Brazilian Journal of Pain
Brazilian Journal of Pain
Original Article

Association between migraine, constipation and lactose intolerance in adults patients

Associação entre enxaqueca, constipação intestinal e intolerância à lactose em adultos

Lorraine Lacerda Brasil Souza; Luana de Oliveira Leite; Carina Marcia Magalhães Nepomuceno

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BACKGROUND AND OBJECTIVES: Considering the bidirectional connection between intestine and brain, the present study examined the association between migraine, lactose intolerance, and intestinal constipation in patients with status migrainosus.

METHODS: This is a cross-sectional retrospective study that included 97 patients aged 20 years or older. The impact of pain was assessed by the Migraine Disability Assessment and the Headache Impact Test-6 questionnaires. The pain intensity was measured by the visual analog scale. Chi-square and Student-t tests were used for the statistical analysis.

RESULTS: The sample consisted of 88.7% women, 56.8% overweight, 76.3% sedentary, 32% constipated and 23.7% lactose intolerant. Higher pain intensity (8.9±1.3) and impact pain mean was assessed by the Headache Impact Test-6 (67.6±5.3) and the Migraine Disability Assessment (36.7±26.3) in constipated patients compared to those without constipation. Lactose-intolerant patients presented higher migraine mean time (19.9±14.2) compared to lactose tolerant patients. Constipated and lactose intolerant patients presented higher prevalence of overweight (58.1 and 65.2%) and abdominal obesity (70.0 and 68.2%) compared to non-constipated and lactose tolerant patients, respectively.

CONCLUSION: Although were observed in the evaluated sample a considerable prevalence of constipation and lactose intolerance, higher mean scores in the questionnaires used for pain impact and intensity in constipated patients and longer migraine diagnosis time in those with lactose-intolerance, there was no statistical significance in the association between migraine and these two gastrointestinal disorders.


Constipation, Dysbiosis, Headache, Lactose intolerance, Migraine disorders


JUSTIFICATIVA E OBJETIVOS: Ao considerar a conexão bidirecional entre intestino e cérebro, o presente estudo avaliou a associação entre enxaqueca, intolerância à lactose e constipação intestinal em pacientes em estado migranoso.

MÉTODOS: Trata-se de um estudo transversal e retrospectivo que incluiu 97 pacientes com idade igual ou superior a 20 anos. O impacto da dor foi avaliado pelos questionários: Migraine Disability Assessment e Headache Impact Test-6. A intensidade da dor foi avaliada pela escala analógica visual. Os testes Qui-quadrado e Student-t foram utilizados para análise estatística.

RESULTADOS: A amostra foi composta por 88,7% de mulheres, 56,8% com excesso de peso, 76,3% sedentários, 32% constipados e 23,7% intolerantes à lactose. Os constipados apresentaram maiores médias de impacto da dor pelo Headache Impact Test-6 (67,6±5,3) e pelo Migraine Disability Assessment (36,7±26,3) e intensidade da dor (8,9±1,3) do que os não constipados. Os pacientes intolerantes à lactose apresentaram maior média de tempo de enxaqueca (19,9±14,2) em relação aos tolerantes à lactose. Os pacientes constipados apresentaram maiores prevalências de excesso de peso (58,1 e 65,2%) e obesidade abdominal (70,0 e 68,2%) e intolerantes em relação aos sem constipação intestinal e aos tolerantes à lactose, respectivamente.

CONCLUSÃO: Embora identificadas prevalências consideráveis de constipação intestinal e intolerância à lactose na amostra avaliada, além de maiores médias de pontuação nos questionários utilizados para impacto e intensidade da dor nos pacientes constipados e de maior tempo de diagnóstico da migrânea nos intolerantes à lactose, não houve significância estatística na associação entre enxaqueca e esses distúrbios gastrointestinais.


Cefaleia, Constipação intestinal, Disbiose, Intolerância à lactose, Transtornos de enxaqueca


Machado J, Barros J, Palmeira M. Enxaqueca: fisiopatogenia, clínica e tratamento. Rev Port Clin Geral. 2006;22:461-70.

Queiroz LP, Silva Junior AA. The prevalence and impact of headache in Brazil. Headache. 2015;55(^sSuppl 1):32-8.

Hindiyeh N, Aurora SK. What the gut can teach us about migraine. Curr Pain Headache Rep. 2015;19(7):33.

Dinan TG, Cryan JF. The microbiome-gut-brain axis in health and disease. Gastroenterol Clin North Am. 2017;46(1):77-89.

van Hemert S, Breedveld AC, Rovers JM, Vermeinden JP, Witteman BJ, Smits MG. Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol. 2014;5:241.

Aamodt AH, Stovner LJ, Hagen K, Zwart JA. Comorbidity of headache and gastrointestinal complaints. The head-HUNT Study. Cephalalgia. 2008;28(2):144-51.

Park MN, Choi MG, You SJ. The relationship between primary headache and constipation in children and adolescents. Korean J Pediatr. 2015;58(2):60-3.

Mattar R, Mazo DF. Intolerância à lactose: mudança de paradigmas com a biologia molecular. Rev Assoc Med Bras. 2010;56(2):230-6.

Antropometria: como pesar e medir. 2004.

Cronk CE, Roche AF. Race- and sex-specific reference data for triceps and subscapular skinfolds and weight/stature. Am J Clin Nutr. 1982;35(2):347-57.

Life in the 21st century a vision for all. 1998:61p-111p.

Obesity: preventing and managing the global epidemic. 1997.

Headache Classification Committee of the International Headache Society (IHS) the international classification of headache disorders. Cephalalgia. 2018;38(1):1-211.

Stewart WF, Lipton RB, Kolodner KB, Sawyer J, Lee C, Liberman JN. Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers. Pain. 2000;88(1):41-52.

Kosinski M, Bayliss MS, Bjorner JB, Ware Jr JE, Garber WH, Batenhorst A. A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res. 2003;12(8):963-74.

Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117-26.

Wong RK, Palsson OS, Turner MJ, Levy RL, Feld AD, von Korff M. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. Am J Gastroenterol. 2010;105(10):2228-34.

Merikangas KR. Contributions of epidemiology to our understanding of migraine. Headache. 2013;53(2):230-46.

Pinkerman B, Holroyd K. Menstrual and nonmenstrual migraines differ in women with menstrually-related migraine. Cephalalgia. 2010;30(10):1187-94.

Martin VT, Lipton RB. Epidemiology and biology of menstrual migraine. Headache. 2008;48(^sSuppl 3):S124-30.

Straube A, Müller H, Stiegelbauer V, Frauwallner A. Migraine prophylaxis with a probiotic. Results of an uncontrolled observational study with 1,020 patients. MMW-Fortschr Med. 2018;160(^sSuppl 5):16-21.

Rees T, Watson D, Lipscombe S, Speight H, Cousins P, Hardman G. A prospective audit of food intolerance among migraine patients in primary care clinical practice. Headache Care. 2005;2(1):11-4.

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2016;390(10100):1211-59.

Ruscheweyh R, Müller M, Blum B, Straube A. Correlation of headache frequency and psychosocial impairment in migraine: a cross-sectional study. Headache. 2014;54(5):861-71.

Chai NC, Scher AI, Moghekar A, Bond DS, Peterlin BL. Obesity and headache: part I--a systematic review of the epidemiology of obesity and headache. Headache. 2014;54(2):219-34.

Peterlin BL, Rapoport AM, Kurth T. Migraine and obesity: epidemiology, mechanisms, and implications. Headache. 2010;50(4):631-48.

Ford ES, Li C, Pearson WS, Zhao G, Strine TW, Mokdad AH. Body mass index and headaches: findings from a national sample of US adults. Cephalalgia. 2008;28(12):1270-6.

Vo M, Ainalem A, Qiu C, Peterlin BL, Aurora SK, Williams MA. Body mass index and adult weight gain among reproductive age women with migraine. Headache. 2011;51(4):559-69.

Blau JN. Migraine: theories of pathogenesis. Lancet. 1992;339(8803):1202-7.

Marchesi J, Shanahan F. The normal intestinal microbiota. Curr Opin Infect Dis. 2007;20(5):508-13.

Li D, Wang P, Wang P, Hu X, Chen F. The gut microbiota: a treasure for human health. Biotechnol Adv. 2016;34(7):1210-24.

Spahis S, Delvin E, Borys JM, Levy E. Oxidative stress as a critical factor in nonalcoholic fatty liver disease pathogenesis. Antioxid Redox Signal. 2017;26(10):519-41.

de Roos NM, Giezenaar CG, Rovers JM, Witteman BJ, Smits MG, van Hemert S. The effects of the multispecies probiotic mixture Ecologic Barrier on migraine: results of an open-label pilot study. Benef Microbes. 2015;6(5):641-6.

D'Amico D, Mosconi P, Genco S, Usai S, Prudenzano AM, Grazzi L. The Migraine Disability Assessment (MIDAS) questionnaire: translation and reliability of the Italian version. Cephalalgia. 2001;21(10):947-52.

Shin HE, Park JW, Kim YI, Lee KS. Headache Impact Test-6 (HIT-6) scores for migraine patients: their relation to disability as measured from a headache diary. J Clin Neurol. 2008;4(4):158-63.

Constantinides V, Anagnostou E, Bougea A, Paraskevas G, Kapaki E, Evdokimidis I. Migraine and tension-type headache triggers in a Greek population. Arq Neuropsiquiatr. 2015;73(8):665-9.

Martami F, Ghorbani Z, Abolhasani M, Togha M, Meysamie A, Sharifi A. Comorbidity of gastrointestinal disorders, migraine, and tension-type headache: a cross-sectional study in Iran. Neurol Sci. 2018;39(1):63-70.

Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: a comprehensive review. World J Gastroenterol. 2016;22(36):8149-60.

Aydinlar EI, Dikmen PY, Tiftikci A, Saruc M, Aksu M, Gunsoy HG. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013;53(3):514-25.

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