Helicobacter pylori infection and migraine -: Possible role in aetiology and therapeutic implications

Migraine is the most frequent subtype of primary headache. It affects about 18% of females and 6% of males in the general population. Despite this high frequency the disease is substantially underdiagnosed and undertreated. Several hypotheses have been put forward to explain the pathogenesis of migraine; at present, a derangement of vascular tone is believed to be an essential component for the development of clinical attacks of the disease. Helicobacter pylori infection, the most common cause of gastritis and peptic ulcer, has been recently associated with various primary functional vascular disorders such as primary Raynaud's phenomenon and recurrent spontaneous abortion. The infection causes a persistent activation of the immune system, which results in local and systemic release of a variety of vasoactive substances. Recent evidence suggest that infection with H. pylori may also be associated with migraine. In patients with migraine who are infected with H. pylori, eradication of the bacterium resulted in the complete disappearance of migraine attacks in 20% of individuals and a significant decrease in intensity, duration and frequency of symptoms in the vast majority of the others. Further studies, however, remain necessary to better determine the pathogenetic mechanisms underlying this association. If confirmed, this could represent a novel diagnostic and therapeutical approach for at least a subgroup of migraineurs.