The study published in Neurology Clinical Practice states that people who take acid-reducing drugs may have a higher risk of migraine and other severe headache than people who do not take these medications.
A total of 25 percent of participants taking proton pump inhibitors had migraines or severe headaches, compared to 19 percent of those who were not taking the drugs. (Creative Commons)
Have you heard of Bollywood’s (in)famous Orry? Orhan Awatramani is a social media influencer known for having, well, famous friends.
His claim to fame lies not in the creative arts but in capturing selfies with various celebrities.
In the world of pharmaceuticals, there exists a medicine that — much like Orry — is famous for its wide use by association. We’re talking about pantoprazole.
As Orry’s social media posts gained traction in the last few months, doctors began to draw a hilarious parallel between him and pantoprazole.
Pantoprazole with almost all medications in prescriptions #MedTwitter pic.twitter.com/ejkq88vS3c
— Dr Deepak Krishnamurthy (@DrDeepakKrishn1) November 3, 2023
Like Orry, pantoprazole remains quite close to other medicines because of its usage. Pantoprazole is a proton pump inhibitor (PPI) commonly prescribed to manage conditions such as gastroesophageal reflux disease.
Basically, it works by reducing stomach acid production and promoting digestive tract healing.
When prescribing any high-dosage medication, doctors also prescribe pantoprazole, commonly sold as Pantop-DSR or PAN-DSR, to keep the stomach acid balanced.
However, a study has now found that PPIs are associated with an increased risk for migraine and other severe headache types.
The study, published in Neurology Clinical Practice, states that people who take acid-reducing drugs might have a higher risk of migraine and other severe headaches than people who do not take these medications.
The acid-reducing drugs include PPIs such as pantoprazole, omeprazole, and esomeprazole, histamine H2-receptor antagonists — or H2 blockers such as cimetidine, ranitidine (Zantac), and famotidine — and antacid supplements like digene.
It should be mentioned that the study does not prove that acid-reducing drugs cause migraine; it only shows an association.
Acid reflux is when the stomach acid flows into the oesophagus, usually after a meal or when lying down. People with acid reflux may experience heartburn and ulcers.
People with frequent acid reflux may develop gastroesophageal reflux disease, or GERD, which can lead to cancer of the oesophagus.
“Given the wide usage of acid-reducing drugs and these potential implications with migraine, these results warrant further investigation,” said study author Margaret Slavin of the University of Maryland in College Park in a statement.
She added that these drugs are often considered to be overprescribed, “and new research has shown other risks tied to long-term use of proton pump inhibitors, such as an increased risk of dementia”.
For the study, researchers looked at data on 11,818 people who provided information on the use of acid-reducing drugs and whether they experienced migraines or severe headaches in the past three months.
Around 25 percent of participants taking PPIs had migraines or severe headaches, compared to 19 percent of those who were not taking the drugs.
Again, 25 percent of those taking H2 blockers had severe headaches, compared to 20 percent of those who were not taking those drugs.
And finally, 22 percent of those taking antacid supplements had severe headaches, compared to 20 percent of those not taking antacids.
When researchers adjusted for other factors that could affect the risk of migraines, such as age, sex and use of caffeine and alcohol, they found that people taking proton pump inhibitors were 70 percent more likely to have migraine than people not taking proton pump inhibitors.
Those taking H2 blockers were 40 percent more likely and those taking antacid supplements were 30 percent more likely.
“It’s important to note that many people do need acid-reducing medications to manage acid reflux or other conditions, and people with migraines or severe headaches who are taking these drugs or supplements should talk with their doctors about whether they should continue,” said Slavin.
Slavin noted that the study looked only at prescription drugs. Some of the drugs became available for over-the-counter (OTC) use at non-prescription strength during the study period, but the use of these OTC drugs was not included in this study.
Other studies have shown that people with gastrointestinal conditions might be more likely to have migraine, but Slavin said that the relationship was unlikely to fully explain the tie between acid-reducing drugs and migraine found in the study.
A limitation of the study is that a small number of people were taking the drugs, especially the H2 blockers.
Hyderabad-based neurologist Dr Sudhir Kumar said it was possible that these observed associations were related to comorbidity between gastrointestinal (GI) conditions and migraine disease and its symptoms.
“Numerous studies have observed associations between the presence of migraine and GI conditions, including Helicobacter pylori infection, irritable bowel syndrome, celiac disease, peptic ulcers, gastroparesis and GERD,” he explained.
“New cases of migraine have been noted after starting PPI/H2RA therapy. Therefore, further studies are needed to establish the cause-effect relationship,” added Kumar.
He suggested that in people who were suffering from migraine or other severe headaches, and were taking PPIs or H2RAs for treating GI symptoms, “it may be worthwhile stopping these medicines to see, if their headaches reduce”, said Kumar.
Anti-acidity medications are linked to a higher incidence of migraine and other headaches
In a recently published study, association of anti-acidity medication use and migraine or other headaches were looked into:
Main findings
🔴Proton pump inhibitors (PPIs) use was associated…— Dr Sudhir Kumar MD DM (@hyderabaddoctor) May 5, 2024
Dr Clifford Segil, one of the authors of the study, said that PPIs’ effect on magnesium absorption in the body could have a strong role in the development of migraine episodes or severe headaches.
He added that the fact that this class of drugs was so often used that it could be a possible connection.
“PPIs are the most potent acid-decreasing medications available and are newer and work better than old H2 (histamine)-blocking medications and antacids,” said Segil.
“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 told Healthline.
(Edited by Arkadev Ghoshal)
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