Constipation and I go way back. We have been lifelong companions though not friends. I can confidently say that after decades, I now have the upper-hand and rarely fall into the “strained” relationship. OK, pardon the pun. As a registered dietitian, I am sure that my professional and personal experience can help you with migraine and constipation.
In our coaching practice as well as in social media we often see people inquiring about the link between constipation and migraine. This gastrointestinal (GI) upset is sometimes referenced as part of Irritable Bowel Syndrome – Constipation (IBS-C). According to a comprehensive article in the Annals of Gastroenterology, 10-20% of the adult Western countries have IBS symptoms . From that same article, it was estimated that IBS-C has an estimated prevalence of 35% of those with IBS.
It turns out that yes, there is a connection between migraine and constipation but once again I am frustrated by the lack of adult studies on the topic. Might this simply be correlation and co-existing conditions or might migraine be causing constipation?
Women are 3 times more likely to have constipation than men. And, as you probably already know, women have a much higher prevalence of migraine than men. But, maybe there is a causative link or behavior that leads to more frequent attacks of both. Might constipation cause migraine attacks? Maybe it’s part of prodrome (the first phase of migraine, before the full attack). You can read more about prodrome in this article from the American Migraine Foundation.
I’m not sure we will get to a universal truth about this last question as we are all so different, but by the end of this article, you should get a better sense of what might be behind your gastrointenstinal strife. My goal is to help you figure out how to find relief from current constipation as well as keep ahead of it so you don’t find yourself searching the internet about this topic again.
What constipation is and what it is not.
Constipation is defined as difficult or strained passing of stool or hard stool.
It has less to do with frequency. For some people it is “normal” for them to move their bowels twice per day, while others my skip a day or 2 during the week. In general, a doctor would consider you constipated if you had less than 3 bowel movements per week. Additionally, stool that is very hard or lumpy or stool that is broken into pellets or balls is a sign of constipation. If passing stool is causing a lot of strain, is painful or feels incomplete, that is considered constipation.
6 Reasons why migraine and constipation are a problem for so many of us.
There are a number of theories. It’s doubtful that any single theory is true for most people. It’s likely a combination of the following factors:
1- The bi-directional gut- brain axis
The research about the gut-brain connection being part of a variety of medical conditions is very exciting. I’m sure that for many of us, we think the research is way overdo. It seems obvious that there is a connection between our brain and GI tract as we are living proof. For instance, how strange is it that anti-nausea medications like Zofran and Compazine are also migraine medications when nausea isn’t even present. Or, for some people, a painful migraine attack comes to an end with vomiting or having a bowel movement.
Serotonin, migraine and constipation
Serotonin is a critically important neurotransmitter for our mental, emotional and physical health. It is considered one of the “happy hormones” and is primarily made in the GI tract.
For many people with migraine, abnormal activity of serotonin is thought to play a significant role in the cascade of biochemical changes that result in an attack. Some important medications we take for migraine impact our serotonin levels.
It turns out that serotonin also has important roles in the GI tract. Serotonin effects motility of the bowel, secretions into the bowel and the way we perceive sensations in the bowel. Perhaps the link between migraine and constipation has to do with altered metabolism of this important neurotransmitter.
The connection between migraine and stress is well-known. Stress is often sited as the most significant trigger of migraine attacks. Did you know that stress is also associated with constipation? Stress can alter the hormones that specifically effect motility in the gut and slow things down.
3- Medications and Supplements
Many of us are on medications for migraine or other medical conditions. Some of the more commonly prescribed medications with constipation as a side effect are anti-depressants (both SSRIs and tricyclic antidepressants), blood pressure medications like propranolol, and anti-nausea medications like Zofran. Some people are prescribed opioids occasionally and those can certainly get us stopped-up quickly. Over-the-counter medications that are associated with constipation are antihistamines and antacids like Tums.
There have been many more queries about constipation since the release of the newer migraine medications, especially Aimovig (erenumab). A known side effect for some people is constipation that is more than a passing nuisance. I think there are lots of neurologists that had to bone-up on their knowledge of effective constipation remedies for our crowd. For some people, this side effect was enough to have them switch to one of the other medications recently on the market.
Some common mineral supplements can contribute to constipation. Both iron and calcium supplements are known to be problematic. If you have been prescribed these by a doctor continue to take them but work on the below tips to get things moving regularly again.
Most people in the United States do not get enough fiber. For many who deal with debilitating migraine attacks and vestibular migraine, getting enough fiber may be especially challenging. Reaching for lower-fiber, prepared foods and highly processed foods is understandable when we aren’t feeling well. This isn’t a judgement or an excuse. It’s a reality of chronic illness.
5- Hydration, migraine and constipation
Checkout my blog about hydration and migraine. There is evidence that suggests that we need more hydration than the average person who does not have migraine. This alone may explain part of the migraine and constipation link.
One reason some people become constipated is that they may drink a low amount of fluid each day. For others, they may have a colon that is an over-achiever. One of the main jobs of our colon is to remove excess water. Perhaps your colon has a tendency to take away a too much fluid and leave behind stool that is too dry and hard to move along.
6- Inadequate activity and exercise
When we are inactive, the natural and necessary muscle contractions that move food and stool through the GI tract slow down. If you are prone to frequent migraine attacks, your desire and ability to be active or exercise is likely impacted.
5 critical steps for constipation relief
1- Boost your water intake.
I know, I know, some of you may bristle at this advice. I really don’t like drinking water and know that I am far from alone about that. If you haven’t already read my article about the importance of hydration, please do so. This is a necessity to minimize both constipation and migraine.
Some of you may bristle for a different reason – you already drink plenty of water. Kudos to you for that!
2– Dietary Fiber
Boosting your fiber intake may not be news for you. As you might know, some forms of fiber can cause bloating and discomfort while others help speed things ups, soften the stool and bring about relief.
Soluble fiber helps our digestion by serving as a bulking and softening agent. It is soluble in water and holds onto water from within the stool so it can move through the intestines. Examples of soluble fiber that are often helpful are found in oats and many fresh, whole vegetables and fruits.
My personal favorite soluble fiber supplement is made by RegularGirl. It’s my favorite as it mixes easily in water, does not cause gas and gets the job done. It is blended with helpful probiotics (see below). If you use the coupon code, MIGRAINESTRONG10 you get 10% off of your first order.
Insoluble fiber is made softer inside GI tract, but it does not dissolve in water. A helpful role it has is to add even more bulk to the stool so that the muscles along your GI tract can propel it toward its ultimate goal, your colon and ultimately, your commode.
Both forms of fiber are important and both can be supplemented when fiber food is not doing the trick. Some experimentation with different forms of added soluble fiber and insoluble fiber may be necessary for you to find the right one or combination.
Our GI tract is loaded with a large variety of bacteria that is mostly helpful to our health. Having a good balance of the beneficial bacteria helps to keep the harmful bacteria in check. When we eat good sources of probiotics like fermented foods, it helps keep a healthy balance of beneficial bacteria. In addition to helping the healthy bacteria thrive with probiotics, eating foods high in both soluble and insoluble fiber help provide it with nutrients.
4– Be Active
As stated above, when you are active the muscles responsible for moving the contents of your GI tract forward contract more. If you want your GI motility to increase, boost your own movement.
For many of us with chronic conditions, exercise is hard. And, for some people, exercise may induce headaches or migraine attacks. This website is a great resource for getting you moving in spite of migraine.
5- Magnesium for constipation AND migraine
I’m certain you’ve seen us recommend magnesium glycinate many times in Migraine Strong. That’s because it’s great for migraine prevention, highly absorbable and the least likely form of magnesium to cause tummy trouble. But, the hidden work horse that is mentioned much less often is magnesiums citrate. It is likely the most highly absorbable form of magnesium. The good news here is that it’s a great form to reach for to help lessen your migraine attacks and if you’re constipated, it’s the perfect form to reach for to help loosen your stools and make it easier to go. We like Pure Encapsulations magnesium citrate and Natural Vitality Calm. Just be sure to choose the original unflavored version. You can also look for magnesium citrate in our supplement dispensary to receive a significant discount and free shipping with every $50 purchase.
When you need more help for constipation and migraine:
If increased hydration, boosting fiber and probiotics along with regular exercise aren’t getting you the results you are looking for, it’s probably time to try some over-the-counter intervention.
First, start slowly. Bombarding your colon with multiple types of laxatives may make you extremely uncomfortable and have unintended and embarrassing consequences.
I recommend trying products in this order. IMPORTANT– All of these products need you to drink additional fluids for them the work properly. Read and abide by the package instructions including calling your doctor if your symptoms continue.
These products add fiber to your diet in a convenient beverage. Common brands include Fibercon, Metamucil, Citrucel, Benefiber. You may have to try a few to find the best one for you in terms of results and tolerance of potential gas and bloating. Read the ingredients to and avoid the supplements that contain sugar-substitutes as they are migraine-triggering for some people.
As I said above, my favorite product to help with constipation is Regular Girl as it’s a blend of soluble fiber and probiotics in one compact powder that dissolves easily in water. It’s simple and effective for me.
Miralax is a popular brand using polyethylene glycol to draw water into the GI tract to add bulk and soften the stool to make it easier to move through your body. There are generics available. Polyethylene glycol is effective and tends to be well-tolerated and gentle. It may take a few days for this to start working. Because of the lack of taste, this product is popular and recommended by doctors often.
Saline osmotic laxatives
Like polyethylene glycol, this type of osmotic laxative works by pulling water into the GI tract but it does so using the mineral salts in different forms like magnesium citrate and magnesium hydroxide. Phillip’s Milk of Magnesium is a popular brand of magnesium hydroxide. People often get much faster results with saline osmotic laxatives but it’s less accepted due the the taste.
This type of medication works by causing the gastrointestinal tract to absorb water and soften the stool. Common brands of the substance docusate sodium, are Colace and Correctol. Stool softeners usually take a few days to work and have been less prescribed by doctors over the years in favor of the osmotic laxatives.
The way that stimulant laxatives work is by stimulating contractions of the nerves and muscles along the GI tract. These drugs are widely available over-the-counter but they are recommended less often by doctors and pharmacists. There is a risk of becoming dependent on them if overused. Additionally, some people have significant cramping after taking them. This can make migraine and constipation that much more unpleasant. An advantage is that typically, the results are faster than with osmotic laxatives and stool softeners. Popular brands are Senokot, Ex-Lax and Dulcolax.
Knowing when you need “help from below” for constipation
Things are about to get a little more sensitive. I apologize in advance for the TMI (too much information), but it’s usually left out of articles on constipation and my goal is to give you practical advice.
When stool slows down in your GI tract or when you suppress the urge to move your bowels, your colon gets the opportunity to draw more water out of the stool. Your colon is about 5 feet long so there is a lot of room for storage. It is especially important to notice changes in your poop so you know when it may be time to step things up and avoid severe constipation and possible fecal impaction.
Your goal should be to easily pass poop that is similar in shape and firmness to a banana. Lumpy poops, hard pellets or poop balls are signs that the stool has been in your colon for a long time and too much water has been removed. For many people, if nothing is done the poop becomes a larger rounded mass like a tennis ball and can seem impossible to pass without tearing the anus. Let me help you avoid this!
Take a peek!
First, always glance in the toilet and see what you’ve produced. Was it an easy-to-pass smooth banana? Gold star! If it was lumpy you probably still have time to help yourself by drinking more water, eating higher fiber foods and exercising. If you are uncomfortable and/or the stool was hard to pass, I suggest that you not wait longer and add a bulking agent.
When the stool is very difficult to pass, I suggest you enlist some “help from below” so that you don’t strain more and develop or worsen hemorrhoids or cause a tear and some bleeding. The hardened ball of dry poop can be helped out by making it slippery with a solid glycerin suppository or liquid glycerin suppository delivered by a convenient small, bulb. This is a popular brand of liquid suppository designed for kids that should do the trick for adults when the solid suppositories are not helpful.
If you have noticed that your stool is chronically hard and difficult to pass, it may take a few weeks to notice a difference. You may have quite a lot of old stool that needs to come out of your colon. Remember, your colon is about ~5 feet long. Between your new focus on hydration, increased activity level, changes in diet and experimenting with different laxatives, you can find relief from constipation as well as prevent it.
Don’t hold it in!
It is also important to mention the possibility that poop suppression could be part of the problem. I assume most of you reading this are female. You may be more hesitant of pooping while away from home than men. For some of us, when and where and who’s around has been a consideration. If you’re super self conscious about possible odor, try carrying a natural toilet spray in your bag. Many contain no synthetic fragrance & are made with only essential oils or other natural ingredients. It’s time to stop that practice and answer the call of nature as soon as you get the urge (assuming that there is a potty nearby). Pay attention to the urge. We are talking about your health.
When to see a doctor
The above is designed as general helpful information. It is not medial advice nor meant to replace individualized attention from a doctor. There are times when individualized intervention is needed from a qualified medical professional.
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