Imagine your head throbbing for hours, your eyes hypersensitive to light, ears vexed with every sound, plus a constant feeling of nausea and vomiting. On top of that, you’re having a gallbladder attack! How horrible must it be! Unfortunately, this ordeal happens to a good number of people. Migraine and gallbladder issues are very much connected. Studies show that individuals with gallstones and other gut issues are at greater risk of developing migraines too.
Migraine Attacks Linked to the Biliary System
Migraine is a neurovascular disorder with various gastrointestinal and autonomic symptoms like light and sound aversion. It is recurring and untreatable at the moment, making it an extremely disabling condition. Migraine is complex and still not fully understood but some of the factors believed to play a role in its development include genetics, hormones, diet, food allergens, and environmental factors.
The idea that migraine and gallbladder (and the digestive system as a whole) is not new. As early as the 1800s, doctors and traditional medicine practitioners had already documented their theories that the debilitating headache is caused by the “superfluity of bilious humour” or by the “hot distemper of the liver”. Early research about the bilious type of migraine characterized by profuse and intense vomiting regarded it as a complication of dyspepsia or a manifestation of a biliary disorder.
Gallstone and Migraine Attacks
According to a study published in the 1930s, gallbladder stasis or dyskinesia has been identified as the origin of certain migraines. Liver functional disturbance and high amounts of bilirubin in the blood have also been commonly observed among patients with migraines and gallbladder issues.
In a 2018 study that followed 1,000,000 individuals for 12 years, researchers concluded that the incidents of migraines among gallbladder patients were significantly greater. Upper abdominal symptoms including unexplained right upper quadrant discomfort were also often reported by migraine patients.
A 2014 study among individuals with NAFLD showed that migraine patients with non-alcoholic fatty liver disease (NAFLD) had significantly more attacks and a higher frequency of auras. Fatty liver, obesity, and metabolic disorders, which are important determinants of NAFLD, are associated with an increased risk of gallstones.
Other Gastrointestinal Issues Linked to Migraine
Gastrointestinal function is controlled by the enteric nervous system, which is heavily influenced by the autonomic nervous system and receives input from the central nervous system. All these connections are present in the pathology of migraine and gallbladder issues as well. This is additional proof of the complex gut-brain interaction which goes beyond the maintenance of daily digestion.
Heliobacter pylori is often implicated in the development of gastritis and peptic ulcer but recent evidence shows that it is also a possible cause of various extra digestive manifestations, including neurological diseases like migraine. A 1998 study showed that among 200 subjects suffering from migraines, 40% had H. pylori infection. Based on their observation, migraine intensity, duration, and frequency of attacks were significantly reduced after patients started medication for H.pylori infection. It is believed that migraine is triggered by the inflammation and vascular reaction prompted by the infection. There is also enough evidence to show that the bacterial population of H.pylori increases the risk of developing cholesterol-type gallstones.
Irritable bowel syndrome is considered a neuro-gastroenterologic functional disorder because it does not only deal with smooth muscle dysfunction but is also widely prevalent among individuals with psychological and nervous system conditions. Chronic headaches are prevalent among IBS patients, affecting around 30-50% of the patient population. The links between IBS and migraine are believed to be the brain-gut axis, inflammation, and the impact of intestinal microbiota.
Gastroparesis – Partial Stomach Paralysis
In our previous blog about gastroparesis, we discussed possible causes, symptoms, and treatment. Gastroparesis is a serious disease that disables the stomach from digesting food and moving it to the small intestine for nutrient absorption and eventually, elimination. Typical symptoms include heartburn, poor appetite, throwing up undigested food, and early fullness while eating.
Aside from extreme discomfort, this GI condition may also lead to migraine because of the dysfunction of the enteric autonomic system. According to a study among migraine patients with GI issues, severe or moderate attacks, such as in gastroparesis significantly delay gastric emptying time. This impact on gastric emptying then affects the intensity of headache, nausea, and photophobia among migraine patients. Another study showed that individuals with migraines have meal-induced hypersensitivity of the stomach. This means that aside from experiencing debilitating headaches, those with migraine are highly likely to feel abdominal pain and other gastrointestinal symptoms after eating.
This disease has well-known neurological complications such as epilepsy, occipital calcification or the calcification of certain parts of the brain, and migraine-like headaches. Patients with various neurological conditions like encephalopathy, ataxia, neuropathy, and myopathy have also been found to have Celiac antibodies. Gluten in the diet affects both migraine and CD. Migraine, clinically, follow dairy or gluten ingestion. This triggers an inflammatory response which can last up to a few days later.
Celiac disease and migraine share a lot of psychosocial and pathophysiological characteristics.
Possible Mechanisms Connecting the Gut and Gallbladder
Migraine, gallbladder issues, and other gastrointestinal disorders share several pathophysiological mechanisms. The exact mechanisms relating to the conditions remains undetermined but below are some possible explanations according to various studies.
Similar at-risk groups and related diseases
Some migraine-associated co-morbidities like obesity, diabetes, heart disease, depression, and anxiety are the same risk factors for gallstones and gallbladder diseases. Gallstones are also more common among older females, just like migraines.
In our blog post about inflammation, we have discussed how this supposedly normal physiological reaction is to be blamed for the development of numerous chronic conditions. This includes gallbladder and digestive diseases as well as migraines. Since migraine and gallbladder attacks may be triggered or worsened by chronic inflammation, it is important to learn how to manage it and nip it in the bud. To learn more, read Chronic Inflammation Causes Chronic Diseases.
Alterations in the Microbiota
In the same manner that a healthy gut microbiota can help us ward off diseases, dysbiosis, or alteration in the intestinal microbiota also greatly contributes to the development of migraine. Dysbiosis has an impact on immune function, epithelial barrier permeability, absorption, and metabolism of nutrients affecting the gut and the nervous system. This also explains why certain foods or the lack of a proper diet trigger migraine attacks for some people. To manage debilitating headaches, studies show that dietary interventions and some modifications of the gut microbiome through probiotics may be beneficial.
The vagus nerve extends from the brain stem to the lowest viscera of the abdomen, traveling through multiple organs such as the lungs and the heart, spreading its network to the tongue, throat, intestines, and glands. It’s no wonder that migraine affects the gut and vice versa. In our blog The Vagus Nerve and Gallbladder Connection, we enumerated various ways to stimulate the vagus and help improve overall health. During migraine attacks, some of these measures can also be effective in managing pain.
Estrogen, CCK, serotonin, and dopamine are just some of the identified hormones that are in play in migraine and gallstone development.
Changes in estrogen levels affect cholesterol levels, which then influences biliary secretion and impairs gallbladder motility – two of the many factors that trigger a migraine. Estrogen can also increase nitric oxide synthesis which increases vascular dilatation capacity. It also increases the likelihood of migraine by intensifying inflammation and neuropathic pain by upregulating gene expression and some intracellular signaling.
The main neurotransmitters involved in mood-triggered migraine symptoms are dopamine and serotonin. At the same time, psychological stress impairs gallbladder emptying by increasing the sympathetic tone. Serotonin, in particular, affects intestinal motility, vasoconstriction, and liver repair, thus affecting the gallbladder directly.
Lastly, the pathophysiological mechanisms shared by migraine and gallbladder patients have a lot to do with cholecystokinin (CCK). This is because this hormone has a dilating effect on arterial vessels.
What to do about it?
Migraine is one of the most disabling chronic disorders. So if you have been suffering from it, it is best to see a specialist. However, to manage symptoms similarly experienced by gallbladder patients, here are some of my recommendations.
Fos Formula may help reduce nausea and vomiting
Fos is my number one choice for migraines. Although some migraine patients believe that vomiting helps them feel better, this natural supplement can help you manage the constant queasy feeling during the whole duration of the attack. It can also help you be more mobile and functional while you are having mild to moderate migraine attacks.
Adaptogen for stress, anxiety, and fatigue
Stress triggers migraine and gallbladder attacks. The adaptogenic herbs in Adaptogen may support you with additional energy for work and function while helping you achieve better rest as well.
Bile Salts Booster for toxicity and balance of bile
A research study on bilious migraine recommends bile salt preparations for treatment during attacks. Aside from supporting digestion and absorption, bile salt supplements may also help remediate inflammation, normalize bile flow, and soothe general digestive symptoms. BSB is helpful for those with both migraine and gallbladder issues.
As a licensed acupuncturist, I could also recommend acupuncture treatments. According to a study, a migraine headache can be relieved by regulating cerebral blood flow with acupuncture. A separate 2014 publication on acupuncture also states that the gallbladder meridian points can help relieve migraine pain.
Cámara-Lemarroy, C. R., Rodriguez-Gutierrez, R., Monreal-Robles, R., & Marfil-Rivera, A. (2016). Gastrointestinal disorders associated with migraine: a comprehensive review. World journal of gastroenterology, 22(36), 8149.
Celikbilek A, Celikbilek M, Okur A, Dogan S, Borekci E, Kozan M, Gursoy S. Non-alcoholic fatty liver disease in patients with migraine. Neurol Sci. 2014;35:1573–1578.
Chai, N. C., Shapiro, R. E., & Rapoport, A. M. (2013). Why Does Vomiting Stop a Migraine Attack? Current Pain and Headache Reports, 17(9). doi:10.1007/s11916-013-0362-7
Chen, C. H., Lin, C. L., & Kao, C. H. (2018). Gallbladder stone disease is associated with an increased risk of migraines. Journal of clinical medicine, 7(11), 455.
Hunt, T. (1933). Bilious migraine: Its treatment with bile salt preparations. The Lancet, 222(5736), 279-285.
Kaufman, J., & Levine, I. (1936). Acute gastric dilatation of stomach during attack of migraine. Radiology, 27(3), 301-302.
Lin, X. M., Yao, X., & Di, Z. (2014). Acupuncture at” Siguan” combined with Gallbladder Meridian acupoints for migraine: a randomized controlled trial. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 34(10), 947-950.
Park, K. H., & Yoo, T. W. (2001). Relieving migraine headache by regulating cerebral blood flow with Koryo Hand Therapy. Internet J Altern Med, 1(1).