Dear Editor, we read the article by Ozan et al. about the study of 115 women with tension type headache11. Ozan ZT, Tanik N, Inan LE. Constipation is associated with tension type headache in women. Arq Neuropsiquiatr. 2019 Mar;77(3):161-5. https://doi.org/10.1590/0004-282x20190015
https://doi.org/https://doi.org/10.1590/...
, of whom 48 had constipation manifestation. We have the following comments and concerns. In our study, we reviewed the recent studies of current medicine research, such as the clinical trials and observational articles in Medline in the field of constipation and headache. Studies with non-related subjects were removed and only those with simultaneous evaluation of constipation and headache in title were selected, according to the period from 2000 to July 2017.
In our study, primary assessments showed a strong association between constipation and headache in general22. Madahian A, Togha M, Movahhed M, Ghorbani Z, Dehghan S, Riahi SM, et al. Constipation and headache relationship: a narrative review on Persian medicine texts and modern literature. Indo Am J Pharm. 2017 Nov;4(11):4539-46. https://doi.org/10.5281/zenodo.1068287
https://doi.org/https://doi.org/10.5281/...
(Table 1). Although the Upper GI problem has more incidence in migraine patients33. Fazljou SMB, Togha M, Ghabili K, Alizadeh M, Keshavarz M. In commemorating one thousandth anniversary of the Avicenna's Canon of Medicine: gastric headache, a forgotten clinical entity from the medieval Persia. Acta Med Iran. 2013 May;51(5):279-83., as the result of study conducted by Ozan et al., most papers in our study have indicated a positive relation between headache (especially tension headache) and constipation, despite the study by Le Gal44. Le Gal J, Michel JF, Rinaldi VE, Spiri D, Moretti R, Bettati D, et al. Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. Lancet Gastroenterol Hepatol. 2016 Oct;1(2):114-21. https://doi.org/10.1016/S2468-1253(16)30038-3
https://doi.org/https://doi.org/10.1016/...
, in which a negative relation has been mentioned between migraine headache and constipation and we do not have explanation for this result. But the type of headache in syndrome differentiation model was not applied to our study. Maybe, if it was used, the result of our study could be different.
These results may raise the idea of the existence of a possibly unique diagnostic entity in the second classification of headache disorders, the “Headache of GI Origin”.
It seems that insufficient attention is given to constipation treatment in the process of headache management in modern medical texts. On the other hand, considering constipation is the side effect of some of the medicines used for treating headaches, such as calcium channel blockers and tricyclic antidepressants55. Uher R, Farmer A, Henigsberg N, Rietschel M, Mors O, Maier W, et al. Adverse reactions to antidepressants. Br J Psychiatry. 2009 Sep;195(3):202-10. https://doi.org/10.1192/bjp.bp.108.061960
https://doi.org/https://doi.org/10.1192/...
,66. Russell RP. Side effects of calcium channel blockers. Hypertension. 1988 Mar;11(3 Pt 2):II42. https://doi.org/10.1161/01.HYP.11.3_Pt_2.II42
https://doi.org/https://doi.org/10.1161/...
, paying enough attention to choose appropriate medications with no constipation as a side effect might help in a more efficient treatment of headache. Possibly, the implementation of complementary and alternative medicine (CAM) should be considered.
However, more studies are needed to clarify the relation between headache (tension headache especially) and constipation.
References
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1Ozan ZT, Tanik N, Inan LE. Constipation is associated with tension type headache in women. Arq Neuropsiquiatr. 2019 Mar;77(3):161-5. https://doi.org/10.1590/0004-282x20190015
» https://doi.org/https://doi.org/10.1590/0004-282x20190015 -
2Madahian A, Togha M, Movahhed M, Ghorbani Z, Dehghan S, Riahi SM, et al. Constipation and headache relationship: a narrative review on Persian medicine texts and modern literature. Indo Am J Pharm. 2017 Nov;4(11):4539-46. https://doi.org/10.5281/zenodo.1068287
» https://doi.org/https://doi.org/10.5281/zenodo.1068287 -
3Fazljou SMB, Togha M, Ghabili K, Alizadeh M, Keshavarz M. In commemorating one thousandth anniversary of the Avicenna's Canon of Medicine: gastric headache, a forgotten clinical entity from the medieval Persia. Acta Med Iran. 2013 May;51(5):279-83.
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4Le Gal J, Michel JF, Rinaldi VE, Spiri D, Moretti R, Bettati D, et al. Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. Lancet Gastroenterol Hepatol. 2016 Oct;1(2):114-21. https://doi.org/10.1016/S2468-1253(16)30038-3
» https://doi.org/https://doi.org/10.1016/S2468-1253(16)30038-3 -
5Uher R, Farmer A, Henigsberg N, Rietschel M, Mors O, Maier W, et al. Adverse reactions to antidepressants. Br J Psychiatry. 2009 Sep;195(3):202-10. https://doi.org/10.1192/bjp.bp.108.061960
» https://doi.org/https://doi.org/10.1192/bjp.bp.108.061960 -
6Russell RP. Side effects of calcium channel blockers. Hypertension. 1988 Mar;11(3 Pt 2):II42. https://doi.org/10.1161/01.HYP.11.3_Pt_2.II42
» https://doi.org/https://doi.org/10.1161/01.HYP.11.3_Pt_2.II42
Publication Dates
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Publication in this collection
08 June 2020 -
Date of issue
July 2020
History
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Received
25 Dec 2019 -
Accepted
16 Jan 2020