Targeting the microbiome in pediatric migraine: gastrointestinal manifestations and the therapeutic role of Bifidobacterium longum.

Pediatric migraine patients exhibited distinct gut microbiota compared to healthy controls, characterized by reduced Bifidobacterium longum and elevated Bacteroides.

• Study enrolled 126 pediatric migraine patients (ages 6-19) and 50 age-matched healthy controls
• Fecal microbiota was profiled using 16S rRNA sequencing
• B. longum was specifically identified as reduced in migraine patients relative to controls
• Elevated Bacteroides was identified as a distinguishing feature of the migraine microbiome

GI disorders were present in 46.8% of pediatric migraine patients and were associated with significantly worse clinical outcomes.

• GI disorders were defined using Rome IV criteria
• Migraine patients with GI disorders had significantly higher rates of abdominal pain (50% vs. 13%, p < 0.001) compared to those without GI disorders
• Migraine-related disability was significantly greater in patients with GI disorders (PedMIDAS: 60 ± 13.2 vs. 29 ± 7.0, p = 0.042)
• Patients with GI disorders also showed elevated fecal calprotectin

Streptococcus gallolyticus was enriched in migraine patients with GI disorders.

• S. gallolyticus enrichment was identified through 16S rRNA sequencing analysis
• This enrichment was specific to the subgroup of migraine patients who also had GI disorders
• This microbiota signature distinguished migraine patients with GI disorder from those without

Faecalibacterium prausnitzii positively correlated with B. longum and was linked to milder symptoms and shorter disease duration in migraine patients without GI disorder.

• F. prausnitzii abundance was positively correlated with B. longum abundance
• Higher F. prausnitzii was associated with milder migraine symptoms in the non-GI disorder subgroup
• Higher F. prausnitzii was also associated with shorter disease duration in migraine patients without GI disorder

B. longum attenuated trigeminal activation in both young and adult rat models of capsaicin-induced migraine.

• Probiotic effects were tested in both young (3-4 weeks) and adult capsaicin-induced migraine rat models
• B. longum supplementation reduced trigeminal activation in both age groups
• The use of both young and adult animal models was intended to reflect pediatric and adult migraine conditions

An exploratory pilot study of B. longum supplementation in pediatric migraine patients showed reductions in headache days, intensity, and frequency.

• The pilot study enrolled 23 pediatric migraine patients
• Outcomes measured included headache days, headache intensity, and headache frequency
• B. longum supplementation was associated with reductions across all three headache outcome measures
• The study was described as exploratory, indicating preliminary rather than confirmatory evidence

Clinical measures including plasma CGRP, cytokines, and fecal calprotectin were evaluated as part of the characterization of pediatric migraine with and without GI disorders.

• Plasma calcitonin gene related peptide (CGRP) was measured as 'a key biomarker of migraine'
• Cytokine levels were assessed in migraine patients stratified by GI disorder status
• Fecal calprotectin was elevated in the GI disorder subgroup
• PedMIDAS scores were used for migraine-related disability assessment