April 19 is World IBS Day, intended to raise awareness about IBS, which affects the stomach and intestines, also called the gastrointestinal tract.

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"Irritable bowel syndrome is a common disorder in the United States, affecting approximately 10% of U.S. adults," says Dr. Brian Lacy, a Mayo Clinic gastroenterologist.

The symptoms of IBS are sometimes embarrassing and can affect a person's physical and emotional well-being.

"Patients have symptoms of disordered defecation. And that, in some patients, means constipation, skipping days without a bowel movement, straining of a bowel movement, or diarrhea, loose, watery urgent bowel movements," says Dr. Lacy.

The exact cause of IBS is still unclear, but it's believed to be a combination of factors, including changes in the gut microbiome and food intolerances.

IBS is now categorized as a disorder of gut-brain interaction, which means there is a problem with how the gut and the brain communicate with each other.

"That stress, which can affect the brain, then sends signals to the gut, changing gut function and worsening your IBS symptoms," says Dr. Lacy.

There is no cure for IBS, but symptoms can be managed. Try eating smaller, more frequent meals, and exercising regularly. Deep breathing and yoga are also helpful to reduce stress.

When to see a doctor for irritable bowel syndrome

See your healthcare professional if you have significant changes in bowel habits. Some severe symptoms include:

• Bloody stools.
• Unintended weight loss.
• Unexplained vomiting.

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LA CROSSE, Wis. — Receiving a medical diagnosis can be difficult. You may only hear parts of the conversation as you start to think about what treatment will be needed and how this will affect your daily life. It can be especially challenging when different diseases have names that sound similar, such as inflammatory bowel disease, or IBD, and irritable bowel syndrome, or IBS. Daisy Batista, M.D., a gastroenterologist at Mayo Clinic Health System-La Crosse, explains the difference between the two diseases. 

Inflammatory bowel disease is a group of autoimmune diseases that include ulcerative colitis and Crohn's disease. In inflammatory bowel disease, the immune system attacks the bowel and causes inflammation, Dr. Batista says. 

“Inflammatory bowel disease may be triggered by a combination of a genetic predisposition and an illness or exposure to something in your environment that causes the immune system to attack the bowel and create inflammation,” Dr. Batista says.” There are two peak times for diagnosis in adults: people in their early 20s to 30s and people in their 50s and 60s.” 

Common symptoms of inflammatory bowel disease are: 

• Diarrhea 
• Rectal bleeding 
• Bloating 
• Occasional constipation 
• Gas 
• Urgent bowel movements
• Cramping abdominal pain 

Symptoms of inflammatory bowel disease may be experienced regularly and can significantly affect quality of life, Dr. Batista says. Treatment typically involves using immunosuppressive drugs to help the immune system avoid attacking the bowel. Changes in diet can decrease inflammation. 

People who have symptoms should tell their health care provider, Dr. Batista says, adding that there is no need to feel embarrassed.  

Irritable bowel syndrome is a bowel disorder that causes digestive organs to look normal but not function normally. For most people, irritable bowel syndrome is a chronic condition that can fluctuate from mild to severe symptoms, and sometimes symptoms disappear, Dr. Batista says. 

While irritable bowel syndrome can affect almost anyone, there are risk factors. Those who are young, female, have a family history of the disease, or have a history of anxiety or depression are at higher risk, Dr. Batista says. 

While irritable bowel syndrome cannot be cured, it does not permanently harm the intestines, she says.  

“Irritable bowel syndrome may affect your quality of life, so it is important to learn about your symptoms and what you can do to control them,” Dr. Batista says. 

The current understanding of irritable bowel syndrome suggests hypersensitivity in the gut causes the symptoms. This affects how the body perceives stimuli related to bowel function. Treatment focuses on relieving symptoms so people with the disease can live as normally as possible, Dr. Batista says. 

In most cases, mild symptoms of irritable bowel syndrome can be controlled by learning to manage stress and making healthy changes to diet and lifestyle. This includes exercising regularly, drinking plenty of fluids and getting enough sleep. Your health care team may prescribe other specific dietary changes, medications and supplementary treatments. 

“While living with irritable bowel syndrome can present daily challenges, your health care team is available to help,” Dr. Batista says. “They can guide you through an appropriate evaluation of your symptoms and provide treatments to help you optimize your quality of life.” 

Journalists: Dr. Batista is available for interviews in Spanish and English.  

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About Mayo Clinic Health System 
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DEAR MAYO CLINIC: I have been diagnosed with a mild case of irritable bowel syndrome, and I talked to my doctor about managing my symptoms without medication. I am interested in trying to focus more on diet to control my condition. Are there certain things that I should be mindful of, or will medication be the only way for me to manage my symptoms?

ANSWER: Although medications can be used to treat irritable bowel syndrome, not everyone who has this disorder will require or need medication. For some people — particularly those with mild symptoms — lifestyle adjustments, such as diet modification, stress management and regular exercise, are enough to control symptoms. For moderate to severe symptoms, a combination of lifestyle changes and medication may be necessary to manage irritable bowel syndrome.

Irritable bowel syndrome affects the large and sometimes small intestines. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract. When you have irritable bowel syndrome, those contractions may be stronger or more noticeable than normal. That can lead to abdominal cramping and pain as food, gas or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation. Other symptoms can include gas and bloating.

In those diagnosed with irritable bowel syndrome, it’s important to be aware that some abdominal issues are not associated with this disorder and could signal another underlying problem. In particular, these symptoms require prompt medical attention: blood in the stool, unexplained or rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting, significant pain with or difficulty swallowing, or an abdominal mass or lump.

Irritable bowel syndrome is a chronic condition, and symptoms tend to come and go over time. There’s no cure, but symptoms often can be eased with diet, lifestyle and stress management.

More than 60% of people who have irritable bowel syndrome say their symptoms are connected to food in some way. However, because symptoms vary significantly from one person to another, it’s difficult to give specific dietary advice that works for everyone with this disorder.

In general, though, eating high-fiber foods and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. Avoid foods and beverages that contribute to gas and bloating, including carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli and cauliflower. Reducing or eliminating gluten may ease diarrhea that’s related to irritable bowel syndrome.

Research has shown that certain carbohydrates, known as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP), can lead to abdominal pain, bloating and gas in people with irritable bowel syndrome. These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese and yogurt; and artificial sweeteners.

Following a diet low in FODMAPs can ease symptoms of irritable bowel syndrome. But because so many foods contain these compounds, it can be difficult for patients to create such a diet on their own. Finding a dietitian familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended dietary changes, and develop an individualized food plan to ease symptoms.

Stress also affects irritable bowel syndrome, with episodes of higher stress associated with an increase in symptoms. Using stress reduction techniques and participating in activities that relieve stress, such as yoga and meditation, may decrease stress-related flare-ups. Working with a therapist or counselor experienced in stress management, mindfulness and behavior modification also may help those with irritable bowel syndrome better control stress and ease symptoms.

Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines and promotes overall wellness.

If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care professional about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome. — Dr. Robert Kraichely, Gastroenterology, Mayo Clinic, Rochester, Minnesota

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LONDON — Special foods are among the pleasures of holiday celebrations. On the negative side, for people with digestive diseases or those who overindulge, holiday feasting can quickly produce the food version of a hangover. James East, M.D., a gastroenterologist at Mayo Clinic Healthcare in London, explains why this sometimes happens and how we can enjoy the menu while also making holidays happy for our digestive systems.

Why indigestion and heartburn happen

Indigestion, or an upset stomach, can be caused by overeating; eating fatty, greasy or spicy foods; consuming too much caffeine, chocolate, alcohol or carbonated beverages; smoking; anxiety and certain medications, such as some antibiotics, pain relievers and iron supplements.

It also can be a symptom of an underlying digestive disease, such as pancreatitis, celiac disease, irritable bowel syndrome or gastritis.

While indigestion involves discomfort in the upper abdomen, heartburn is a pain in the chest behind the breastbone.

“Heartburn is caused by acidic stomach content moving into the oesophagus, or gullet, which is much less resistant to acid,” Dr. East says. “This results in irritation and damage to the lining of the oesophagus, literally a burn, that causes pain.”

Like indigestion, heartburn can be caused by large, fatty, greasy or spicy meals, chocolate, alcohol, carbonated beverages and caffeine. But the list of foods linked to heartburn is longer: Onions, citrus fruits, tomato-based foods and peppermint are among the additional culprits.

Chronic heartburn is known as gastroesophageal reflux disease.

“The ring of muscle at the bottom of the gullet usually squeezes tightly except when we swallow food; however it can get weaker with age, or disrupted if patients develop a hiatal hernia,” Dr. East explains. “Conditions that slow gastric emptying, such as gastroparesis, or increase pressure within the abdomen, such as obesity or pregnancy, also can make reflux more likely.”

Other ways food can irritate the digestive system

Holiday foods that seem benign can pose hazards for those with digestive diseases, Dr. East says.

For example, dairy products, alcohol, caffeine and large meals can make people with inflammatory bowel disease feel worse.

Sticky foods such as peanut butter and caramel, thin liquids such as coffee and juice, and alcohol, caffeine or large meals can prove difficult for people with swallowing disorders, known as dysphagia. A menu lacking fiber such as those heavy in processed foods, meat, dairy products can make chronic constipation worse.

Avoiding raw fruits and vegetables, carbonated drinks, alcohol and large meals is recommended for people with gastroparesis, a motility or food movement disease that slows or stops the stomach’s ability to move food through the digestive tract.

Preventing digestive discomfort

“Lower-fat food options are helpful for many digestive diseases, as are nonalcoholic beverages,” Dr. East says. “Decaffeinated beverages are helpful for some patients, as is a reasonable level of portion control so that guests don’t feel pressured into overeating.”

Taking antacids or even acid suppressing drugs, such as omeprazole, preemptively can reduce symptoms but should not be an excuse to overindulge, he says: Although these medications reduce acid, they do not help with the volume or regurgitation component of reflux,  so overeating can still lead to uncomfortable symptoms.

“Moderation in both food and alcohol and enjoying the range of dishes available from your host is a better strategy than additional medication,” Dr. East says.

Taking steps to cope with anxiety and stress is also important.

“Anxiety and stress play a major role in gastroenterological symptoms, especially irritable bowel syndrome, which is a disorder of the brain-gut axis,” Dr. East says. “Our brains and gut have very dense neural connections and being stressed or anxious can lead to gut nerves being oversensitive where they fire off pain signals, such as cramping or bloating, at much lower levels of stimulation than would normal be required, known as visceral hypersensitivity.”

Techniques to reduce stress and anxiety such as mindfulness, cognitive behavioral therapy or hypnotherapy can help, he says. Physical positioning also plays a role.

“Classical triggers for reflux include a large fatty meal late in the day, with alcohol, and then lying down flat,” Dr. East says. “To avoid heartburn, we should do the opposite and have our main meal in the middle of the day, not eat within three hours of bedtime, avoid fatty foods, moderate alcohol intake and consider raising the head of the bed.”

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic’s Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center.

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• Sharon Theimer, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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Mayo Clinic researchers published a comprehensive analysis of the gut virome in Gastroenterology, showing how disease, diet and genomics interact with the gut virome in irritable bowel syndrome. This common disorder affects the intestine and manifests as abdominal pain associated with constipation, diarrhea or both.

The gut virome is one component of the microbiome (bacteria, fungi, viruses). It includes viruses that specifically attack bacteria (bacteriophages/phages) or those affecting humans (eukaryotic viruses. e.g., norovirus). Hence the gut virome can cause symptoms by direct effects on the gut or by shaping the composition and function of the gut bacteria, which then alter gut function. Purna Kashyap, M.B.B.S., the Bernard and Edith Waterman Co-Director for the Microbiome Program in Mayo Clinic's Center for Individualized Medicine Microbiome Program explains the virome's role is especially relevant in conditions where the microbiome is considered an essential factor in the development of disease and irritable bowel syndrome is one such condition.

Researchers take a step further by analyzing the virome

"Most present-day virome studies use metagenomic DNA sequencing as a starting point," says Dr. Kashyap. "However, this would miss a significant number of human gut pathogenic viruses (e.g., rotavirus, Norwalk virus, picornaviruses) that have RNA genomes."

Researchers analyzed the virome after enriching viral-like particles in the sample and converting RNA genomes to DNA. They combined this with multi-omics (a biological approach using multiple omics technologies), clinical and dietary data to understand how the virome fits within the context of health and disease.

Gut virome is stable and is associated with changes in gene expression in the gut

With data collected from healthy participants and different subsets of patients with irritable bowel syndrome, the researchers found that the gut virome was relatively stable over the 6-month study period. They also found the virome links with the expression of specific genes (the process of turning on a gene to produce RNA and eventually protein) linked to immune function in the intestine. Dr. Kashyap adds many plant genomes and an increasing number of known phages use RNA as their core genetic construct.

Gut virome in irritable bowel syndrome

Gut bacteria and their metabolites have been found to regulate many of the mechanisms underlying irritable bowel syndrome. Still, there is little known about the gut virome, especially in different subsets of the condition, with symptoms of either constipation or diarrhea. In multi-omics analysis, researchers found a correlation between bacteriophages and gut bacterial composition and function. They also identified irritable bowel syndrome subset-specific changes in the bacteriophage population.

"This is important as bacteriophages may be responsible in part for shaping the gut bacterial population in these disease subsets and would also be important when considering probiotic therapy," says Dr. Kashyap. "If patients have bacteriophage that can kill the probiotic bacteria —  it may not be very effective — do we need to tailor probiotics to match the bacteriophage population?"

Norovirus transmission was observed in healthy participants, independent of genetics. Dr. Kashyap says he was surprised to find norovirus almost exclusively in healthy asymptomatic participants rather than those with irritable bowel syndrome, even though asymptomatic norovirus carriage can be as high as 30% based on individual diet and lifestyle.

Dr. Kashyap explains a possible reason why it was not as prevalent in patients with irritable bowel syndrome is that patients with gastrointestinal symptoms are more likely to have had stool testing for viral and bacterial pathogens and treated if norovirus was detected. The finding of norovirus matched the time when it was found to be in circulation, highlighting the technical capability of the researcher's analysis pipeline.

Plant-specific viruses covary with irritable bowel syndrome and, to a small extent, with diet. The researchers found connections between plant viruses and diet, consistent with diet as a source of viruses. Significant correlations were found between each group of plant viruses and food groups, but these correlations were more prominent in patients with constipation-predominant irritable bowel syndrome. Researchers note that this may reflect specific dietary intake or an altered microbial ecosystem, given the longer transit time in the gut.

"Our study considered all genomic virus types to provide a comprehensive analysis of the virome, adding to the accumulating data on gut virome changes in irritable bowel syndrome and the temporal stability of the virome," says Dr. Kashyap.

Funding

This work was a joint effort between the University of Minnesota, Washington University at St. Louis and Mayo Clinic. This work was supported by National Institutes of Health grant DK114007 (Purna Kashyap), Mayo Clinic Center for Individualized Medicine, Rochester, Minn. (Purna Kashyap), Minnesota Partnership for Biotechnology and Medical Genomics (Purna Kashyap and Dan Knights.); and National Institutes of Health grant 5RC2DK116713-02 (Scott Handley).

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Mayo Clinic researchers have found new evidence linking the millions of bacteria residing in our digestive systems, known as the microbiome, to a network of factors that drive irritable bowel syndrome (IBS). The findings, published in the Sept. 10, 2020 issue of Cell, raise the possibility of targeting the newly discovered microbial pathways to improve debilitating symptoms associated with IBS, including bloating, cramps, diarrhea and constipation.

Irritable bowel syndrome (IBS) is a globally prevalent disorder affecting up to 20% of the U.S. population, predominantly females, and costing nearly $30 billion annually in health care expenses. Like many other diseases, the gut microbiome has been suggested to play a role in IBS, based on studies which show the microbiome in patients with IBS may be different. 

Characterized by abdominal pain and changes in stool form or frequency, IBS symptoms are known to be triggered by diet, host genes and environment, which are also known to modulate the human gut microbiome. But until now, a lack of an integrated systems approach has made it difficult to understand where the microbiome fits in the overall picture. This is also why there has been little success in treating IBS patients with probiotics.

“By integrating multiple layers of data from patients and gut microbiota, we identified purine metabolism as a novel  metabolic pathway in IBS with contribution from both host and gut microbiota,” says author Purna Kashyap, M.B.B.S., the Bernard and Edith Waterman co-director of the Center for Individualized Medicine Microbiome Program at Mayo Clinic.

“The study significantly advances our understanding of how the microbiome plays a role in IBS while at the same time identifying several microbial pathways that can be targeted to lessen abdominal pain or symptoms associated with specific IBS subsets, like diarrhea or constipation.” - Dr. Kashyap

“The fact that this pathway was not previously discovered in animal studies highlights the importance of doing multi-omics studies in humans — including investigating the microbial metagenome, metabolome, host transcriptome, methylome, patient symptoms, diet and gastrointestinal physiology — to identify potential disease mechanisms that may depend on human-specific responses,” Dr. Kashyap says.

Using multiple data layers, individualized approach

For the study, Dr. Kashyap and his team integrated multiple layers of patient data over a six-month period, including symptoms, diet, gastrointestinal function and changes in gene expression in the gastrointestinal (GI) tract. They collected patient stool samples to measure gut bacteria and compounds produced by them, and conducted large intestine exams to obtain colonic biopsies longitudinally — repeated observations of the same variables.

“Then we integrated all of this data into a meaningful format to understand the biological relationships in this highly dynamic ecosystem,” Kashyap says.

Dr. Kashyap explains, one way to approach large data sets is to say, “A is always found when B is present but not when C is present. So A and B must be related.”

However, when his team analyzes large data sets, many of these correlations may not be biologically meaningful. So, his team tried a different approach.

For instance, if a microbe A and compound B were correlated, they went on to check if that microbe A can truly produce or consume the compound B.  Then, to ensure these compounds were biologically relevant, they looked at gene expression and functional changes in the colon. As a result, they focused on a small number of compounds where they found a relevant biological function. These can now be targeted to treat IBS.

In one major finding, the researchers were able to determine how molecules produced by bacteria affect GI function, and how changes in production of specific molecules by bacteria can drive worsening symptoms. 

“Our study highlights the importance of longitudinal sampling and integrating complementary multi-omics data to identify functional mechanisms that can serve as therapeutic targets in a comprehensive treatment strategy for chronic GI diseases,” Dr. Kashyap

Interestingly, these were not the same for every patient, suggesting that an individualized approach is needed.

“Some examples include bacterial production of the compound tryptamine, which increases secretion of water in the intestines, causing diarrhea,” Dr. Kashyap explains. “Also, a lack of bacterial conversion of primary to secondary bile acids; primary bile acids can irritate the colon and cause diarrhea as well."

The researchers also found that short chain fatty acids, which normally increase movement of stool across the intestines, were decreased in patients with constipation.

Applying multi-omics view of microbiome’s impact

Dr. Kashyap says a majority of previous studies faced hurdles in linking the microbiome to IBS because data was investigated with a single snapshot — just one point in time.

“But neither IBS nor the microbiome are static,” Dr. Kashyap explains. “Patients’ symptoms can wax and wane and the microbiota composition and function can change over time. Longitudinal sampling allows us to get over the heterogeneity introduced by these changes.”

That’s why Dr. Kashyap and his team designed the study to get a multi-omics view with repeated observations of the gut microbiome in the context of IBS.

“The study significantly advances our understanding of how the microbiome plays a role in IBS while at the same time identifying several microbial pathways that can be targeted to lessen abdominal pain or symptoms associated with specific IBS subsets, like diarrhea or constipation,” he says. 

The team now intends to follow up on their findings to target some of the pathways they have identified with a goal of developing the next-generation of probiotics that target specific mechanisms responsible for patient symptoms.  But the impact of this study is not limited to IBS.

“Our study highlights the importance of longitudinal sampling and integrating complementary multi-omics data to identify functional mechanisms that can serve as therapeutic targets in a comprehensive treatment strategy for chronic GI diseases,” Dr. Kashyap says.

The research was also led by co-author Dan Knights, Ph.D., associate professor with the Biotechnology Institute, Department of Computer Science and Engineering at the University of Minnesota, Minneapolis, Minn.

This work was supported by NIH DK114007 (P.C.K.), the Center for Individualized Medicine, Mayo Clinic, Rochester, MN (P.C.K.), and Minnesota Partnership for Biotechnology and Medical Genomics (P.C.K. and D.K.). Additional funding was provided by the STRATiGRAD PhD training program of Imperial College London and Societe des Produits Nestle (Y.Y.).

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Arthur Beyder, M.D., Ph.D., runs a research laboratory at Mayo Clinic focused on examining the molecular mechanisms of gastrointestinal function and dysfunction in diseases such as irritable bowel syndrome. His goal is to discover better ways to diagnose and treat these conditions, including individualized treatment options.

"These conditions affect 10-15 percent of Americans, and it's amazing how much we still have to learn about the molecular mechanisms of these diseases," says Dr. Beyder. 

Dr. Beyder believes that the "high risk, high reward" approach may be the best way to go when it comes to tackling this problem. He recently received a 2019 NIH Director’s New Innovator Award,  honoring his work as an "exceptionally creative early career investigator," an award given to support the researchers who pursue high risk, high reward research.

What is high-risk, high-reward research?

High-risk, high-reward research is innovative research that pushes the boundaries of science and has the potential for broad impact.

"Incremental questions lead to incremental progress," says Dr. Beyder. "High-risk questions allow us to break away to view the problems in a completely different light or from a different perspective. These approaches allow us to make big leaps forward and often bring true transformation in science and medicine."

"At Mayo Clinic, we're focused on turning scientific discoveries into treatments quickly, so patients can benefit as soon as possible," says Gianrico Farrugia, M.D., president and CEO of Mayo Clinic, and one of Dr. Beyder's mentors. "To achieve that, we need to think big, move fast, and take well-calculated risks. Researchers like Dr. Beyder are helping advance a new mindset that will accelerate innovation."

Read the rest of the article on Advancing the Science.
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Other Mayo Clinic medical research websites:

• Research at Mayo Clinic
• Discovery’s Edge
• Advancing the Science
• Forefront
• Mayo Clinic Center for Individualized Medicine
• Center for Regenerative Medicine
• Center for the Science of Health Care Delivery

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On the next Mayo Clinic Radio program, Dr. Robert Kraichely, a Mayo Clinic gastroenterologist, will discuss treatment for IBS. Also on the program, Dr. Jennifer Vande Voort, a Mayo Clinic psychiatrist, will discuss esketamine nasal spray — a fast-acting treatment for depression that recently was approved by the Food and Drug Administration. And Dr. Nipunie Rajapakse, a Mayo Clinic infectious diseases specialist, will share what you need to know about childhood vaccines.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

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In young children, several syndromes that cause gastrointestinal symptoms are also associated with migraines. These syndromes can cause episodes of vomiting (cyclical vomiting), abdominal pain (abdominal migraine) and dizziness (benign paroxysmal vertigo). They're often called childhood periodic syndromes or episodic syndromes that may be associated with migraine.

Although these syndromes usually aren't accompanied by head pain, they're considered a form of migraine. In many cases, childhood periodic syndromes evolve into migraines later in life.

Research has shown that people who regularly experience gastrointestinal symptoms — such as reflux, diarrhea, constipation and nausea — have a higher prevalence of headaches than do those who don't have gastrointestinal symptoms.

These studies suggest that people who get frequent headaches may be predisposed to gastrointestinal problems. Digestive conditions, such as irritable bowel syndrome and celiac disease, also may be linked to migraines. Treating these digestive conditions may help reduce the frequency and severity of migraines. However, more research is needed to understand these connections.

If you experience nausea, vomiting or diarrhea with your headaches, talk to your health care provider about treatment options. Treating the headache usually relieves gastrointestinal symptoms.

However, in some cases, your health care provider may recommend an anti-nausea or anti-diarrheal medication or a nonoral pain medication. Keep in mind that some pain medications, such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), may increase nausea.

This article is written by Dr. Jerry W. Swanson and Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

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