 20 years of age and older who had undergone a national health examination in 2009 and were followed until 2019 (Sci Rep 2024;14[1]:1157). The study investigators divided the patients into two groups: those with migraine and those without. During the follow-up period, they documented newly developed cases of IBD, including Crohn’s disease or ulcerative colitis.

Migraine affected 2.8% of the study population. During the follow-up period, the incidence of IBD was significantly higher in those with migraine than those without migraine (adjusted hazard ratio, 1.31; P<0.001).

Concluding that “migraine is significantly associated with the development of IBD,” the researchers recommended that “patients with migraine should be monitored carefully for the development of IBD.”

However, Aline Charabaty, MD, AGAF, FACG, an assistant professor of medicine at the Johns Hopkins University School of Medicine, in Baltimore, and the clinical director of the Inflammatory Bowel Disease Center at Johns Hopkins–Sibley Memorial Hospital, in Washington, D.C., said she doesn’t believe the research means that all patients with migraine need to be screened for IBD.

Dr. Charabaty told Gastroenterology & Endoscopy News that there are several possible explanations for the observed association between migraine and the subsequent diagnosis of IBD. “It could be a common root that’s causing both as opposed to one causing the other,” she said. “For instance, gut microbiome dysbiosis, a common genetic factor, or environmental factors. For example, we know that the westernized diet, as well as anxiety and depression, are associated with an increased risk of IBD as well as migraine.”

Another potential explanation may be the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) for migraine pain relief. NSAIDs at high frequency and long duration can increase the risk for developing IBD, Dr. Charabaty said.

Finally, Dr. Charabaty said it’s plausible that patients could have had undiagnosed Crohn’s disease at the time of the migraine diagnosis. Unlike ulcerative colitis, which typically presents with rectal bleeding, early symptoms of Crohn’s disease can be more subtle and not properly recognized. “So it’s not uncommon for patients with Crohn’s disease and diarrhea or abdominal cramping to be initially misdiagnosed as having irritable bowel syndrome, lactose intolerance or some kind of food poisoning before receiving proper evaluation and the correct diagnosis,” she said.

Ultimately, understanding more about the connections between multiple disorders and their potential common root causes can enable clinicians to better serve their patients, Dr. Charabaty said. “I think the main takeaway for us as specialists is to really look at the patient as a whole, and when we’re treating any disease involving our specialty to really look at potential manifestation in other organs,” she said. “So that means gastroenterologists asking about non-GI symptoms and neurologists asking about GI symptoms, joint symptoms, etc. This is the most immediate thing we can do to provide better patient care.”

—Ashley Welch

The sources reported no relevant financial disclosures. Dr. Charabaty is a member of the Gastroenterology & Endoscopy News editorial board.