![](data:image/png;base64,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BAWwIAAKAtAQAA0JYAAACgLQEAANCWAAAAaEsAAAC0JQAAAGhLAAAAtCUAAADaEgAAAG0JAAAA2hIAAABtCQAAgLYEAABAWwIAAIC2BAAAQFsCAACgLQEAANCWAAAAoC0BAADQlgAAAGhLAAAAtCUAAABoSwAAALQlAAAA2hIAAABtCQAAANoSAAAAbQkAAIC2BAAAQFsCAACAtgQAAEBbAgAAoC0BAADQlgAAAKAtAQAA0JYAAABoSwAAALQlAAAAaEsAAAC0JQAAANoSAAAAbQkAAADaEgAAAG0JAACAtgQAAEBbAgAAgLYEAABAWwIAAKAtAQAA0JYAAACgLQEAANCWAAAAaEsAAAC0JQAAAGhLAAAAtCUAAADaEgAAAG0JAAAA2hIAAABtCQAAgLYEAABAWwIAAIC2BAAAQFsCAACgLQEAANCWAAAAoC0BAADQlgAAAGhLAAAAtCUAAABoSwAAALQlAAAA2hIAAABtCQAAANoSAAAAbQkAAIC2BAAAQFsCAACgLQEAAEBbAgAAoC0BAADQlgAAAGhLAAAA0JYAAABoSwAAALQlAAAA2hIAAAC0JQAAANoSAAAAbQkAAIC2BAAAAG0JAACAtgQAAEBbAgAAoC0BAABAWwIAAKAtAQAA0JYAAABoSwAAANCWAAAAaEsAAAC0JQAAANoSAAAAtCUAAADaEgAAgJ9JYgQAAAC6HsuAJ1jZAVxtAAAAAElFTkSuQmCC)
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)
PP
PP
P
athogenesis of headache in DC and GSathogenesis of headache in DC and GS
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 wouldWhere headaches related to CD/GS would
Where headaches related to CD/GS would
enter in classificationenter in classification
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