Migraines and Gastroparesis: A Histologic, Physiologic, and Clinical Analysis with Temporary Gastric Stimulation

Abstract

Purpose: A relationship between migraines and gastroparesis (GP) has been observed but the pathophysiology and mechanisms are unknown. We compared histologic, electrophysiologic, and clinical outcomes to define any differences between drug refractory GP patients with Migraines and those with No Migraines, undergoing temporary gastric electrical stimulation (GES). Methods: We reviewed data on 80 consecutive patients: 28 Migraine (35%) and 52 No Migraine (65%); 13 males, 67 female, mean age of 43 (26 diabetic, 53 idiopathic, 1 post surgical) undergoing temporary and latter permanent GES for drug refractory GP. Symptoms evaluated included vomiting, nausea, epigastric pain, bloating/distension, and anorexia/early satiety (scored from 0 to 4 for each) and total symptom score (TSS) with a max of 20. Vomiting score and TSS were measured before treatment and during treatment with temporary GES. Four hour Gastric Emptying Time (GET) % retention before and during treatment along with cutaneous, mucosal, and serosal EGG was also measured, reported as frequency and amplitude. Outcomes were reported as change in vomiting scores, change in TSS, and change in 4 hour GET. A full thickness gastric biopsy was performed at the time of subsequent permanent GES placement and was analyzed for S-100 (neuronal) and CD-117 (Cajal) cells. Two tailed unpaired t tests were performed for each category. Results: Vomiting and TSS scores at baseline were higher among patients with migraines. Also the migraine patients had more improvement in vomiting scores with temporary GES. Patients with migraines had more normal gastric emptying scores at baseline and a greater change after temporary GES. The amplitude of mucosal EGG in patients with Migraines was higher than in the No Migraine group. There was no statistical difference between the Migraine group and the No Migraine group in outer or inner S-100 cells (neuronal) outer or inner CD-117 (Cajal) cells, cutaneous EGG frequency and amplitude, or serosal EGG frequency and amplitude. (See Table).Table: Table. Comparison of Migraine vs. No MigraineConclusion: GP Patients with Migraines have different baseline physiology as well as better symptom improvement from temporary GES compared with No Migraine GP patients. Disclosure: Dr Thomas Abell-Licensor, Consultant, Investigator, Medtronic, Inc.