**Background:** Survey studies have previously reported an increased prevalence of migraine in patients with inflammatory bowel disease (IBD), but the clinical characteristics of migraines in this population were unknown. Both migraine and IBD share inflammatory mechanisms, including abnormalities in TNF-α, IL-1β, IL-6, and IL-8, as well as dysfunction in natural killer cells and endothelial dysfunction. The gut-brain axis, involving bidirectional communication between the gastrointestinal tract and central nervous system, may also play a role. This study aimed to characterize migraines in IBD patients compared to migraine patients without IBD.
**Methods:** This retrospective multicenter study included 675 migraine patients (280 with IBD, 395 without IBD) seen at Mayo Clinic Rochester, Mayo Clinic Arizona, or Mayo Clinic Florida between July 2009 and March 2021. Patients with ICD codes for both migraine and either Crohn's disease (CD) or ulcerative colitis (UC) were selected. Electronic health records were reviewed, and patients confirmed to have both IBD and migraine by Mayo Clinic gastroenterology and neurology providers were included. Data were collected on patient demographics (age, sex, BMI, Charlson Comorbidity Index, smoking), IBD characteristics (type, treatment history, extraintestinal manifestations), and migraine characteristics (type, age at diagnosis, associated symptoms, treatments). Statistical analysis used Wilcoxon rank sum tests, Fisher's exact tests, and multivariable logistic/linear regression models adjusted for sex, Charlson comorbidity index, and smoking.
**Key Results:** Compared to migraine patients without IBD, those with IBD were less often male (8.6% vs 21.3%, P<.001) and had a higher Charlson Comorbidity Index (>2: 24.6% vs 15.7%, P=.003). Among IBD patients, 54.6% had Crohn's disease, 39.3% had ulcerative colitis, and 6.1% had both. In multivariable analysis adjusting for sex, Charlson comorbidity index, and smoking, IBD patients had significantly higher odds of migraine with aura (OR 2.79, 95% CI 1.93-4.04, P<.001) and migraine without aura (OR 2.20, 95% CI 1.51-3.22, P<.001) compared to non-IBD patients. Conversely, IBD patients had lower odds of chronic migraine (OR 0.23, 95% CI 0.16-0.32, P<.001). IBD patients also had a younger age at migraine diagnosis (β: -11.54 years, P<.001), and were less likely to have migraine-associated symptoms such as nausea (OR 0.54, P=.001), vomiting (OR 0.65, P=.016), photophobia (OR 0.57, P=.004), phonophobia (OR 0.34, P<.001), vertigo (OR 0.12, P<.001), ptosis (OR 0.05, P=.003), lacrimation (OR 0.32, P=.010), conjunctival injection (OR 0.19, P=.008), and rhinorrhea (OR 0.28, P=.006). IBD patients were also less likely to receive migraine treatments, including Botox (OR 0.55, P=.003), topiramate (OR 0.25, P<.001), lamotrigine (OR 0.34, P=.037), tricyclic antidepressants (OR 0.23, P<.001), beta blockers (OR 0.31, P<.001), triptans (OR 0.52, P<.001), and NSAIDs (OR 0.31, P<.001). No significant differences in migraine characteristics were found between Crohn's disease and ulcerative colitis patients.
**Clinical Implications:** This study demonstrates that IBD patients have significantly higher odds of migraine with and without aura but lower odds of chronic migraine compared to migraine patients without IBD. The lower rates of chronic migraine and reduced treatment utilization in IBD patients may reflect underdiagnosis or undertreatment of migraine, possibly due to a clinical focus on gastrointestinal symptoms. The increased prevalence of migraine with aura in IBD is similar to that seen in other autoimmune conditions like systemic lupus erythematosus and multiple sclerosis. These findings suggest that clinicians should maintain a high index of suspicion for migraine in IBD patients and consider appropriate treatment. Further prospective studies are needed to clarify migraine prevalence in community-based IBD populations, assess treatment response, and understand the mechanisms linking IBD and migraine, including the role of systemic inflammation and the gut-brain axis.