102 Headache Medicine, v.4, n.4, p.102-104, Oct./Nov./Dec. 2013

Headache and celiac disease or gluten sensitivity –

a review

Cefaleia e doença celíaca ou sensibilidade ao glúten – uma revisão

VIEW AND REVIEWVIEW AND REVIEW

VIEW AND REVIEW

ABSTRACTABSTRACT

ABSTRACT

The aim of this study is to do a review of the relationship of

celiac disease (CD) or gluten sensitivity (GS) with headache.The

authors conclude that there is a connection between

headaches and gluten intolerance.

KeywordsKeywords

Keywords: Headache; Gluten; Migraine

RESUMORESUMO

RESUMO

O objetivo do estudo foi fazer uma revisão sobre a relação

da doença celíaca (DC) ou sensibilidade ao glúten (GS) com

as cefaleias em geral. Os autores concluem que existe

associação entre cefaleia e intolerância ao glúten.

alavrasalavras

alavras

chavechave

chave: Cefaleia; Glúten; Migrânea

disease. It is associated with the genes of the main

histocompatibility complex (MHC) and, in particular, to

the HLA-DQ2 or HLA-DQ8 allelic variants. The intestinal

lesion is mediated by humoral and cellular components

of the immune response. The existing treatment is a diet

free of prolaminas, especially gluten.

The diagnosis is established by the demonstration of

the histological characteristics of the duodenum changes.

(1)

In gluten sensitivity (GS), there are gastrointestinal and

extraintestinal symptoms, and the tests usually do not meet

histological alterations of the mucous membrane of the

small intestine and autoimmune antibodies [tissue

transglutaminase (tTG) and endomysial (EMA)]; However,

an increased level of anti-gliadinal antibodies (AGA) is

frequently observed. In GS, allergy to gluten is also absent.

The exact criteria for the diagnosis of this nosology is not

identified, but most researchers believe that the prevalence

of gluten intolerance is much higher than of celiac disease.

A gluten free diet leads to the disappearance of clinical

symptoms.

Population studies indicate that between 0.5% and

1% of the population of Western Europe and North

America, respectively, suffer from CD. This corresponds

to about three to six million people, and the largest part

of them remain undiagnosed.

(2)

Most complaints related to CD or GS have no

familiarity in the case of headaches. None of the authors

say migraine headache, they just say headache. In other

words the headache, probably by homeostatic-metabolic

changes of the disease, might be migraine-like.

Eliana Meire Melhado, Ana Carolina Botelho Cardoso, Stella Regina Mastrangi Ignácio Ribeiro,

Mariana de Lima Frachia, Thaís Figueiredo de Castro

Integrated Medical School of Catanduva – FIPA – Catanduva, SP, Brazil

Melhado EM, Cardoso AC, Ribeiro SR, Frachia ML, Castro TF. Headache and celiac disease or

gluten sensitivity – a review. Headache Medicine. 2013;4(4):102-4

INTRODUÇÃO

Celiac disease (CD) is an absence of intestinal

peptidase that digest gluten protein, whose intolerance

results in a total or subtotal atrophy of the proximal small

intestine causing malabsorption of nutrients. Gluten,

derived from the Latin gluten is the main ingredient for a

wide variety of pastas and breads, it is an amorphous

protein composed by mixing long protein chains of gliadin

and glutenin.

Interaction between genetic, immunological and

environmental factors account for the heterogeneity of the

Headache Medicine, v.4, n.4, p.102-104, Oct./Nov./Dec. 2013 103

The aim of this study is to do a review of the

relationship of celiac disease (CD) or gluten sensitivity (GS)

with headache.

METHODS

The method used was searching scientific literature.

We researched articles and bibliographic reference on

the internet. Bireme, MedLine, Scielo, Lilacs and PubMed

are websites that we used. The articles were requested

in their entirety through the College Library.

Bibliographic sources were cited by the Vancouver

guidelines.

RESULTS

In a German study of 72 patients (that were recruited

through advertisements in the Journal of the German

Celiac Society), 28% of them with CD reported

migraines. In most cases there was no decrease in the

frequency and intensity of migraine crises after the

introduction of gluten free diet.

(1)

In an Italian study taken between 2003 and 2006,

there was a retrospective portion, which included patients

with diagnosed CD in Bari and Catania. All patients

(and their caregivers) received a questionnaire asking

how their headaches were before their diagnosis. Among

them, 88 (24.8%) with CD complained of headaches

before the diagnosis of CD versus 16 (8%) from the

control group. After introducing a gluten free diet, 77.3%

showed an improvement in headaches (27.3%

disappeared), and 23.9% did not improve. In almost

50% of children who did not improve, diet adherence

was poor.

In the prospective study, there were 67 children with

diagnosed headaches between 2002 and 2005. They

were followed by the Department of Pediatrics of Catania

and agreed to perform a screening for CD between 2006-

2007. Only 4 of 79 children (5%) were positive TgA and

EmA, and the biopsies confirmed diagnosis of CD (injury

March IIIB). None complained of gastric symptoms

suggestive of CD, it was impossible to identify headaches

with some food or a meal. Therefore, the prevalence of

CD was high in these patients with headache, 5% versus

0.6% of the population in the same geographical area,

featuring comorbidity.

(3)

An Israeli study conducted between 1977 and 2001

included 111 patients with DC (with biopsy) and 211

controls. The patients were an average age of 20. In both

groups the majority of patients were women (58% of the

patients versus 59% in the control group). 52.5% of

patients with mal absorption syndrome featured classic

CD. 51.4% of patients had neurologic manifestations

versus19% of the control group, the most common

neurological disorder being headache at 18%. There

was a predominance of female headaches (2.1: 1 F:M),

and 64.5% of patients with headaches started CD later

or were asymptomatic; therefore, 35.5% had classic CD

during childhood. And as for the headaches, 45% meet

criteria for migraine; 19.4% for tension-type headache;

and 35.5% had headaches that could not be specified.

In 16 patients (80%) the headaches disappeared or

improved with gluten free diet.

(4)

athogenesis of headache in DC and GSathogenesis of headache in DC and GS

athogenesis of headache in DC and GS

Association between headache and CD may be due

to a long state of malnutrition, leading to vitamin deficiency

and to lower levels of serotonin, a well-known cause of

headache. There is a hypothesis in which an autoimmune

process and immunoinflammatory disorder would induce

a vascular tonus disordered (CD and migraine) this was

supported by the study of positron emission tomography

(PET) Scans, demonstrating the presence of abnormalities

of cortical regional blood flow, improved after 6 months

of gluten free diet in adult patients with CD and migraine

with aura.

(5)

Where headaches related to CD/GS wouldWhere headaches related to CD/GS would

Where headaches related to CD/GS would

enter in classificationenter in classification

enter in classification

These headaches would best be classified under item

10. Headaches attributed to homeostasis disorders, and

sub-item 10.7 Headaches attributed to other homeostasis

disorders.

(6,7)

CONCLUSIONS

` There is a connection between headaches and

gluten intolerance;

` Headache related to CD/GS would be headache

attributed to homeostasis disorder;

` CD and GS appear to be triggering factor of

migraines and do not have a spurious association; and

` The highest percentage of headache in celiacs

relative to the control group in most studies indicates that

these entities are comorbidities.

HEADACHE AND CELIAC DISEASE OR GLUTEN SENSITIVITY – A REVIEW

104 Headache Medicine, v.4, n.4, p.102-104, Oct./Nov./Dec. 2013

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Correspondência

Eliana Meire MelhadoEliana Meire Melhado

Eliana Meire Melhado

neuroeliana@hotmail.com

Received: September 17, 2013

Accepted: December 2, 2013

MELHADO EM, CARDOSO AC, RIBEIRO SR, FRACHIA ML, CASTRO TF