The Role of the Gut-Brain Axis in Migraine Pathophysiology: Emerging Evidence
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Objective: This review explores the emerging role of the gut-brain axis [GBA] in migraine pathophysiology, emphasizing gut microbiota dysbiosis, intestinal permeability, and neuroinflammatory mechanisms. We analyze the interplay between gastrointestinal [GI] health and migraine and assess potential microbiome-targeted therapeutic strategies. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science for studies published in the last two decades on migraine and the GBA. Relevant research on gut microbiota composition, immune modulation, neurotransmitter synthesis, and microbiome-based interventions was reviewed. Clinical and preclinical studies investigating the comorbidity between gastrointestinal disorders and migraine were analyzed. Discussion: The gut microbiota profoundly affects the central nervous system through immune regulation, metabolite production, and neurotransmitter synthesis. Dysbiosis, characterized by an imbalance of commensal bacteria, has been linked to systemic inflammation, increased intestinal permeability, and activation of the trigeminovascular system, all contributing to migraine pathogenesis. Evidence suggests that conditions such as irritable bowel syndrome and inflammatory bowel disease frequently co-occur with migraine, indicating a shared pathophysiological basis. Emerging therapeutic interventions, including probiotics, prebiotics, dietary modifications, and fecal microbiota transplantation, have shown promise in modulating gut health and alleviating migraine symptoms. However, the causality between gut dysbiosis and migraine remains inconclusive, necessitating further longitudinal and interventional studies. Conclusion: The gut-brain axis is critical in migraine pathophysiology, with gut dysbiosis and neuroinflammation emerging as key contributors. Targeting gut microbiota may offer novel, non-invasive therapeutic strategies for migraine management, warranting further research.