Acid Reflux Drugs Linked to Higher Migraine Risk, Study Finds

Some drugs used to treat acid reflux may also increase the risk of migraines and other severe headaches, a new study finds. The drugs include prescription proton pump inhibitors – such as omeprazole – as well as H2 blockers and antacid supplements.

The research is published in Neurology Clinical Practice.

Investigating possible links to migraine

Acid reflux is caused by acid flowing from the stomach up into the esophagus. It can be triggered after a meal or when lying down. Stomach acid can damage tissues, causing heartburn and ulcers, and can potentially progress to gastric acid reflux disease (GERD) which can increase the risk of esophageal cancer.

Acid reflux is very common and can be treated with a variety of drugs. However, many of these are considered to be over-prescribed, and some – such as proton pump inhibitors (PPIs) – have even been linked to dementia.

There is also some evidence of a potential link between anti-acid drugs and increased risks of migraine, said the new study’s senior author, Dr. Margaret Slavin, an associate professor at the University of Maryland Department of Agriculture and Natural Resources.

“We’d heard a few anecdotal reports of people saying their migraines improved when they stopped taking an acid-suppressing medication,” explained Slavin, speaking to Technology Networks. “ When we looked in the literature to see what evidence existed, there were a few publications reporting signs that PPIs might be associated with migraine or severe headache.”

Assessing migraine risks associated with acid-suppressing drugs

In the new study, the researchers analyzed data from over 11,000 people gathered from the National Health and Nutrition Evaluation Survey (NHANES). The participants had been prescribed drugs to treat acid reflux (either prescription antacids, H2 antagonists or PPIs), and also self-reported having severe headaches or migraine in the previous three months.

The results that these acid-suppressing drugs were associated with an increased risk of migraine or severe headaches – 25% of participants taking PPIs reported these symptoms compared to 19% of those not on PPIs.

“The risk was highest with PPIs as compared to people who did not use any of these acid-suppressing drugs, but we also observed some elevated risk in other the classes of acid suppressors that were studied, H2 receptor antagonists and common antacids,” Slavin added.

For H2 antagonists, 25% reported severe headaches compared to 20% of those not on those drugs, as well as 22% of people taking antacids compared to 20% of people who did not use antacids.

However, several factors affect a person’s risk of migraines, such as age, sex, caffeine and alcohol. The researchers adjusted their analysis for these factors and found that people taking PPIs were 70% more likely to have migraine compared to those not taking PPIs, while people taking H2 antagonists and antacids were 40% and 30% more likely to have migraine, respectively.

“There are a number of possible mechanisms which might explain this. Acid suppression therapies have broad effects on our digestion and absorption, which could influence how and to what extent other drugs and nutrients from our foods are absorbed.”

Other factors may also be at play, according to Slavin – some evidence suggests people with migraine are affected by gastrointestinal conditions at higher rates, and some people taking PPIs may also be more genetically susceptible.

Further analysis and ironing out limitations

Importantly, the drugs investigated in this study were prescription-only, and they did not include over-the-counter drugs in the analysis – something that can be explored in additional studies.

“We can only use this data to observe if these two factors are associated – it cannot determine what is causing the association,” Slavin adds. “We also could not study what happens when someone with existing migraine begins to take these medications.”

“We’re looking toward a prospective analysis, which uses data to follow people over time and would give greater ability to explore what may be causing the associations observed here.  We’re also studying nutrition and dietary intake in relation to migraine as a related topic.”

Dr. Margaret Slavin was speaking to Dr. Sarah Whelan, Science Writer for Technology Networks.

Reference: Slavin M, Frankenfeld CL, Guirguis AB, Seng EK. Use of acid-suppression therapy and odds of migraine and severe headache in the National Health and Nutrition Examination Survey. Neurol. Clin. Pract. 2024;14(3):e200302. doi: 10.1212/CPJ.0000000000200302