Gluten and migraine-is there a link?

I was recently asked to review a book on the benefits of gluten-free diets. Gluten is a protein found in foods made with wheat and other grains.

Some people have an inherited autoimmune disease called celiac disease. People with celiac disease have a reaction in their intestines from gluten that reduces the body's ability to absorb food nutrients. When eating foods containing gluten these individuals will experience digestive complaints, like diarrhea, be unable to gain weight, and have problems related to poor nutrition.

Avoiding gluten results in the intestines being able to repair themselves so food can be properly absorbed. It's estimated that celiac disease affects about 3 million Americans. The diagnosis is made by testing for specific antibodies and a biopsy of the intestine.

Later this year, an article will be published in the Journal of Parenteral and Enteral Nutrition, clarifying the differences between celiac disease, wheat allergy, and gluten sensitivity. Here's a synopsis:

  • Celiac disease has been linked to increased risk for cancer and other autoimmune disorders and the only proven treatment is a gluten-free diet.
  • Wheat allergy is an allergy to wheat, improved by avoiding wheat. Avoiding other gluten-containing foods, like rye, barely, and oats, is not necessary.
  • Gluten sensitivity is not linked to a higher risk for cancer or other autoimmune diseases.
  • A gluten-free diet may improve symptoms for patients with celiac disease, wheat allergy, or gluten sensitivity.

Because of the obvious health benefits for people with celiac disease from eating a low-gluten diet, researchers have wondered if gluten intolerance may affect other medical conditions, including migraine. Here's a snapshot of a few recent studies:

  • In 2003, Italian researchers screened individuals with migraines and a control sample for celiac disease. Celiac disease was identified in 4 percent with migraine (four of the 90 patients tested) and less than 1/2 of one percent of the controls. When the four migraineurs with celiac disease followed a gluten-free diet, their migraines improved.
  • In 2005, doctors from Spain reported the case of a woman with infrequent headaches who started getting daily headaches, occasionally accompanied by abdominal pain and diarrhea. After carefully evaluating her lifestyle at the time of this change, it was recognized that her dramatic increase in headaches coincided with a dietary change where she had added several wheat biscuits to her morning breakfast. Eliminating the biscuits resulted in a return of her headaches to occurring only infrequently.
  • In 2009, researchers at the University of Marburg screened patients with celiac disease proven by intestinal biopsy for symptoms of nervous system disease. Most of the patients were women (86 percent). All participants were following a gluten-free diet. One in three individuals with celiac disease reported having migraines. (In a normal population sample, about one in five women and one in fifteen men have migraines.)
  • In 2011, Shiraz University of Medical Sciences researchers screened a group of children with migraines and a comparable group without migraines for celiac disease. Positive testing for celiac disease was found in 2 percent in both groups, showing no increased risk among those with migraine.

These studies highlight that there may indeed be a link between gluten and migraine, although the jury is still out on how strong of a link there might be and whether a gluten-free diet may be beneficial. People with gluten sensitivity, wheat allergy, or celiac disease may experience an improvement in both digestive and other health symptoms after following a gluten-free diet. Most studies, however, are needed before a gluten-free diet will become a general recommendation for most people with migraines.

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