Migraine (Headache)

What Is Migraine?

[dropcap]M[/dropcap]igraine is a neurologic disorder characterized by reduced cerebral blood flow that causes a severe headache. The pain is usually on one side of the head, pulsates, and is aggravated by bodily exertion that increases blood pressure.

The type of migraine can be classic with an aura or non-classic without an aura.

Classic migraine begins with an aura that develops over minutes and may last up to an hour before, during, or after the headache. Some people can tell when they are about to have a migraine because they see flashing lights or zigzag lines or they temporarily lose their vision.

Q: What does the aura signify?

A: According to the International Headache Society, an aura signifies an area of brain dysfunction. An aura is different from a trigger. A trigger brings on a migraine while an aura is a response to decreased blood flow.

A study investigating what triggers a migraine found these statistics in 1027 participants of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently).

The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%).¹

Migraine affects about 12% of the U.S. general popululation. It is three times more common in women than in men.

What Is Migraine In Celiac Disease and/or Gluten Sensitivity?

• Relationship between migraine and celiac disease. Migraine headache is an atypical neurologic disorder of celiac disease.
• Relationship between migraine and blood flow in the brain. A CT (cat scan) study investigating blood flow in the brain of patients with celiac disease at diagnosis demonstrated a regional baseline reduction in brain tracer uptake in all patients with celiac disease which completely resolved at 6 month follow-up for patients on a gluten free diet.²
• Relationship between migraine and other neurologic presentations of celiac disease. A study by Diaconu et al. investigating the incidence of neurologic manifestations in 48 children aged 2-18 years diagnosed with celiac disease found that 16 children presented one or more neurologic symptoms as the onset manifestation of celiac disease and that headache/migraine was the most frequent.³

How Prevalent Is Migraine In Celiac Disease and/or Gluten Sensitivity?

• A significant proportion of patients with migraine (4.4%) have celiac disease.⁴
• In a study of 72 patients with biopsy proven celiac disease, Bürk et al. found migraine in 28%.⁵

What Are The Symptoms Of Migraine?

Migraine headache is marked by these symptoms:

• Periodic, usually one-sided pulsing pain with, or without, aura such as zigzag lines or flashing light.
• Nausea.
• Sensitivity to light and noise.
• Increased pain with physical exertion.

How Does Migraine Develop In Celiac Disease and/or Gluten Sensitivity?

• Migraine headache results from unclear etiology involving gluten exposure in celiac disease and malabsorption of magnesium.
• A single photon emission CT study investigating cerebral perfusion (blood flow) demonstrated a regional baseline reduction in brain tracer uptake in all patients with celiac disease which completely resolved at 6 month follow-up for patients on a gluten free diet.²
• A study screening neurologic disorders in children and young adults demonstrated that 35.5% migraine patients had classical early infantile enteropathic celiac disease and 64.5% presented with late-onset symptoms, showing malabsorption did not play a significant role in the pathogenesis.⁶

Does Migraine Respond To Gluten-Free Diet?

Yes. Gluten free diet leads to normalization of blood flow and resolution or improvement in frequency, duration, and intensity of migraine within 6 months.⁷

6 Steps To Improve Migraine In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both migraine and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁸
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain prescription drugs can cause nutritional deficiencies that can affect migraine. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTIVIRAL AGENTS

• Foscanet depletes Magnesium.

ANTIBIOTICS  disrupt intestinal permeability.

• Tetracyclines deplete Magnesium.

ANTI-INFLAMMATORIES  disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Magnesium.

FEMALE HORMONES disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Magnesium.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete magnesium.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete magnesium.
• Loop Diuretics (Lasix®, Bume®x, Edecrin®) deplete magnesium.

[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Chelated magnesium as prescribed by your physician. Best not to take without other supplements for best absorption.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table. [/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Migraine In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Celiac disease with neurologic manifestations in children.” This study investigating the incidence of neurologic manifestations in 48 children aged 2-18 years diagnosed with celiac disease found that 16 children presented one or more neurologic symptoms as the onset manifestation of celiac disease. The neurologic signs in order of frequency were: headache/migraine, attention-deficit/hyperactivity disorder, epileptic seizures, mental retardation, cerebellar ataxia and behavior disorders. Brain CT-scan showed cerebral calcifications in 3 patients with epilepsy, and atrophy in 2 cases with cerebellar ataxia.

The diagnosis of celiac disease was made by serological tests and intestinal biopsy. The study protocol included: measurement of weight and height, biological and immunological tests, histological examination, questionnaires filled out by parents about their child motor development and some neurologic signs, psychological exam, electroencephalogram, and brain CT-scan.

All children received gluten free diet, but a favorable course was noticed only in the children with migraine and epilepsy, in the other patients this diet having no influence on neurologic symptoms.

This study proved the variety of neurologic symptoms that can be included in the clinical signs of celiac disease in pediatric patients. That is why in the presence of different neurologic symptoms of unknown etiology and resistant to treatment, celiac disease must be taken into account and laboratory investigations have to include intestinal biopsy and immunological test.³

“Neurological symptoms in patients with biopsy proven celiac disease.” This study investigating the prevalence  of neurological problems in celiac disease found that migraine is common, occurring in 28% of these patients.

Most studies in this field are focused on patients under primary neurological care. To exclude such an observation bias, patients with biopsy proven celiac disease were screened for neurological disease. A total of 72 patients with biopsy proven celiac disease were recruited through advertisements. All participants adhered to a gluten-free diet.

Patients were interviewed following a standard questionnaire and examined clinically for neurological symptoms. Medical history revealed neurological disorders such as migraine (28%), carpal tunnel syndrome (20%), vestibular dysfunction (8%), seizures (6%), and myelitis (3%). Physical examination yielded stance and gait problems in about one third of patients that could be attributed to afferent ataxia in 26%, vestibular dysfunction in 6%, and cerebellar ataxia in 6%. Other motor features such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus were infrequent. 35% of patients with celiac disease showed deep sensory loss and reduced ankle reflexes in 14%.¹⁰

“The triggers or precipitants of the acute migraine attack.”  This study investigating the triggers of acute migraine attack found that triggers were more likely to be associated with a more florid acute migraine attack. Differences were seen between women and men, aura and no aura, episodic and chronic migraine, and between migraine and probable migraine.

Patients rated triggers on a 0-3 scale for the average headache. Demographics, prodrome, aura, headache characteristics, postdrome, medication responsiveness, acute and chronic disability, sleep characteristics and social and personal characteristics were also recorded. One thousand two hundred and seven patients with International Classification of Headache Disorders-2 (1.1-1.2, and 1.5.1) were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%).¹¹

“Association between migraine and celiac disease: results from a preliminary case control and therapeutic study.” This single photon emission CT study investigating cerebral perfusion demonstrated a regional baseline reduction in brain tracer uptake in all patients with celiac disease which completely resolved at 6 month follow-up for patients on a Gluten Free Diet.¹²

“Range of Neurologic Disorders in patients with celiac disease.” This study screening neurologic disorders in children and young adults demonstrated that 35.5% migraine patients had classical early infantile enteropathic Celiac Disease and 64.5% presented with late-onset symptoms, showing malabsorption did not play a significant role in the pathogenesis.⁶

CASE REPORT SUMMARIES

“Migraine, cortical blindness, multiple cerebral infarctions and hypocoagulapathy in celiac disease.” This case report describes a patient with untreated Celiac Disease who presented with a state of acute migraine accompanied by multiple neurologic deficits including transient cortical blindness with CT and MRI alterations, and hypocoagulation due to factor VII deficiency. She was receiving estroprogestin therapy. There was a prompt response to cortisone therapy followed by a state of complete well-being, which also led to the disappearance of migraine attacks after 5 years of dietary treatment alone.¹³

Sources:

1. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007 May;27(5):394-402. Epub 2007 Mar 30. [↩]
2. Gabrielli M, Cremonini F, Fiore G, et al. Association between migraine and celiac disease: results from a preliminary case control and therapeutic study. American Journal of Gastroenterology. Mar 2003;98(3):625-9. [↩] [↩]
3. Diaconu G, Burlea M, Grigore I, Anton DT, Trandafir LM. Celiac disease with neurologic manifestations in children. Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94. [↩] [↩]
4. Gabrielli M, Cremonini F, Fiore G, et al. Association between migraine and celiac disease: results from a preliminary case control and therapeutic study. American Journal of Gastroenterology. Mar 2003;98(3):625-9. [↩]
5. Bürk K, Farecki ML, Lamprecht G, Roth G, Decker P, Weller M, Rammensee HG, Oertel W. Neurological symptoms in patients with biopsy proven celiac disease. Mov Disord. 2009 Dec 15;24(16):2358-62. doi: 10.1002/mds.22821. [↩]
6. Zelnick N, Pacht A, Obeid R, Lerner A. Range of Neurologic Disorders in patients with celiac disease. Pediatrics. Jun 2004;113(6):1672-1676. [↩] [↩]
7. Gabrielli M, Cremonini F, Fiore G, et al. Association between migraine and celiac disease: results from a preliminary case control and therapeutic study. American Journal of Gastroenterology. Mar 2003;98(3):625-9. [↩]
8. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
9. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
10. Bürk K, Farecki ML, Lamprecht G, Roth G, Decker P, Weller M, Rammensee HG, Oertel W. Neurological symptoms in patients with biopsy proven celiac disease. Mov Disord. 2009 Dec 15;24(16):2358-62. doi: 10.1002/mds.22821. [↩]
11. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007 May;27(5):394-402. [↩]
12. Gabrielli M, Cremonini F, Fiore G, et al. Association between migraine and celiac disease: results from a preliminary case control and therapeutic study. American Journal of Gastroenterology. Mar 2003;98(3):625-9. [↩]
13. Morello F, Ronzani G, Cappellari F. Migraine, cortical blindness, multiple cerebral infarctions and hypocoagulapathy in celiac disease. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. Jun 2003;24(2):85-9. [↩]