Skip to main content

Advertisement

Log in

What the Gut Can Teach Us About Migraine

  • Episodic Migraine (R Cowan, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

During gestation, cells of the brain and gut develop almost simultaneously into the central nervous system (CNS) and enteric nervous system (ENS), respectively. They remain connected via the vagal nerve lifelong. While it is well known that the brain sends signal to the gut, communication is in fact bidirectional. Just as the brain can modulate gut functioning, the gut, and likely what we ingest, can in fact influence our brain functioning. We will first review both gastrointestinal (GI) function and migraine pathophysiology and then discuss evidence linking the migraine brain to various GI disorders. Lastly, we discuss the effects of gut microbiota on brain functioning and speculate how the gut and particularly diet may affect migraine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lipton RB, Stewart FW, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41:646–57.

    Article  CAS  PubMed  Google Scholar 

  2. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  3. Kurth T, Holtmann G, Neufang-Huber J, Gerken G, Diener HC. Prevalence of unexplained upper abdominal symptoms in patients with migraine. Cephalalgia. 2006;26:506–10.

    Article  CAS  PubMed  Google Scholar 

  4. Aurora SK, Papapetropoulos S, Kori SH, Kedar A, Abell TL. Gastric stasis in migraineurs: etiology, characteristics, and clinical and therapeutic implications. Cephalalgia. 2013;33:408–15.

    Article  PubMed  Google Scholar 

  5. Aamodt AH, Stovner LJ, Hagen K, Zwart J-A. Comorbidity of headache and gastrointestinal complaints. The head-HUNT study. Cephalalgia. 2008;28:144–51.

    CAS  PubMed  Google Scholar 

  6. Cady RK, Farmer K, Dexter JK, Hall J. The bowel and migraine: update on celiac disease and irritable bowel syndrome. Curr Pain Headache Rep. 2012;16:278–86.

    Article  PubMed  Google Scholar 

  7. Selby G, Lance JW. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiat. 1960;23:23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Lipton RB, Buse DC, Saiers J, Fanning KM, Serrano D, Reed ML. Frequency and burden of headache-related nausea: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2013;53:93–103.

    Article  PubMed  Google Scholar 

  9. Bouras EP, Vazquez Roque MI, Aranda-Michel J. Gastroparesis: from concepts to management. Nutr Clin Pract. 2013;28:437–47.

    Article  PubMed  Google Scholar 

  10. Lee A. Gastroparesis: what is the current state-of-the-art for evaluation and medical management? What are the results? J Gastrointest Surg. 2013;17:1553–6.

    Article  PubMed  Google Scholar 

  11. Jung HK, Choung RS, Locke 3rd GR, Schleck CD, Zinsmeister AR, Szarka LA, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–33.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–622.

    Article  PubMed  Google Scholar 

  13. Quigley EM. Changing face of irritable bowel syndrome. World J Gastroenterol. 2006;12:1–5.

    PubMed Central  PubMed  Google Scholar 

  14. Chang FY, Lu CL. Irritable bowel syndrome and migraine: bystanders or partners? J Neurogastroenterol Motil. 2013;19:301–11.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Hadjivassiliou M, Sanders DS, Grunewald RA, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010;9:318–30.

    Article  CAS  PubMed  Google Scholar 

  16. Dimitrova AK, Ungaro RC, Lebwohl B, Lewis SK, Tennyson CA, Green MW, et al. Prevalence of migraine in patients with celiac disease and inflammatory bowel disease. Headache. 2013;53:344–55.

    Article  PubMed  Google Scholar 

  17. Furness JB. The enteric nervous system and neurogastroenterology. Nat Rev Gastroenterol Hepatol. 2012;9:286–94.

    Article  CAS  PubMed  Google Scholar 

  18. Benarroch EE. Enteric nervous system: functional organization and neurologic implications. Neurology. 2007;69:1953–7.

    Article  PubMed  Google Scholar 

  19. Gershon MD, Chalazonitis A, Rothman TP. From neural crest to bowel: development of the enteric nervous system. J Neurobiol. 1993;24:199–214.

    Article  CAS  PubMed  Google Scholar 

  20. Oh JH, Pasricha PJ. Recent advances in the pathophysiology and treatment of gastroparesis. J Neurogastroenterol Motil. 2013;19:18–24.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Browning KN, Travagli RA. Plasticity of vagal brainstem circuits in the control of gastric function. Neurogastroenterol Motil. 2010;22:1154–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Bailey TW, Hermes SM, Andresen MC, Aicher SA. Cranial visceral afferent pathways through the nucleus of the solitary tract to caudal ventrolateral medulla or paraventricular hypothalamus: target-specific synaptic reliability and convergence patterns. J Neurosci. 2006;26:11893–902.

    Article  CAS  PubMed  Google Scholar 

  23. Travagli RA, Hermann GE, Browning KN, Rogers RC. Brainstem circuits regulating gastric function. Annu Rev Physiol. 2006;68:279–305.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Ischiguchi T, Nakajima M, Sone H, Tada H, Kumagai AK, Takahashi T. Gastric distension-induced pyloric relaxation: central nervous system regulation and effects of acute hyperglycaemia in the rat. J Physiol. 2001;533:801–13.

    Article  Google Scholar 

  25. Reddymasu SC, Bonino J, McCallum RW. Gastroparesis secondary to a demyelinating disease: a case series. BMC Gastroenterol. 2007;7:3.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2013;12(8):453–66.

    Article  Google Scholar 

  27. Holstege G, Bandler R, Saper CB. The emotional motor system. Prog Bran Res. 1996;107:3–6.

    CAS  Google Scholar 

  28. Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000;47:861–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Olesen J, Burstein R, Ashina M, Tfelt-Hansen P. Origin of pain in migraine- evidence for peripheral sensitization. Lancet Neurol. 2009;8:679–90.

    Article  PubMed  Google Scholar 

  30. Waeber C, Moskowitz MA. Migraine as an inflammatory disorder. Neurology. 2005;64:9–15.

    Article  Google Scholar 

  31. Moskowitz MA, Buzzi MG, Sakas DE, Linnik MD. Pain mechanisms underlying vascular headaches. Progress report 1989. Rev Neurol. 1989;145:181–93.

    CAS  PubMed  Google Scholar 

  32. Cosentino G, Fierro B, Brighina F. From different neurophysiological methods to conflicting pathophysiological views in migraine: a critical review of literature. Clin Neurophysiol. 2014;125:1721–30.

    Article  PubMed  Google Scholar 

  33. Rossi R, Ambrosinin A, Buzzi MG. Prodromes and predictors of migraine attack. Funct Neurol. 2005;20:185–91.

    PubMed  Google Scholar 

  34. Andreatta M, Puschmann AK, Sommer C, Weyers P, Pauli P, Muhlberger A. Altered processing of emotional stimuli in migraine: an event-related potential study. Cephalalgia. 2012;32:1101–8.

    Article  PubMed  Google Scholar 

  35. Bolay H. The first phase of a migraine attack resides in the cortex. J Neural Transm. 2012;119:569–74.

    Article  PubMed  Google Scholar 

  36. Alstadhaug KB. Migraine and the hypothalamus. Cephalalgia. 2009;29:809–17.

    Article  CAS  PubMed  Google Scholar 

  37. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013;154:44–53. A good review on migraine pathophysiology reviewing recent data on the trigeminovascular pathway and its modulation by the brainstem and hypothalamus.

    Article  Google Scholar 

  38. Denuelle M, Fabre N, Payoux P, Chollet F, Geraud G. Hypothalamic activation in spontaneous migraine attacks. Headache. 2007;47:1418–26.

    PubMed  Google Scholar 

  39. Peroutka SJ. Migraine: a chronic sympathetic nervous system disorder. Headache. 2004;44:53–64.

    Article  PubMed  Google Scholar 

  40. Shechter A, Stewart WF, Silberstein SD, Lipton RB. Migraine and autonomic nervous system function: a population-based, case-control study. Neurology. 2002;58:422–7.

    Article  PubMed  Google Scholar 

  41. Gass JJ, Glaros AG. Autonomic dysregulation in headache patients. Appl Psychophysiol Biofeedback. 2013;38:257–63.

    Article  PubMed  Google Scholar 

  42. Takeshima T, Takao Y, Takahashi K. Pupillary sympathetic hypofunction and asymmetry in muscle contraction headache and migraine. Cephalalgia. 1987;7:257–62.

    Article  CAS  PubMed  Google Scholar 

  43. Takeshima T, Takao Y, Urakami K, Nishikawa S, Takahasi K. Muscle contraction headache and migraine. Cephalalgia. 1989;9:7–13.

    Article  CAS  PubMed  Google Scholar 

  44. Yerdelen D, Acil T, Goksel B, Karatas M. Autonomic function in tension-type headache. Acta Neurol Belg. 2007;107:108–11.

    PubMed  Google Scholar 

  45. Raieli V, Giordano G, Spitaleri C, Consolo F, Buffa D, Santangelo G, et al. Migraine and cranial autonomic symptoms in children and adolescents: a clinical study. J Child Neurol. 2014; 1-5.

  46. Aurora SK, Kori SH, Barrodale P, McDonald SA, Haseley D. Gastric stasis in migraine: more than just a paroxysmal abnormality during a migraine attack. Headache. 2006;46:57–63.

    Article  PubMed  Google Scholar 

  47. Yates BJ, Miller AD, Lucot JB. Physiological basis and pharmacology of motion sickness: an update. Brain Res Bull. 1998;47:395–406.

    Article  CAS  PubMed  Google Scholar 

  48. Hasler WL. Pathology of emesis: its autonomic basis. Handb Clin Neurol. 2013;117:337–52.

    PubMed  Google Scholar 

  49. Kovacic K, Li BU. Childhood chronic nausea: is it just a queasy stomach? Curr Gastroenterol Rep. 2014;16:395.

    Article  PubMed  Google Scholar 

  50. Jericho H, Adams P, Zhang G, Rychlik K, Saps M. Nausea predicts delayed gastric emptying in children. J Pediatr. 2014;164:89–92.

    Article  PubMed  Google Scholar 

  51. Napadow V, Sheehan J, Kim J, LaCount L, Park K, Kaptchuk TJ, et al. The brain circuitry underlying the temporal evolution of nausea in humans. Cereb Cortex. 2013;23:806–13.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Chai NC, Shapiro RE, Rapoport AM. Why does vomiting stop a migraine attack? Curr Pain Headache Rep. 2013;17:362–7.

    Article  PubMed  Google Scholar 

  53. Volans GN. The effect of metoclopramide on the absorption of effervescent aspirin in migraine. Br J clin Pharmac. 1975;2:57–63.

    Article  CAS  Google Scholar 

  54. Volans GN. Migraine and drug absorption. Clin Pharmacokinet. 1978;3:313–8.

    Article  CAS  PubMed  Google Scholar 

  55. Aurora SK, Kori S, Barrodale P, Nelsen A, McDonald S. Gastric stasis occurs in spontaneous, visually induced, and interictal migraine. Headache. 2007;47:1443–6.

    Article  PubMed  Google Scholar 

  56. Yu YH, Jo Y, Junn JY, Kim BK, Seok JW. Gastric emptying in migraine: a comparison with functional dyspepsia. J Neurogastroenterol Motil. 2012;18:412–8.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Yalcin H, Okuyucu EE, Ucar E, Duman T, Yilmazer S. Changes in liquid emptying in migraine patients: diagnosed with liquid phase gastric emptying scintigraphy. Intern Med J. 2012;42:455–9.

    Article  CAS  PubMed  Google Scholar 

  58. Abell TL, Adams KA, Boles RG, Bousvaros A, Chong SK, Fleisher DR, et al. Cyclic vomiting syndrome in adults. Neurogastroenterol Motil. 2008;20:269–84.

    Article  CAS  PubMed  Google Scholar 

  59. Li BUK, Murray RD, Heitlinger LA, Robbins JL, Hayes JR. Is cyclic vomiting syndrome related to migraine? J Pediatr. 1999;134:567–72.

    Article  CAS  PubMed  Google Scholar 

  60. Prakash C, Staiano A, Rothbaum RJ, Clouse RE. Similarities in cyclic vomiting syndrome across age groups. Am J Gastroenterol. 2001;96:684–8.

    Article  CAS  PubMed  Google Scholar 

  61. Rashed H, Abell TL, Familoni BO, Cardoso S. Autonomic function in cyclic vomiting syndrome and classic migraine. Dig Dis Sci. 1999;44:74–8.

    Google Scholar 

  62. Chelimsky TC, Chelimsky GG. Autonomic abnormalities in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2007;44:326–30.

    Article  PubMed  Google Scholar 

  63. Christensen CJ, Johnson WD, Abell TL. Patients with cyclic vomiting pattern and diabetic gastropathy have more migraines, abnormal electrogastrograms, and gastric emptying. Scand J Gastroenterol. 2008;43:1076–81.

    Article  PubMed  Google Scholar 

  64. Hejazi RA, Lavenbarg TH, Pasnoor M, Dimachkie M, Foran P, Jerbelin L, et al. Autonomic nerve function in adult patients with cyclic vomiting syndrome. Neurogastroenterol Motil. 2011;23:439–43.

    Article  CAS  PubMed  Google Scholar 

  65. Evans RW, Whyte C. Cyclic vomiting syndrome and abdominal migraine in adults and children. Headache. 2013;53:984–93.

    Article  PubMed  Google Scholar 

  66. Myers B, Greenwood-Van Meerveld B. Role of anxiety in the pathophysiology of irritable bowel syndrome: importance of the amygdala. Auton Neurosci. 2009;3:47.

    Google Scholar 

  67. Seminowicz DA, Labus JS, Bueller JA, Tillsch K, Naliboff BD, Bushnell MC, et al. Regional gray matter density changes in brains of patients with irritable bowel syndrome. Gastroenterology. 2010;139:48–57.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Piche M, Chen JI, Roy M, Poitras P, Bouin M, Rainville P. Thicker posterior insula is associated with disease duration in women with irritable bowel syndrome (IBS) whereas thicker orbitofrontal cortex predicts reduced pain inhibition in both IBS patients and controls. J Pain. 2013;14:1217–26.

    Article  PubMed  Google Scholar 

  69. Lau CI, Lin CC, Chen WH, Wang HC, Kao CH. Association between migraine and irritable bowel syndrome: a population-based retrospective cohort study. Eur J Neurol. 2014;21:1198–204.

    Article  PubMed  Google Scholar 

  70. Robbins MS. Cluster belly: a variant of irritable bowel syndrome. Headache. 2014;54:1644–6.

    Article  PubMed  Google Scholar 

  71. Van der WD, Sturm CA. Antibiotic decontamination of the digestive tract of mice. Technical procedures. Lab Anim Care. 1968;18:1–10.

    Google Scholar 

  72. Verdu EF, Bercik P, Verma-Gandhu M, et al. Specific probiotic therapy attenuates antibiotic induced visceral hypersensitivity in mice. Gut. 2006;55:182–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  73. Hooper LV, Wong MH, Thelin A, Hansson L, Falk PG, Gordon JI. Molecular analysis of commensal host-microbial relationships in the intestine. Science. 2001;291:881–4.

    Article  CAS  PubMed  Google Scholar 

  74. Skehel PA, Armitage BA, Bartsch D, et al. Proteins functioning in synaptic transmission at the sensory to motor synapse of Aplysia. Neuropharmacology. 1995;34:1379–85.

    Article  CAS  PubMed  Google Scholar 

  75. Bailey MT, Coe CL. Maternal separation disrupts the integrity of the intestinal microflora in infant rhesus monkeys. Dev Psychobiol. 1999;35:146–55.

    Article  CAS  PubMed  Google Scholar 

  76. Collins SM, Bercik P. The relationship between intestinal microbiota and the central nervous system in normal gastrointestinal function and disease. Gastroenterology. 2009;136:2003–14.

    Article  PubMed  Google Scholar 

  77. Desbonnet L, Garrett L, Clarke G, Bienenstock J, Dinan TG. The probiotic Bifidobacteria infantis: an assessment of potential antidepressant properties in the rat. J Psychiatr Res. 2008;43:164–74.

    Article  PubMed  Google Scholar 

  78. Saulneir DM, Ringel Y, Heyman MB, Foster JA, Bercik P, Shulman RJ, et al. The intestinal microbiome, probiotics and prebiotics in neurogastroenterology. Gut Microbes. 2013;4:17–27. Good review of the “brain-gut axis”and discussion of the use of prebiotics and probiotics in neurogastroenterology. Both animal and human studies are highlighted as well as the neuroimmune system on the composition of the microbiota.

    Article  Google Scholar 

  79. Diaz Heijtz R, Wang S, Anuar F, Qian Y, Björkholm B, Samuelsson A, et al. Normal gut microbiota modulates brain development and behavior. Proc Natl Acad Sci U S A. 2011;108:3047–52.

    Article  PubMed  Google Scholar 

  80. Neufeld KM, Kang N, Bienenstock J, Foster JA. Reduced anxiety-like behavior and central neurochemical change in germ-free mice. Neurogastroenterol Motil. 2011;23:255–64.

    Article  CAS  PubMed  Google Scholar 

  81. Bercik P, Verdu EF, Foster JA, Macri J, Potter M, Huang X, et al. Chronic gastrointestinal inflammation induces anxiety-like behavior and alters central nervous system biochemistry in mice. Gastroenterology. 2010;139:2102–12.

    Article  CAS  PubMed  Google Scholar 

  82. Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, et al. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr. 2011;105:755–64.

    Article  CAS  PubMed  Google Scholar 

  83. Lyte M, Li W, Opitz N, Gaykema RP, Goehler LE. Induction of anxiety-like behavior in mice during the initial stages of infection with the agent of murine colonic hyperplasia Citrobacter rodentium. Physiol Behav. 2006;89:350–7.

    Article  CAS  PubMed  Google Scholar 

  84. Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA. Gastrointestinal flora and gastrointestinal status in children with autism—comparisons to typical children and correlation with autism severity. BMC Gastroenterol. 2011;11:22.

    Article  PubMed Central  PubMed  Google Scholar 

  85. Wang L, Christophersen CT, Sorich MJ, Gerber JP, Angley MT, Conlon MA. Low relative abundances of the mucolytic bacterium Akkermansia muciniphila and Bifidobacterium spp. in feces of children with autism. Appl Environ Microbiol. 2011;77:6718–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  86. Finegold SM, Dowd SE, Gontcharova V, Liu C, Henley KE, Wolcott RD, et al. Pyrosequencing study of fecal microflora of autistic and control children. Anaerobe. 2010;16:444–53.

    Article  CAS  PubMed  Google Scholar 

  87. Sandler RH, Finegold SM, Bolte ER, Buchanan CP, Maxwell AP, Väisänen ML, et al. Short-term benefit from oral vancomycin treatment of regressive-onset autism. J Child Neurol. 2000;15:429–35.

    Article  CAS  PubMed  Google Scholar 

  88. Collins SM, Surette M, Bercik P. The interplay between the intestinal microbiota and the brain. Nat Rev Microbiol. 2012;10:735–42.

    Article  CAS  PubMed  Google Scholar 

  89. Tillisch K, Labus J, Kilpatrick L, Jiang Z, Stains J, Ebrat B, et al. Consumption of fermented milk product with probiotic modulates brain activity. Gastroenterology. 2013;144:1394–401.

    Article  CAS  PubMed  Google Scholar 

  90. Finkel AG, Yerry JA, Mann JD. Dietary considerations in migraine management: does a consistent diet improve migraine? Curr Pain Headache Rep. 2013;17:373.

    Article  PubMed  Google Scholar 

  91. Akerman S, Holland PR, Goadsby PJ. Diencephalic and brainstem mechanisms in migraine. Nat Rev Neurosci. 2011;12:570–84.

    Article  CAS  PubMed  Google Scholar 

  92. Grazzi L, Corsini E, Ciusani E, Usai S, Vasco C, Bussone G. Evaluation of immune parameters in chronic migraine with medication overuse. Neurol Sci. 2014;35:171–3.

    Article  PubMed  Google Scholar 

  93. Aydinlar EI, Dikne PY, Tiftikci A, Saruc M, Aksu M, Gunsoy HG, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013;53:514–25. A double-blind, randomized, controlled cross-over clinical trial evaluating the therapeutic potential of IgG based elimination diet in patients with migraine and IBS. Results suggest symptom decrease and improved quality of life with these changes.

    Article  PubMed  Google Scholar 

  94. Sensenig J, Marrongelle J, Johnson M, Staverosky T. Treatment of migraine with targeted nutrition focused on improved assimilation and elimination. Altern Med Rev. 2001;6:488–94.

    CAS  PubMed  Google Scholar 

  95. Ramsden CE, Faurot KR, Zamora D, Suchimdran CM, Macintosh BA, Gaylord S, et al. Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain. 2013;154:2441–51.

    Article  CAS  PubMed  Google Scholar 

  96. Bunner AE, Agarwal U, Gonzales JF, Valente F, Barnard ND. Nutrition intervention for migraine: a randomized crossover trial. J Headache Pain. 2014;15:69.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Nada Hindiyeh and Sheena K. Aurora each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nada Hindiyeh.

Additional information

This article is part of the Topical Collection on Episodic Migraine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hindiyeh, N., Aurora, S.K. What the Gut Can Teach Us About Migraine. Curr Pain Headache Rep 19, 33 (2015). https://doi.org/10.1007/s11916-015-0501-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-015-0501-4

Keywords

Navigation