Abstract
Celiac disease (CD) is an immune-mediated disorder with various manifestations. The aim of this study was to evaluate the prevalence of gastrointestinal (GI) and extra-intestinal symptoms of celiac patients, especially migraine, and compare it with healthy individuals. We compared 1000 celiac subjects (CS) registered at our celiac center with the control group for headache-based on International Classification of Headache Disorders, third edition criteria and their GI symptoms. Besides, CS with migraine and non-migrainous headache were compared in terms of GI symptoms and accompanied conditions. Headache was more common in CS than controls (34% vs 27% respectively, P value<0.001) and more prevalent in females (71.9% in females vs 28% in males, P value = 0.004). Moreover, the prevalence of migraine in CS was higher than controls (20.7 vs 11.9% respectively, P value<0.001). Furthermore, migraine was more prevalent in females with CD (80% in females vs 19% in males, P value = 0.033), and often without aura (76%). Abdominal pain (76.9%, P value = 0.025), diarrhea (54.9%, P value = 0.002), and constipation (42.9%, P value = 0.011) were the most common GI symptoms in CS with headache and more prevalent in CS with migraine. Conversely, type 1 diabetes mellitus was less common in CS with migraine than in CS with non-migrainous headache. (P value = 0.001). On multivariate logistic regression analysis, female sex (OR 1.50, 95%CI 1.22-1.83, P value < 0.001), and CD (OR 1.36, 95%CI 1.12-1.65, P value = 0.002) were independent predictors of headache, whereas age more than 60 years (OR 0.70, 95%CI 0.50-0.97, P value = 0.032) had a protective effect. Headache especially migraine is more prevalent in CS than healthy controls. In addition, abdominal pain, diarrhea, and constipation are more common in CS with migraine than in CS with non-migrainous headaches. Therefore, evaluation of CD in patients with migraine and these simultaneous GI symptoms seems reasonable.
Highlights
Celiac disease (CD) affects about 1% of the population worldwide [1]
Headache was more common in celiac subjects (CS) than controls (34% vs 27% respectively, P value
Type 1 diabetes mellitus was less common in CS with migraine than in CS with non-migrainous headache. (P value = 0.001)
Summary
Celiac disease (CD) affects about 1% of the population worldwide [1] It is an immune-mediated disorder occurs in genetically predisposed people after a gluten exposure [2]. The exact pathophysiology of migraine is not fully understood [16,17], the level of pro-inflammatory cytokines like tumor necrosis factor alpha (TNF α) and interleukin 1 Beta (IL 1β) have been increase in serum of patients during migraine attack [18]. These substances cause migraine attack by affecting the trigeminal nerve nociceptors. Some evidence show that migraine are dramatically improved by treatment of the underlying GI disease (i.e. Gluten- free diet in CD) [23,26,27]
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