Migraine Increased in Celiac and Inflammatory Bowel Disease

February 28, 2013

Patients with celiac disease or inflammatory bowel disease appear to have an increased prevalence of migraine, a new study shows.

Senior author Peter H. Green, MD, Columbia University, New York, said he was expecting to see a higher incidence of migraine in patients with celiac disease, but the increased migraine rate in those with inflammatory bowel disease was a "complete surprise."

"We primarily wanted to study migraine rates in celiac patients as there have been several reports suggesting celiac patients may have an increased prevalence of headaches, but no studies have included a control group," Dr. Green told Medscape Medical News. "We included two control groups — one made up of healthy volunteers and another made up of patients with inflammatory bowel disease because we wanted a GI [gastrointestinal] disease control as well. We didn't think the inflammatory bowel disease group would actually show a high rate of migraine too."

The study is published in the February issue of Headache.

Mechanism Could Be Inflammation?

Dr. Green said the results generated some interesting ideas about the mechanisms involved. "Celiac disease is known to have some neurologic manifestations, such as peripheral neuropathy and ataxia. Migraine may be another one of these symptoms. But we don't know whether gluten is the link, or if it is inflammation mediated," he said. "The fact that we also found an increased risk of headache in inflammatory bowel disease patients suggests it could be inflammation, unless there is a different mechanism associated with each condition."

The current study included 502 participants: 188 with celiac disease, 111 with inflammatory bowel disease, 25 with gluten sensitivity, and 178 controls. They undertook a survey containing clinical, demographic, and dietary data, as well as questions about headache type and frequency. The ID-Migraine screening tool and the Headache Impact Test (HIT-6) were also used.

Results showed that chronic headaches were reported by 30% of patients with celiac disease, 56% of gluten-sensitive participants, 23% of patients with inflammatory bowel disease, and 14% of controls.

On multivariate logistic regression, those with celiac disease, gluten sensitivity, and irritable bowel disease all had significantly higher prevalence of migraine headaches compared with controls.

Table. Risk for Migraine With Gastrointestinal Conditions

Condition Odds Ratio (95% Confidence Interval)
Controls 1.0 (reference)
Celiac disease 3.79 (1.78 - 8.10)
Gluten sensitivity 9.53 (3.24 - 28.09)
Inflammatory bowel disease 2.66 (1.08 - 6.54)

 

Female sex, depression, and anxiety were other independent predictors of migraine headaches, whereas age older than 65 years was protective.

Migraine was graded as severe by 72% of those with celiac disease, 60% of those with gluten sensitivity, 30% of those with inflammatory bowel disease, and 50% of controls. "The migraines experienced by celiac disease patients appear to be more debilitating compared with those in the other groups, and thus may represent a separate phenotype," the researchers suggest.

There was no correlation between years on gluten-free diet and migraine severity, but some patients reported migraine improvement or resolution after starting a gluten-free diet.

Dr. Green said that this study did not focus on whether a gluten free diet is associated with an improvement in migraine, but he noted that several of his patients report that it does.

"People often look to natural therapies for migraine, they try giving up red wine and chocolate. Why not try giving up gluten? It is not an unreasonable idea," he said. "Many people are trying gluten-free diets at the moment, and several people have noticed that their migraine appears to improve on this diet. But these are just anecdotal reports. We need more studies to evaluate the gluten free diet as a possible prophylactic intervention for migraine both in celiac and nonceliac patients."

Future studies should also test patients with migraine for celiac disease, particularly those with severe and treatment-resistant headaches, the researchers add.

Dr. Green has received personal compensation for activities with Alvine Pharmaceuticals and ImmusanT as a participant on an advisory board.

Headache. 2013;53:344-355. Abstract

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