Migraine Linked to Celiac Disease

Laurie Barclay, MD

March 25, 2003

March 25, 2003 — About 4% of migraine sufferers may have celiac disease and symptom control may be improved with a gluten-free diet, according to the results of a study published in the March issue of the American Journal of Gastroenterology.

"If larger, randomized, controlled trials confirm these preliminary findings, serological screening for celiac disease could be proposed as part of management of migraine, and the gluten-free diet as the first-line therapy in the subgroup of patients with evidence of celiac disease," write Maurizio Gabrielli, MD, from Gemelli Hospital in Rome, Italy, and colleagues.

Of 90 patients diagnosed with idiopathic migraine, four (4.4%; 95% confidence interval [CI], 1.2 - 11.0%) had celiac disease, compared with 0.4% of 23 blood donors used as controls (95% CI, 0.01 - 2.3; P < .05). These four patients were treated with a gluten-free diet for six months. During that time, one had no migraine attacks, and migraine frequency, duration, and severity improved in the other three. All four patients had resolution of baseline regional reduction in brain tracer uptake on single-photon emission computed tomography scan.

"The improvement observed in both symptoms and cerebral blood flow after a gluten-free diet is intriguing," the authors write, noting that in this uncontrolled study, placebo effect could not be ruled out. "It needs to be clarified, however, whether celiac disease itself is associated with cerebral blood flow abnormalities, or whether these flow alterations are present only in those patients with both celiac disease and migraine. Also, one might argue that migraine has different underlying mechanisms in individuals who are affected by celiac disease versus those who are not."

Am J Gastroenterol. 2003;98:625-629

Reviewed by Gary D. Vogin, MD

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