Tag Archives: celiac disease and headaches

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Celiac Disease and Headaches

I’ve been intending to write about the association between celiac disease and headaches over the last month, but every time I’ve sat down in front of my computer to start to write this post, I’ve given myself a headache :)

Seriously, though, I have had a lot of readers ask about whether or not headaches can be a symptom of celiac disease. Although I’ve always answered “yes,” because headaches are always on the lists of celiac symptoms, I had not dived into any of the research about this subject until now.

One of the first studies regarding celiac disease and headaches was published by a group of researchers from Columbia University in 2013.  The study group included 188 subjects with celiac disease and 25 subjects with non-celiac gluten sensitivity (NCGS).  Chronic headaches were reported by 30% of those with celiac disease and 56% of those with NCGS, while only 14% of the control group (n=178) reported having chronic headaches. A significant proportion of celiac subjects with chronic headaches also met criteria for having migraines.  The authors speculate that widespread inflammation and/or celiac antibodies attacking the nervous system may cause headache symptoms.

There was a larger scale study examining the association between celiac disease and headaches that was published earlier this year.  28,648 Swedish subjects with celiac disease were compared to 143,126 controls. The risk of headaches in subjects with celiac disease was significantly higher than in the controls (4.7% v 2.9%).  Interestingly enough, the investigators also found that subjects with elevated celiac antibodies but normal small intestinal biopsies (aka “potential” celiac) as well as subjects with intestinal inflammation, but not villous atrophy (the classic abnormality on small bowel biopsy in celiac disease), were also at a higher risk of having headaches.

Although the first two studies involved only adult patients with celiac disease, there has been some research showing an association between celiac disease and headaches in the pediatric population as well. The first was a well-designed Italian study published in 2009. 354 children with celiac disease were compared to 200 healthy controls. Almost 25% of the children with celiac suffered from headaches prior to their celiac diagnoses compared with only 8% of those without celiac.  Over ¾ of the children with celiac disease and headaches reported an improvement in headaches after going onto the gluten-free diet.  In addition, 5% of the control children with chronic headaches were found to have undiagnosed celiac disease. In another recent study a large sample of children attending a clinic for pediatric headaches were screened for celiac disease.  The prevalence of celiac disease in the children with chronic headaches was found to be twice as high as the general population (2.04% v 1.2%).

Some hypotheses regarding the link between celiac disease and headaches include that celiac-induced inflammation may spread to the brain and nervous system, that TTG antibodies can attack the nervous system, that they may be the result of long-standing vitamin deficiencies (i.e. B12, D, E, folic acid, and pyridoxidine) and/or lower than normal levels of serotonin, or might be due to an alteration of the microbiome (bacterial imbalance in the body).

In conclusion, there has been some solid research over the last few years that those of us with celiac disease have a higher risk of headaches than the general population, that patients with chronic headaches should probably be screened for celiac disease, and that following the gluten free diet may help to alleviate headache symptoms.

Have any of you with celiac disease or gluten sensitivity suffered from recurrent headaches either before or after diagnosis? If so, please feel free to share your story, as it will likely help a future reader. Thank you!

Happy End of Celiac Awareness Month too!

 

References

Dimitrova, AK, Ungaro, RC, Lebwohl, B, Lewis SK, Tennyson, C, Green, M, Babyatsky, MW, and Green, P.  (2013), Prevalence of Migraine in Patients with Celiac Disease and Inflammatory Bowel Disease. Headache: The Journal of Head and Face Pain, 53: 344-355.

Lebwohl, B, Roy, A, Alaedini, A, Green, PH, Ludvigsson, JF. Risk of Headache-Related Healthcare Visits in Patients with Celiac Disease: A Population-Based Observational Study.  Headache, Epub ahead of print on Mar 12, 2016.

Lionetti, E, Francavilla, R, Maiuri, L, et al. (2009), Headache in Pediatric Patients with Celiac Disease and its Prevalence as a Diagnostic Clue.  Journal of Pediatric Gastroenterology and Nutrition, 49(2): 202-207.

Nenna, R, Petrarca, L, Verdecchia, P, at al. (2016), Celiac Disease in a Large Cohort of Children and Adolescents with Recurrent Headache: A Retrospective Study.  Dig Liver Dis, 48(5): 495-498.

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Spring 2016 Celiac Research Round-Up

I figured that there’s no better way to celebrate the sixth anniversary of my celiac disease diagnosis (March 2010, I have no clue what my actual date of diagnosis was) than by scouting out the medical literature for interesting new articles. I love doing this, but lately it’s been on the back burner.

  1. “Risk of Headache-Related Healthcare Visits in Patients with Celiac Disease: A Population-Based Observational Study.” By Lebwohl, B, Alaedini, A, Green, P, and Ludvigsson, J. Published in the March 12, 2016 issue of Headache.

This was a retrospective study in which almost 30,000 Swedish patients with biopsy-confirmed celiac disease were compared with controls (people without celiac). The research team found that those with celiac disease had 50% more doctors’ visits for headaches than the control population did. Interestingly enough, patients with elevated celiac antibody levels, but normal biopsies (aka “potential” celiacs) also had a significantly higher risk of headaches.

Take Home Point(s): Patients with celiac disease have a high risk of headaches. Headaches can be a presenting symptom of celiac disease.

  1. “HLA typing using buccal swabs as accurate and non-invasive substitute for venipuncture in children at risk for celiac disease.” By Adriaanse, M, et al. Published in March 2016 issue the Journal of Gastroenterology and Hepatology.

The two main genes associated with the development of celiac disease are HLA-DQ2 and HLA-DQ8. Testing for the celiac genes is typically done via obtaining a blood sample (requiring a blood draw, which can be challenging in toddlers and young children). In this study researchers compared gene analysis from buccal swabs (tissue samples obtained from swabbing the inside of the mouth) vs blood samples. They found that the buccal samples were of good enough quality to do gene analysis in all 77 subjects who were tested.

Take Home Point: Celiac genetic testing can now be performed in children without having to have blood drawn. This testing can also be done at home.

  1. “Decrease by 50% of plasma IgA tissue transglutaminase antibody concentrations within 2 months after start of gluten-free diet in children with celiac disease used as a confirming diagnostic test.” By Lund, F. et al. Published in the April 2016 issue of the Scandinavian Journal of Clinical Lab Investigations.

This article’s title is a mouthful, so bear with me! In children with biopsy-confirmed celiac disease, TTG-IgA antibodies on average decrease by 50% after 2 months on the GF diet.  In this study researchers examined a group of children who had suspected celiac disease (high TTG-IGA antibodies and symptoms) but who went GF without ever having a small bowel biopsy.  They found that this group of children (suspected or presumed celiacs) also experienced a 50% decrease in celiac antibody levels after starting the GF diet.   The researchers conclude that the significant response to the GF diet can be used as a way to to diagnose celiac disease.

Take Home Point(s): TTG-IgA antibodies decrease by half after two months in children with celiac disease after the GF diet is initiated.  In the future, the response to the GF diet may be used as a way to diagnose celiac disease in children who have not had biopsies.

  1. Infant feeding and risk of developing celiac disease: a systematic review.By Silani, S., Agostini, C., Sanz, Y., and Guandalini, S. Published in BMJ Open on January 25, 2016.

The authors reviewed 16 studies for evidence for the association of breast feeding, breastfeeding duration or the timing of gluten introduction and the later development of celiac disease. They concluded there is no evidence on the optimal breastfeeding duration or the effects of avoiding early (<4 months of age) or late (≥6 or even at 12 months) gluten introduction in children at risk of celiac disease.

Take Home Point: At the present time, there is no scientific evidence that the timing of gluten introduction and/or breastfeeding can prevent the development of celiac disease.

  1. Celiac Disease and Drug-Based Therapies: Inquiry into Patients Demands.” By Branchi, F., et al. Published in the journal Digestion in Jan. 2016.

This was a survey of 372 Italian celiac patients. Although 88% of those sampled accepted the gluten-free diet as treatment, 65% believe there is a need for alternative therapies for treatment of celiac disease.

Take Home Point: Per the authors, The GF diet is favorably accepted by most celiac patients. Nevertheless, a proportion of patients pronounce themselves in favor of the development of alternative drugs.”

Have any of you came across any recent celiac research of interest? If so, please share in the comments section.