Migraine: What role does the gut-brain axis play?

Migraine is far more than just a severe headache and can significantly impair the quality of life for those affected. Research into the condition is increasingly focusing on the connection between the gut and the brain. In this article you will learn what the gut–brain axis consists of, which links between the gut microbiome, inflammatory processes and migraine are being discussed, and what role diet and certain nutrients may play. In addition, we present ten practical ways you can support a gut-friendly lifestyle and thereby possibly usefully complement your migraine prevention.

Migraine: More than just severe headaches

Unilateral, pulsating or throbbing headaches that often last several hours to days, accompanied by nausea, vomiting and pronounced sensitivity to light and sound – these can all be symptoms of migraine. The neurological condition is characterised by recurring headache attacks that go well beyond an ordinary headache. In some affected people an attack is preceded by an aura, which can manifest for example as temporary visual disturbances, tingling or speech difficulties. The frequency and severity of attacks vary considerably from person to person.

The development of migraine is complex and influenced by an interplay of genetic, neurological, hormonal and environmental factors. Stress, lack of sleep, hormonal fluctuations, alcohol or individual dietary habits can also trigger attacks in susceptible people. In recent years the gut–brain axis has moved increasingly into the scientific spotlight in relation to migraine. What this complex connection actually entails, what role it might play in the onset and regulation of migraine, and what influence diet may possibly have, are explained in the further course of this article.

What exactly is meant by the gut–brain axis?

The gut–brain axis refers to the close, bidirectional communication between the gastrointestinal tract and the brain. It is not a single anatomical structure but a complex network of the nervous system, immune system, hormones, metabolic products and the gut microbiome. An important link between gut and brain is the vagus nerve, which transmits signals from the digestive tract to the central nervous system. At the same time the brain can influence gut motility, digestion and the function of the intestinal barrier via the autonomic nervous system and hormonal signalling pathways. Communication therefore runs in both directions: on the one hand the gut sends information to the brain – on the other hand the brain in turn influences the gut.

The gut microbiome, i.e. the totality of microorganisms living in the gut, also plays a key role in this connection. The bacteria residing there can produce, among other things, short-chain fatty acids and other important bioactive substances that affect metabolism, immune responses and the nervous system. Conversely, for example, lack of sleep, stress or psychological strain can alter the composition and activity of the gut microbiome. For this reason the gut–brain axis is now regarded as an important communication system linking domains such as diet, stress, metabolism and the immune system. In neurological disorders, including migraine, researchers are investigating whether changes in this communication may be involved in the onset or severity of symptoms.

Migraine and the gut–brain axis: How are they connected?

Research into the connection between gut and brain has also become significantly more important in relation to migraine in recent years. As several studies show, people with migraine more often suffer from gastrointestinal complaints.¹ In addition, the composition of the gut microbiome can differ from the gut flora of healthy individuals. A systematic review from 2025, for example, found indications of differences in bacterial composition and lower microbial diversity in people with migraine.² What significance these changes actually have for the onset or exacerbation of migraine is however not yet conclusively determined.

1. Inflammatory processes

A possible link between the gut and migraine runs via the immune system and certain inflammatory processes. Changes in the gut microbiome can influence the activity of immune cells and the production of certain signalling molecules (e.g. cytokines). In particular, discussion centres on whether an altered microbial composition is involved in the development of inflammatory and neuroinflammatory processes that in turn may promote a migraine attack. Current reviews describe a possible connection between the gut microbiome, immune activation, oxidative stress and activation of the so‑called trigeminovascular system. A direct causal link between a specific gut flora and migraine has not yet been proven.

2. Intestinal barrier

The integrity of the intestinal barrier may also play a role. Normally the intestinal wall tightly regulates which substances from the gut lumen enter the body. If this barrier is compromised, permeability may increase so that bacterial components and microbial products come into contact with the immune system more frequently. However, it is not yet clearly established whether increased intestinal permeability contributes to the development of migraine or is possibly itself a consequence of other processes associated with migraine.

3. Vagus nerve

The gut and brain are also connected via the vagus nerve. This nerve carries a substantial portion of the communication between the organs of the digestive tract and the central nervous system. Signals from the gut can be transmitted to the brain via the vagus nerve, while the brain via the autonomic nervous system in turn influences gut function. Bacterial metabolic products and changes in the gut milieu can also affect these signalling pathways. In connection with migraine, researchers are therefore investigating whether alterations in gut–brain communication via the vagus nerve can influence pain processing and neuroinflammatory processes.

4. Bacterial metabolic products

Last but not least, the metabolic products of gut bacteria, so‑called gut metabolites, are of particular interest. These include for example short‑chain fatty acids (SCFAs) such as acetate, propionate and butyrate, which are produced by bacterial fermentation of dietary fibre. They influence, among other things, the intestinal barrier, immune responses and metabolic processes and could also act on the nervous system via the gut–brain axis. Changes in such microbially produced metabolites are discussed as a possible migraine mechanism. Direct clinical evidence to date is however limited.

The role of diet and nitrate‑rich foods in migraine

Diet can play a role in migraine both as a possible trigger and as a supportive measure. There is no universally valid “migraine diet”: which foods potentially trigger an attack varies greatly between individuals. A recent systematic review from 2025 concluded that certain dietary approaches, particularly the ketogenic diet and the DASH diet, can reduce the frequency and in part also the severity of migraine attacks.³ At the same time the evidence is still limited, which is why blanket lists of forbidden foods are usually of little use. More important for those affected is to recognise personal links between diet and migraine attacks while maintaining a balanced and regular diet.

Nitrate and the resulting nitric oxide (NO) are also attributed a special role. Nitrates occur naturally in foods such as beetroot and leafy vegetables, but are also used as preservatives in processed meat products. In the body, and already in the mouth, nitrates can be converted via nitrite to nitric oxide. This affects, among other things, vessel diameter and may, in susceptible people, potentially promote migraine processes. Interestingly, one study showed that people with migraine more frequently harboured nitrate‑, nitrite‑ and NO‑reducing bacteria in the mouth.⁴ Experimental investigations also point to a link between the nitrate‑nitrite‑NO metabolism and migraine.

Relevant nutrients for the nervous system and migraine prevention

Some micronutrients and fatty acids are being investigated particularly intensively in relation to migraine prevention. A recent review on diet and migraine classed magnesium, riboflavin (vitamin B2) and omega‑3 fatty acids as relevant, among others.⁵ Below we present these nutrients and their effects in relation to migraine.

• Magnesium: Magnesium is involved in numerous processes of signal transmission, muscle and nerve function and energy metabolism. Whether there is a link between inadequate magnesium status and migraine has been a subject of research for years. A recent systematic review and meta‑analysis from 2025 evaluated 22 randomised trials on various dietary supplements. For magnesium, significant reductions were seen in the number of migraine attacks, monthly migraine days and pain intensity compared with control groups.⁶
• Riboflavin (vitamin B2): Riboflavin plays an important role particularly in mitochondrial energy metabolism. Since possible changes in mitochondrial function and oxidative metabolism are discussed in migraine, vitamin B2 is being investigated as a potential supportive approach. A meta‑analysis of twelve clinical trials with a total of 749 participants found indications of a reduction in the frequency and duration of migraine attacks with riboflavin supplementation.⁷
• Omega‑3 fatty acids: The long‑chain omega‑3 fatty acids EPA and DHA are a central component of our cell membranes and are involved in various processes of inflammation regulation. Whether they can influence the inflammatory processes discussed in migraine is not yet clearly established.

From fibre to exercise: 9 tips for a gut‑friendly lifestyle with migraine

It is not possible to comprehensively optimise the gut–brain axis with a single measure. Rather, various habits can support an overall healthy lifestyle and thus also have a positive effect on the condition. Especially with migraine it makes sense to observe possible personal triggers without prematurely cutting entire food groups out of the diet. The following recommendations combine current findings on migraine prevention with the growing knowledge about the gut–brain axis.

• Do not skip meals: Long fasting periods or highly variable meal times can trigger migraine attacks in some people. Regular food intake throughout the day also helps to keep energy levels stable.
• Focus on a fibre‑rich diet: Vegetables, fruit, pulses, wholegrains, nuts and seeds provide fibre that certain gut bacteria partially ferment to short‑chain fatty acids. This forms an important basis for a diverse gut microbiome.
• Eat as colourfully and diversely as possible: A varied selection of plant foods supplies the body with different fibres and with phytochemicals. Diversity on the plate can at the same time support diversity in the gut microbiome – an aspect whose effects on migraine are currently being intensively researched.
• Drink sufficiently: The recommendation to drink enough fluids is among the best‑known health tips. Adequate fluid intake is particularly important for migraine. On hot days and during physical activity or heavy sweating, regular drinking should be observed.
• Identify your personal dietary triggers: Alcohol, caffeine, certain processed foods or individual intolerances can, in some cases, promote migraine attacks. Rather than routinely avoiding a whole range of foods, you should keep a migraine and diet diary if necessary. Individual reactions to specific foods can vary greatly.
• Ensure adequate intake of magnesium and vitamin B2: Magnesium and riboflavin (vitamin B2) are among the nutrients comparatively well studied in relation to migraine prevention. A balanced diet should therefore regularly include foods rich in magnesium and riboflavin. High‑dose supplementation of these micronutrients should however always be discussed with a doctor.
• Include omega‑3 rich foods in your diet: Oily sea fish, walnuts, flaxseed and chia seeds provide omega‑3 fatty acids, which among other things support regulation of inflammatory processes. Targeted migraine prevention with omega‑3 supplements is not yet supported by the current evidence.
• Aim to exercise daily: Moderate physical activity can help prevent migraine and at the same time positively affect metabolism, stress regulation and general well‑being. Suitable activities include walking, cycling, swimming or moderate strength training – regularity is the decisive factor.
• Prioritise sufficient sleep and sleep routines: Both lack of sleep and highly variable sleep times can trigger migraine attacks in susceptible people. Regular bedtimes support our “internal clock”, the circadian rhythm. This is connected to the gut–brain axis via various signalling pathways.

Disclaimer

This article does not replace treatment by a qualified practitioner. The basis of this article is studies and current literature. It should not be used for self‑diagnosis or self‑treatment. Discuss any ideas from this article with a practitioner you trust.

Biographical

Katharina Korbach regularly writes blog posts on medicinal plants and natural substances for the Narayana Verlag. She developed an interest in language early on and began writing her own literary texts. A serious illness during her final school year led to an intensive engagement with health and nutrition topics that continues to this day. After repeated failures of conventional medical treatment methods, she opted for a more self‑empowering, naturopathic therapeutic approach. A plant‑based diet was a key element in her healing journey.

Katharina studied Cultural Studies (B.A.) and Applied Literary Studies (M.A.). In 2022 she published her debut novel “Sperling” with Berlin Verlag. She now lives in Berlin as a freelance author, medical editor and lecturer. She likes to spend her free time with friends or at barre training. She also loves to travel and try out new vegan recipes.

References

1. Kim J, Lee S, Rhew K. Association between Gastrointestinal Diseases and Migraine. Int J Environ Res Public Health. 2022 Mar 28. https://pubmed.ncbi.nlm.nih.gov/35409704/.
2. Mugo CW, Church E, Horniblow RD, Mollan SP, Botfield H, Hill LJ, Sinclair AJ, Grech O. Unravelling the gut-brain connection: a systematic review of migraine and the gut microbiome. J Headache Pain. 2025 May 21. https://pubmed.ncbi.nlm.nih.gov/40399789/.
3. Roldán-Ruiz A, Bertotti G, López-Moreno M. Effects of Dietary Interventions in Patients With Migraine: A Systematic Review. Nutr Rev. 2025 Jul 1. https://pubmed.ncbi.nlm.nih.gov/39749874/.
4. Gonzalez A, Hyde E, Sangwan N, Gilbert JA, Viirre E, Knight R. Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort. mSystems. 2016 Oct 18. https://pmc.ncbi.nlm.nih.gov/articles/PMC5080405/.
5. Gazerani P, Papetti L, Dalkara T, Cook CL, Webster C, Bai J. The Brain, the Eating Plate, and the Gut Microbiome: Partners in Migraine Pathogenesis. Nutrients. 2024 Jul 11. https://pubmed.ncbi.nlm.nih.gov/39064664/.
6. Talandashti MK, Shahinfar H, Delgarm P, Jazayeri S. Effects of selected dietary supplements on migraine prophylaxis: A systematic review and dose-response meta-analysis of randomized controlled trials. Neurol Sci. 2025 Feb. https://pubmed.ncbi.nlm.nih.gov/39404918/.
7. Amini S, Heidari Z, Clark CCT, Bagherniya M. The effect of riboflavin on the mean attack frequency, severity, and duration of migraine headaches: A systematic review and dose-response meta-analysis of clinical trials. J Res Med Sci. 2026 Jan 31. https://pubmed.ncbi.nlm.nih.gov/41769676/.