Association Between Gut-Brain Axis Dysfunction and Vestibular Migraine Severity.

BACKGROUND: Vestibular migraine (VM) is a condition characterized by regular attacks of vertigo and imbalance, along with migraine symptoms or signs. However, the role of the gut-brain axis (GBA) in mediating the severity of VM symptoms, particularly in the Pakistani population, remains poorly understood. This study aims to elucidate the relationship between GBA dysfunction and the severity of VM. METHODOLOGY: This cross-sectional study was conducted from May 2024 to April 2025 at Jinnah Hospital, Lahore, in collaboration with the Neurology and ENT departments. Convenience sampling was employed to recruit 386 participants diagnosed with VM. Data were collected using three primary instruments: the Gastrointestinal Symptom Rating Scale (GSRS), the Migraine Disability Assessment Test (MIDAS), and the Vertigo Symptom Scale-Short Form (VSS-SF). Demographic and lifestyle data were also collected. Pearson correlation, independent t-tests, analysis of variance (ANOVA), and multiple linear regression were used to study the correlation between GBA dysfunction and VM severity. RESULTS: The sample included 386 participants, with males (296, 77%) and participants aged 60 years or older (154, 40%). Positive correlations were significant between gastrointestinal symptoms, migraine-related disability, and the severity of vertigo (P < 0.001; 95% confidence interval (CI) 0.06-0.18). Multiple linear regression analysis revealed that the severity of gastrointestinal symptoms (95% CI 0.15-0.55), older age (95% CI 2.70-7.70), and a high rate of vertigo incidences (95% CI 0.27-2.23) were significant predictors of increased migraine disability and vertigo symptom severity (P < 0.05). Anxiety and depression were also found to be related to severe symptoms, and this may indicate that mental health is also linked to GBA dysfunction in VM. CONCLUSIONS: The study demonstrates an association between GBA-related symptoms and greater VM severity. These findings highlight the potential importance of assessing gastrointestinal and psychological comorbidities in the management of VM, particularly in Pakistani clinical settings where such factors may be overlooked. Future research should investigate the therapeutic potential of gut-targeted interventions using longitudinal designs and objective measures to clarify causal relationships and assess efficacy.