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 hig h frequency the disease is substantially underdiagnosed and undertreated. S everal hypotheses have been put forward to explain the pathogenesis of migr aine; at present, a derangement of vascular tone is believed to be an essen tial component for the development of clinical attacks of the disease. Helicobacter pylori infection, the most common cause of gastritis and pepti c ulcer, has been recently associated with various primary functional vascu lar disorders such as primary Raynaud's phenomenon and recurrent spontaneou s abortion. The infection causes a persistent activation of the immune syst em, 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 wit h H. pylori, eradication of the bacterium resulted in the complete disappea rance of migraine attacks in 20% of individuals and a significant decrease in intensity, duration and frequency of symptoms in the vast majority of th e others. Further studies, however, remain necessary to better determine th e pathogenetic mechanisms underlying this association. If confirmed, this c ould represent a novel diagnostic and therapeutical approach for at least a subgroup of migraineurs.