Gluten: a family of proteins found in grains, including wheat, rye, spelt, and barley.
Celiac Disease: an autoimmune condition that can cause damage to the intestines if gluten is not eliminated from the diet.
Gluten Sensitivity: may cause digestive symptoms similar to those of people with celiac disease but does not cause intestinal damage or trigger the production of antibodies to gluten.
Your Gluten Migraine Connection
Many people may not be aware that migraine headaches can impact the gastrointestinal system. Celiac disease is one of many GI disorders associated with migraine. I have a lot of patients who ask about gluten and its impact on migraine frequency and severity. Various studies have examined the relationship between celiac disease, migraine, and the effect of a gluten-free diet.
Migraine as a Symptom of Celiac Disease
We know that migraine is more prevalent in those people with celiac disease and that headache can be an early symptom of the disease. In one of many peer-reviewed studies, the estimated prevalence of headache in adults with celiac disease was 26%.
Migraine as a Symptom of Non-Celiac Gluten Sensitivity
The relationship between migraine and non-celiac gluten sensitivity hasn’t been well established. In one study of children and adults with gluten sensitivity, a significant percentage of patients noted an association with headache. Overall, there is limited evidence to suggest that consuming only gluten-free foods is beneficial for chronic headaches in this population.
How Does Gluten Trigger Migraines?
Migraine and GI disorders share a complex connection. Celiac disease is one such autoimmune disorder in which the ingestion of gluten arouses an aggressive reaction from the immune system, damaging parts of the small intestine’s lining and releasing pro-inflammatory chemicals – particularly CGRP – that are known triggers for migraine headaches.
In patients with non-celiac gluten sensitivity, the mechanism isn’t clear. It is possible that gluten triggers some inflammatory gut response in gluten-sensitive people. However, further research is needed.
Get Tested for Celiac Disease
I do not routinely test migraine patients for celiac disease. I do, however, screen for symptoms of gluten sensitivity and refer for testing if present. Gastrointestinal symptoms of gluten intolerance can include diarrhea, bulky and foul-smelling stool, stool that floats at the top of the toilet bowl, and excessive gas. A strong family history of celiac disease may also prompt me to refer a migraine patient for testing.
The Role of a Gluten-Free Diet
For confirmed celiac disease, gluten- elimination diet is always recommended. There is also evidence that patients with diagnosed celiac disease that experience more migraine headaches and switch to a gluten-free diet tend to have fewer and less severe migraine attacks.
Non-celiac gluten sensitivity is much trickier as there is a paucity of data on whether a gluten-free diet improves migraine. Given the risk factors and lack of data, plus the potential health and financial ramifications of going gluten-free, I don’t usually recommend it in the absence of other symptoms of celiac disease.
In my practice, I have seen a handful of patients without celiac disease swear that their often severe headaches had improved after several weeks of cutting out gluten. However, the effect in most seemed short-lived, and the gluten-free diet was difficult for them to sustain.
The Downsides of Going Gluten Free
Going gluten-free is not necessarily the “healthier” alternative that people like to think it is. Gluten-free products tend to be higher in fat, carbohydrates, and sodium and tend to promote weight gain. They are also lower in fiber, iron, and other important vitamins. Aside from differences in nutritional content, gluten-free products are often higher-priced than gluten-containing foods and may cause a financial burden.
Dietary modification is part of a comprehensive treatment plan for a migraine headache; patients can make many diet changes on their own. However, a gluten-free diet is a serious lifestyle change recommended only for those who need it. Thus, discussing it with your doctor first is important.
Other Dietary Modifications for Migraine Headaches
Other dietary modifications for migraine can include avoiding certain substances known as “food triggers.” These are foods that may trigger migraine headaches in some people, such as caffeine, MSG, nitrites (ex., cured meats), alcohol (especially red wine), aspartame, citrus fruits, aged cheese, and chocolate. However, the evidence is overall relatively poor.
In my experience, we are rarely able to find foods that consistently trigger migraine attacks. Plus, searching for one food that triggers can be stressful, and that stress alone can trigger a migraine attack. That said, if you feel like one or more foods may trigger your migraines, you can try to eliminate them and see how that affects your symptoms over a few weeks.
Additionally, eating regular meals and snacks every four to six hours throughout the day is important for maintaining energy levels and preventing hunger-related headaches. Eating a balanced diet with adequate amounts of fruits, vegetables, and whole grains is also recommended. Lastly, drinking enough water and other fluids throughout the day can help to prevent dehydration-induced headaches.
Take Home Points
We have explored the potential relationship between celiac disease, non-celiac gluten sensitivity, and migraine. To recap, there is a clear association between celiac disease and migraine, while the connection between non-celiac gluten sensitivity and migraine headaches remains inconclusive.
So, could gluten or other foods in your diet trigger those painful migraine attacks? If investigating food triggers or making dietary changes seems overwhelming, a headache specialist (like me!) can help. Schedule an appointment today and get on track for healthier, happier days!