Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet

Aims: To describe headache characteristics among celiac disease (CD) patients and to analyze the relationship between CD and headache. Methods: An online survey analyzing the characteristics of headache and its response to the glutenfree diet (GFD) in celiac patients was published on Argentinean Celiac social networks, open to the public to complete. The results were analyzed using chisquare test or Mann-Whitney test accordingly. Results: A total of 1,517 subjects completed the survey, and 866 (55.2%) met the inclusion criteria (headache and CD confirmed with positive biopsy). The subjects were predominantly female (94.5%) and had a median age of 39 ± 11.27 years. Tension-type headache was the most prevalent headache type (52%), followed by migraine without (32.5%) and with aura (15.4%), respectively. Of the included participants, 24% reported headache as the main symptom that resulted in the diagnosis of CD. Following initiation of GFD, headache frequency and intensity improved significantly more in participants with migraine than tension-type headache (P = .02 and P = .013, respectively). Compliance to GFD was higher among subjects with severe manifestations (77% vs 66%, P = .05), and compliant individuals showed a 48% improvement in headache frequency (P = .049). An association between food transgressions and headache was better recognized by migraineurs (P = .02). Conclusion: These results suggest that strict compliance to the GFD could improve headache in celiac patients with headache, even in those without gastrointestinal symptoms. This observation could provide an additional factor when convincing patients to follow a GFD, thus reducing the morbidity related to CD. Keywords: celiac disease, gluten, gluten-free diet, headache, migraine, migraine with aura