Headache, Gi Symptoms and Intestinal Permeability in Obese Adults

Limited evidence exists concerning the role of gastrointestinal (GI) disorders and intestinal barrier function as contributors to headache occurrence. Therefore, the objective of this study was to explore the relationships between headaches, GI symptoms, and gut barrier function in a largely female sample (n=69) of obese (BMI, 37.6 ± 6.3 kg/m2, mean ± SD) adults, aged 45 ± 11 years. In this cross‐sectional study, 24‐hr urine collected after a sugar challenge was analyzed for sucralose and lactulose concentrations using gas chromatography. 24‐hr sucralose (% oral dose) and the ratio of 24‐hr sucralose/lactulose (24‐hr S/L) were used as markers of intestinal permeability (IP) (median IQR; 24‐hr sucralose, 0.23 [0.32, 1.2] and 24‐hr S/L, 0.23 [0.12, 0.39]). Participants completed a 15‐item headache symptom questionnaire and a clinical GI symptom questionnaire in which each symptom was rated on a 10‐point scale. Thirty‐nine percent of participants reported trouble with headaches (89% were women). Mann Whitney‐U tests were used to assess differences in GI symptom ratings and IP between those with and without headaches. Those with headaches reported greater severity of constipation (p=0.001), diarrhea (p=0.048), irregular bowl habits (p=0.004), infrequent bowel movements (p=0.004), hard stools (p=0.024), and straining with bowel movements (p=0.024). There were no significant differences seen between those with and without headache for 24‐hr sucralose (p=0.069) and 24‐hr S/L (p=0.129), but those with higher IP tended to have more headaches. Logistic regression modeling was performed to assess impact of IP and GI symptoms individually on the likelihood of self‐reported headache. In models containing gender, 24‐hr S/L ratio and individual GI symptoms, significant predictors of headaches were constipation, infrequent bowel movements, and hard stools (e.g., constipation with an odds ratio = 1.4 [95% CI, 1.1–1.8; p=0.007]). In a model containing gender, 24‐hr sucralose, and infrequent bowel movements, both gender and GI symptoms were significant predictors of headache (infrequent bowel movements: odds ratio 1.2 [1.0–1.5], p=0.04; gender: 4.6 [1.1–19.8], p=0.041; and 24‐hr sucralose 2.2 [0.9–5.0], p= 0.06). While preliminary, the relationship between GI symptoms, particularly those associated with constipation and gut barrier function on headache occurrence, should be further explored.