Inflammation – The Link Between Celiac Disease & Headaches

There are many people who suffer from both celiac disease and headaches, and who believe the two conditions are related. They will frequently say that their headaches improve on a gluten-free diet. This connection has been reported for many years, but there is not a lot of research to support or explain the relationship. Most often a connection between migraine headaches and celiac disease is mentioned, but there may also be a relationship between celiac disease and other types of headaches.

Migraine headaches are also thought to be more common in people with inflammatory bowel disease. Both people with CD and inflammatory bowel disease have inflammation in the lining of their intestines. It has been suggested the many active chemicals released in response to this kind of inflammation may cause migraine headaches in susceptible people.

Migraine headaches used to be called “sick headaches.” They are, in fact, very common, and a large percentage of people will have at least one during their lifetime. The pain can be felt on one or both sides of the head, in the region of the temples, the back of the head, above the eyes, or even all over. The headache is a throbbing pain, because the blood vessels are involved. In what is called “classic migraines,” the headache is preceded by an aura, which is a disturbance in perception. Many auras are visual, described as wavy lines, shapes, lights or colors, but they can also be olfactory, meaning a smell. Visual aura sensations drawn by migraine sufferers are remarkably similar.

The aura occurs before the headache and usually goes away by the time the pain starts. Classical migraines usually occur on one side. Migraine pain can be very severe, and people suffering with the headache can also have nausea and vomiting. They are frequently sensitive to bright light and sometimes also loud sound. People who suffer from this kind of migraine do best in a dark, cool room where it is quiet. Sometimes if the person falls asleep, they wake up without a headache.

So-called common migraines do not have an aura and may not have all the accompanying symptoms. But they are usually more severe than every day “tension” headaches. Some people with headaches experience both common and classic migraines, as well as tension headaches and “mixed” headaches with a little of everything. Any of these can be a minor nuisance or completely debilitating. They can occur infrequently or very often, as frequently as every day.

Neither the mechanism that causes migraine headaches nor the reasons some people have them frequently are completely understood. Inflammation of the blood vessels seems to play a part. Sometimes people with migraines have a severe attack which does not go away for days. This can be treated with prednisone, which calms inflammation, and is also a treatment that can be used when inflammatory bowel disease is causing a lot of symptoms. It has been used in refractory celiac disease with some limited success.

All of these pieces of information contribute to the idea of a connection between celiac disease and migraine headaches. Research done at Columbia University and published in 2013 confirmed an association between migraines and both CD and inflammatory bowel disease in the group studied. The researchers looked at self-reported migraines in one group of patients with celiac disease and another with inflammatory bowel disease. These were compared with a group of controls, people who had neither intestinal disorder who were otherwise similar in terms of age, sex and other common variables.

502 patients were included in the study. Of these, 188 had celiac disease, while 111 had inflammatory bowel disease. 25 had non-celiac gluten sensitivity (NCGS), and 178 had no intestinal problems or diagnoses. The participants filled out a number of questionnaires, the first designed to make sure they fit the criteria for the study.

To determine the presence, severity and type of headaches, the subjects were asked about headaches and completed two questionnaires made to evaluate headaches, the ID-Migraine screening tool and the Headache Impact Test.

The researchers found evidence of an association between celiac disease, inflammatory bowel disease and non-celiac gluten sensitivity with both migraine headaches and chronic headaches of any type.

30% of the patients with celiac disease reported chronic headaches, while 56% of participants with NCGS reported chronic headaches. 23% of those with inflammatory bowel had chronic headaches. All of these numbers were compared with the frequency of chronic headaches in the control patients without any intestinal symptoms, 14% of whom had chronic headaches. The different rates were statistically significant.

In addition, more of the subjects with either celiac disease or inflammatory bowel disease reported migraine headaches in specific. 21% of the patients with CD had migraines, while 12% of those with inflammatory bowel syndrome had migraines, as compared with 6% of the control patients. The difference in migraines between people with celiac disease as opposed to those with no intestinal complaints (21% vs 6%) was therefore even greater than the difference in chronic headaches (30% vs 14%).

The patients with celiac disease reported more severe headaches. 72% of those with CD and headaches said that their migraines were severe, as opposed to 30% of patients with inflammatory bowel syndrome and headaches who said their headaches were severe. 60% of the study participants with headaches who had non-celiac gluten sensitivity reported severe headaches. Of the participants in the control group who had headaches, 50% reported that they were severe. Therefore, in this study, people with either CD or NCGS had the most severe headaches.

While there was no direct correlation between headaches and staying on a gluten-free diet, some of the study participants said that their migraines got less severe after they gave up gluten. Many celiac disease experts have heard this from their patients.

The authors of the study concluded that migraine headaches were more likely to occur in people with both celiac disease and inflammatory bowel disease. They stated that more studies should be done, for example screening people with migraine headaches for celiac disease, as well as trying to evaluate the effect of the gluten-free diet on the headaches of people with celiac disease.

One of the researchers, Dr. Peter Green, from New York City’s Columbia University said, “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. 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 intervention for migraine both in celiac and non-celiac patients.”

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References
Dimitrova MD, Ryan C. Ungaro MD, Benjamin Lebwohl MD, Suzanne K. Lewis MD, Christina A. Tennyson MD, Mark W. Green MD, Mark W. Babyatsky MD and Peter H. Green MD. Prevalence of Migraine in Patients With Celiac Disease and Inflammatory Bowel Disease.
Headache: The Journal of Head and Face Pain. Volume 53, Issue 2, pages 344–355, February 2013. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2012.02260.x/abstract
Sue Hughes. Migraine Increased in Celiac and Inflammatory Bowel Disease. Medscape Medical News > Neurology. February 28, 2013.