Study Assesses Migraine Prevalence in Celiac Disease

Migraine is more prevalent among individuals with celiac disease (CD) compared with healthy controls, while symptoms such as abdominal pain, diarrhea, and constipation are more common in patients with CD and migraine than in patients with CD and nonmigrainous headaches, according to the results of a cross-sectional study conducted in Iran. Findings were published in Plos One.

Approximately 1% of the global population has CD, an immune-mediated disorder that typically occurs in genetically predisposed individuals after a gluten exposure, the researchers wrote. “CD can present with typical gastrointestinal (GI) symptoms, such as bloating or diarrhea; or with atypical extra-intestinal manifestations, such as neurological disorders; or it may be silent or asymptomatic,” they added.

Previous studies have found migraine can be improved with treatment of an underlying GI disease, although limited investigations have been performed of the association of migraine with CD, specifically in the Iranian population.

To address this knowledge gap, the researchers conducted a case-control, cross-sectional multicenter study and assessed data from over 1000 individuals with CD over the age of 18. All participants were enrolled in a celiac registry center between 2014 and 2019 and had a mean (SD) age of 41.16 (15.12) years.

“The control group included 1000 healthy individuals over 18 years of age (mean 40.27 [14.95]) with negative celiac serologic markers and/or duodenal mucosal biopsy, who were recruited from hospital staff (physicians and nurses), friends, as well as patients’ family members,” the authors said.

Any individual with a history of inflammatory bowel disease, head trauma, brain tumor, or other head or neck surgery was excluded from the final cohorts. The majority of those who reported headache in the CD and control groups were female (71.9% and 60.9%, respectively). In addition, 20.7% of patients in the CD group and 11.9% of those in the control group had migraine (P < .001).

Analyses revealed:

• Headache was more common in CD than controls (34% vs 27% respectively; P < .001) and more prevalent in females than males (71.9% vs 28%; P = .004)
• Migraine was more prevalent in females with CD than in males (80% vs 19%; P = .033), and often without aura (76%)
• Abdominal pain (76.9%; P = .025), diarrhea (54.9%; P = .002), and constipation (42.9%; P = .011) were the most common GI symptoms in CD with headache and more prevalent in CD with migraine
• Type 1 diabetes was less common in CD with migraine than in CD with nonmigrainous headache (P = .001)
• Female sex (odds ratio [OR] 1.50; 95% CI, 1.22-1.83; P < .001) and CD (OR. 1.36; 95% CI, 1.12-1.65; P = .002) were independent predictors of headache, whereas age above 60 years (OR, 0.70; 95% CI, 0.50-0.97; P = .032) had a protective effect

Findings are in accordance with results of previous research that indicate an increased presence of migraine in CD and suggest factors other than genetic susceptibility and gluten exposure may play a role in headache occurrence in patients with CD. “It is important to note that, regardless of CD, migraines can be associated with some GI symptoms that may be helpful in understanding their physiopathology,” the authors said.

Different sex distribution between groups and lack of data on serologic markers, such as antineuronal antibodies, mark limitations to the analysis. In the future, “performing a brain imaging study in celiac patients with migraine before and after the start of a gluten-free diet can be useful in better understanding the physiopathology of migraine in these patients,” they concluded.

Reference

Fanaeian MM, Alibeik N, Ganji A, Fakheri H, Ekhlasi G, Shahbazkhani B. Prevalence of migraine in adults with celiac disease: a case control corss-sectional study. PLoS One. Published online November 17, 2021. doi:10.1371/journal.pone.0259502