Interictal Gastric Motility in Patients with Migraine

ABSTRACT

BACKGROUND: Nausea and vomiting are predominant accompanying symptoms of migraine attacks. Although the underlying mechanism is not yet clear, gastric stasis is assumed to be the main factor. However, few studies have used direct methods to establish delayed gastric emptying of migraine patients. We compared interictal gastric motility between migraine patients and normal controls with the aid of gastric scintigraphy. METHODS: The study population comprised patients who had been diagnosed with episodic migraine, according to the International Classification of Headache Disorders, edition II. The entire study population was completely free of gastrointestinal symptoms during the headache-free period. Gastric scintigraphy was performed to determine the time to half emptying (T 1/2) and the percentage of radioactive material remaining in the stomach (%RMR) at 30, 60, 90, and 120 min. RESULTS: Twenty-six migraine patients and 12 normal controls were recruited. The mean T 1/2 did not differ between the two groups (101.8 vs 95.2 min; p=0.432). The %RMR values in the stomach at 30, 60, 90, and 120 min also did not differ significantly between the two groups [87.5% vs 88% (p=0.900), 70.8% vs 71.2% (p=0.950), 54.2% vs 53.3% (p=0.753), and 39.0% vs 37.3% (p=0.583), respectively]. CONCLUSIONS: There is no gastric stasis in patients with episodic migraine during headache-free periods. Our results suggest that the main mechanism underlying the nausea and vomiting in migraine patients is not a gastric stasis in interictal periods, but rather a central process, as a result of changes occurring in the brainstem during acute migraine attacks.