Case Report: Initial Successful Treatment of Migraine and Irritable Bowel Syndrome With a Low-FODMAP Diet

Abstract

Objective

Migraine and irritable bowel syndrome (IBS) can be difficult-to-treat comorbidities that may be driven by underlying gut–brain axis dysfunction. This report describes utilization of a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet (LFD) in a patient with refractory migraine and co-occurring IBS.

Methods

After unremarkable physical and neurological examinations, a 57-year-old woman with IBS and chronic migraine was started on a LFD under the guidance of a registered dietician. Psychometrically validated surveys administered at baseline and initial follow-up assessed patient-reported outcomes related to migraine and IBS symptoms.

Results

At baseline, the patient reported 80/90 migraine days with average pain of 8/10, a Migraine Disability Assessment (MIDAS) score of 33, and Headache Impact Test-6 (HIT-6) score of 64, the latter 2 scores indicating severe disability. Baseline IBS symptom severity was noted at 9/10. Within 1 week on a LFD, the patient’s IBS symptoms and migraines improved in both frequency and intensity of episodes. After 5 weeks on a LFD elimination, the patient’s clinical improvement continued and she reported significant reduction in migraines, with average pain of 1/10 and IBS severity of 3/10. The patient also improved from severe to minimal levels of disability on validated measures (MIDAS, HIT-6, and IBS Patient Global Impression of Change).

Conclusion

This is the first case report detailing successful initial treatment of migraine and co-occurring IBS utilizing a dietician-guided LFD. There are a number of important reasons for potential improvement in these gut–brain axis disorders which are reviewed as well as an implication for long-term management and food reintroduction. Larger, randomized trials evaluating a LFD in diverse individuals with migraine and co-occurring IBS are warranted to help confirm these results.

Keywords:

• Gut–brain axis
• migraine
• functional abdominal pain
• low-FODMAP diet
• microbiome

Author contributions

RB: conceptualization, supervision, writing, and editing. MS: data collection, analysis, and writing—review and editing. CG, AW, and MV: writing—review and editing. All authors contributed to the article and approved the submitted version.

Disclosure statement

The authors report there are no competing interests to declare.

Ethics statement

This case study was reviewed and approved by the Scripps Health Institutional Review Board (IRB Approval #13-6248). The study was performed according to the principles of the Declaration of Helsinki. The patient provided written informed consent to participate in this study and to publish findings of the case study.

Data availability statement

Raw data to support the study findings were generated at Scripps Center for Integrative Medicine. The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding author.