Share on Pinterest- A study of more than 11,000 adults suggests an association between migraine attacks or severe headaches and acid-suppressing medications like proton pump inhibitors (PPIs).
- An estimated 20% of adults in the U.S. have GERD, which can cause heartburn and acid reflux. These types of drugs are widely used to treat them.
- However, the study does not state that these classes of acid-suppressing medications cause migraine attacks or severe headaches.
People who take antacids may be at greater risk for migraine attacks and severe headaches, a new study using data from more than 11,000 people suggests.
The study, published in Neurology Clinical Practice, [EMBARGOED UNTIL 4PM EST], identified the potential link between proton pump inhibitors (PPIs) like esomeprazole (Nexium) and omeprazole (Prilosec), antacid supplements, and histamine H2-receptor antagonists (H2RAs) like famotidine (Pepcid AC) or cimetidine.
The risk of migraine and severe headache, when compared with people who used no acid-suppression therapy, was 70% higher for those using PPIs, 40% higher for those using H2RAs, and 30% higher for those taking generic antacids.
All drugs examined in the study were prescription only. The data did not look at most over-the-counter medications. Some of them were made available at nonprescription strength during the study, but those were not included.
Acid reflux, a condition in which stomach acids and contents can return to the esophagus, causing irritation, burping, and burning pain, is an aspect of gastroesophageal reflux disease (GERD).
According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 20% of Americans have GERD. Those who are overweight or obese, pregnant, or either smoke or are exposed to secondhand smoke regularly are at the highest risk for GERD, but anyone can develop it.
The study used data from adults in the National Health and Nutrition Examination Survey from the years 1999 to 2004. That survey is a cross-sectional analysis that has been continuously conducted since 1999, but only in those first five years did it contain a question about headaches and migraine attacks.
The study results are associative, so the results do not suggest that antacids are causing migraine episodes or severe headaches.
How are acid reflux and migraine episodes connected?
Dr. Medhat Mikhael, MD, pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, told Healthline that there’s not one known connection between acid reflux and migraine episodes, but all PPI drugs, H2 blockers, and antacids are known to produce side effects like headache, nausea, and fatigue.
“One theory is that it is a problem with the person’s central nervous system or glutamate level, which is one of the pain pathway facilitators, and that might link acid reflux disease and headaches,” Mikhael said. “When acid is overproduced and retained, it causes an inflammatory cascade in the mucosa of the stomach and esophagus.”
He noted that several mechanisms could be behind the triggering of the headache or migraine. The first would be the use of PPI, as the class of drugs can interfere with the absorption of magnesium and other vitamins, which then can trigger headaches and worsen migraine episodes.
“Another theory is the inflammatory cascade reaction that starts at the GI level can trigger the central nervous system to facilitate the release of the calcitonin gene-related peptides that would trigger migraine,” Mikhael added.
Dr. Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, CA, who was also not involved in the study, told Healthline that, in general, high levels of stress could create conditions for GERD or migraine.
“In my clinical practice, I see countless patients with increased life stress causing disabling headaches, and many of these patients’ increased life stress also causes disabling GERD,” Segil said. “It is challenging as a neurologist to explain why any stomach acid level-changing medications would cause a change in a patient’s brain to increase or decrease the frequency of headaches or migraines, but it easy as a neurologist to blame increased life stress on causing patients to have migraine headaches and GERD.”
Why are proton pump inhibitors so associated with migraine episodes?
PPIs are a widely used treatment for GERD that can halt the production of acid and relieve heartburn. They take longer to take effect than H2RAs but tend to have more lasting results, with the intended use being between four and 12 weeks.
Mikhael pointed out that PPIs’ effect on magnesium absorption in the body could have a strong role in the development of migraine episodes or severe headaches, and the fact that this class of drug is so often used could be a possible connection.
Segil again pointed to stress as a significant factor but noted the connection between strong GERD and headaches.
“Proton pump inhibitors are the most potent acid-decreasing medications available and are newer and work better than old H2(histamine) blocking medications and antacids,” Segil said. “Patients with increased life stress would be expected to produce more acid as a stress response, which is what I see in clinical practice. Patients with increased life stress would also be expected to have more frequent headaches,” Segil said.
He added, “I am not surprised to see the treatment group requiring the strongest acid-decreasing family of medications, PPIs, to have the most frequent headaches as a comorbidity. I was surprised to see the placebo group in the weakest of the stomach acid-producing medications to have the highest number of migraines, which was 20% of the placebo group versus 22% of the patients taking antacid supplements.”
Takeaway
A study of more than 11,000 adults suggests an association between migraine attacks or severe headaches and proton pump inhibitors (PPIs) like esomeprazole (Nexium) and omeprazole (Prilosec), antacid supplements, and histamine H2-receptor antagonists (H2RAs) like famotidine (Pepcid AC) or cimetidine.
An estimated 20% of adults in the U.S. have GERD, which can cause heartburn and acid reflux; these drugs are widely used to treat them.
The study does not state that these classes of acid-suppressing medications cause migraine episodes or severe headaches; it’s an associative finding from existing data.
