Acid Suppression & Severe Headache

Results of a cross-sectional analysis were recently published in Neurology, Clinical Practice, which suggest an association between the use of acid-suppressing medications and migraine headaches. Self-reported data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), which included nearly 12,000 adults, found that any type of acid-suppression therapy was associated with a higher risk for migraine and severe headaches. Specifically, proton pump inhibitors (PPIs) were associated with a 70% higher risk, while histamine type 2 receptor antagonists (H2RAs) and generic antacids were associated with a 40% and 30% higher risk, respectively. A 24-hour diet recall was used to estimate magnesium intake, which was associated with H2RA use.

Given the cross-sectional nature of this study, causality cannot be determined. However, there are some plausible mechanisms for this association, and it is not the first to suggest a link between acid suppression and headaches, particularly with longer-term use. For example, in a large prospective general population cohort, PPI and H2RAs have previously been associated with a doubling in the risk for hypomagnesemia, a fairly late-stage marker for depleted magnesium levels. Additionally, the risk was tripled among longer-term PPI users, and over 7-fold higher among people also taking a loop diuretic (which may compromise magnesium reabsorption). A previous analysis of the 1994-2004 NHANES cohort found that most people in the U.S. are not meeting even basic recommended intakes for magnesium, and that doing so through a combination of diet and supplements was associated with approximately a 20% lower risk of migraine.