Headache Associated with Coeliac Disease: A Systematic Review and Meta-Analysis

Abstract

Objective: The aim of this systematic review was to explore the relationship between coeliac disease (CD) and headache. The objectives were to establish the prevalence of each entity amongst the other, to explore the role of gluten free diet (GFD), and to describe the imaging findings in those affected by headaches associated with CD. Methodology: A systematic computer-based literature search was conducted on the PubMed database. Information regarding study type, population size, the age group included, prevalence of CD amongst those with headache and vice versa, imaging results, the nature of headache, and response to GFD. Results: In total, 40 articles published between 1987 and 2017 qualified for inclusion in this review. The mean pooled prevalence of headache amongst those with CD was 26% (95% CI 19.5–33.9%) in adult populations and 18.3% (95% CI 10.4–30.2%) in paediatric populations. The headaches are most often migraine-like. In children with idiopathic headache, the prevalence of CD is 2.4% (95% CI 1.5–3.7%), whereas data for adult populations is presently unavailable. Brain imaging can be normal, although, cerebral calcifications on CT, white matter abnormalities on MRI and deranged regional cerebral blood flow on SPECT can be present. GFD appears to be an effective management for headache in the context of CD, leading to total resolution of headaches in up to 75% of patients. Conclusions: There is an increased prevalence of CD amongst idiopathic headache and vice versa. Therefore, patients with headache of unknown origin should be screened for CD, as such patients may symptomatically benefit from a GFD.

Neurologic Deficits in Patients With Newly Diagnosed Celiac Disease Are Frequent and Linked With Autoimmunity to Transglutaminase 6

“…A similar percentage improvement (75%) was reported in a recent systematic review of headaches in patients with CD. 25 The observation of a high prevalence of white matter abnormalities in patients with CD also was reported in a smaller study of 17 patients who were on a GFD. 26 The concern regarding the white matter abnormalities on MRI is their potential contribution to cognitive decline.…”

Gut-brain Axis and migraine headache: a comprehensive review

“…A "nutritional-microbial-epithelial-neuronal" akin to "environmental-luminal-mucosal-neuronal" brain network may be responsible for these extra-intestinal manifestations [102]. Studies have shown that patients with CD have higher prevalence of migraine compared with healthy controls and vice versa [103,104]. It is estimated that about 21-28% of patients with CD have migraine [104][105][106].…”

“…It is estimated that about 21-28% of patients with CD have migraine [104][105][106]. Migraine-like headache may represent the initial feature of CD [103,[107][108][109]. Some studies suggest that evidence of occipital and parieto-occipital calcifications and white matter abnormalities at brain neuroimaging are associated with comorbid CD in subjects with migraine [103,[110][111][112].…”

“…Migraine-like headache may represent the initial feature of CD [103,[107][108][109]. Some studies suggest that evidence of occipital and parieto-occipital calcifications and white matter abnormalities at brain neuroimaging are associated with comorbid CD in subjects with migraine [103,[110][111][112]. Clinicians may consider to search for CD in subjects with migraine in the presence of such alterations especially if other symptoms suggestive of CD are present.…”

“…The association between migraine and CD may be attributed to several concurrent mechanisms including proinflammatory cytokines induced by gluten (e.g. IFN-and TNF-that are thought to enhance CGRP levels), lack of vitamins and macro elements due to malabsorption, vascular tone disturbances, nervous system hypersensitivity, brain hypoperfusion and perivascular inflammation [18,103,[113][114][115][116][117]. It was also suggested that CD treatment may improve headache [118].…”