Does Gluten Cause Migraine Headaches?
By: Peter Olins, PhD on May 2, 2012.
Almost everyone gets a tension headache from time to time, but migraine headaches are a different matter, and can be quite severe and seriously interfere with normal life. About 10% of people suffer from migraine, and despite a huge amount of research around the world, we still only have a limited picture of the overall cause or what triggers a single episode.
There have been many speculative articles and personal anecdotes in the popular media about a possible role of gluten in triggering migraine. So, I decided to explore this controversy by looking at some of the available research studies.
Gluten causes a wide range of symptoms in the nervous system
Gluten is the only known trigger for celiac disease, which typically involves inflammation of the intestine. It’s also becoming increasingly clear that celiac disease can also have a wide range of neurological effects in the brain and the rest of the body (Ref. 1, Ref. 2). This leads to three questions regarding a migraine-celiac link:
- Are celiacs more likely to have migraines than the general public?
- Are people with migraines more likely to have celiac disease?
- Does gluten cause migraines?
Are celiacs more likely to have migraines?
In a 2001 study of 86 Spanish children with celiac disease, 19% had migraine headaches (Ref. 3), which is substantially higher than the approximately 10% value found in the general public. Interestingly, all the patients were already on a gluten-free diet to treat their celiac disease.
A German study of older celiac patients (mean age of 51) found migraine in 28% of them (Ref. 4). Again, the patients were on a gluten-free diet. One possible complication was that all the patients were volunteers, so we can’t be certain that they represent the celiac population in general.
Finally, in an Israeli study of 111 pediatric celiac disease patients, 14 (12.6%) were found to have migraine, compared to 5.7% in a similar population of non-celiac control subjects (Ref. 2)
Are people with migraines more likely to have celiac disease?
In a 2003 Italian study of 90 migraine patients, 4 were found to also have celiac disease. This frequency (4.4%) was significantly higher than the frequency of celiac disease in a randomly-selected control group of people without migraine headache (0.4%) (Ref. 5). For comparison, the overall prevalence of celiac disease in the general population is thought to be approximately 1%.
In one Turkish study, 73 children with migraine were tested for anti-TG2 antibodies (a strong indicator of the presence of celiac disease) (Ref. 6). Four patients (5.5%) were antibody-positive, compared to 0.6% of a group of 147 control children. Surprisingly, no evidence for actual celiac disease was found after an intestinal biopsy. Perhaps the antibody test may have uncovered a mild or early stage of the disease?
In contrast, a 2011 study of 100 Iranian children found a prevalence of celiac disease of only 2%, which was no different from the prevalence found in 1,500 control children without migraine headache (Ref. 7).
Does gluten cause migraines?
Even if there might be a slight association between these two diseases, this does not mean that the trigger for celiac disease (gluten) is the same as the trigger for migraine. Many diseases show up in clusters: for example, many people have both diabetes and high blood pressure, but this does not mean that diabetes is caused by hypertension, or vice versa. Many patients with celiac disease also have other autoimmune diseases such as diabetes, but there is no clear evidence that one causes the other.
As mentioned previously, two studies in patients whose celiac disease was well-controlled by a gluten-free diet still had a relatively high frequency of migraine. This doesn’t support the idea that gluten is a trigger for migraine (Ref. 3, Ref. 4).
In contrast, in one small study (Ref. 5), four newly-diagnosed celiacs with migraine were followed for 6 months after moving to a gluten-free diet. In this case, one had complete relief from migraine, while the other three showed an improvement in their symptoms. This migraine relief was accompanied by an improvement in blood flow to the brain in a PET scan.
Likewise, in one preliminary study of 14 patients (Ref. 2), migraine was found to be completely or partially relieved after shifting to a gluten-free diet.
It should be stressed that none of these studies was designed to rigorously test the potential role of gluten, while ruling out other possible unrelated effects.
What about non-celiac gluten sensitivity?
“Non-celiac gluten sensitivity” is less well-defined than celiac disease, but we are gradually reaching a consensus on diagnosis of gluten sensitivity. This field is still in flux, but many researchers now believe that this is a distinct condition. Briefly, if wheat allergy has been ruled out, and celiac disease has been ruled out, and the individual has symptoms which appear to be relieved after moving to a gluten-free diet, then the person is considered to be “gluten sensitive”. Very little is known about this condition, but it will be interesting to see how prevalent migraine is in this group, and whether gluten plays a role.
Scientific and ethical challenges in studying the health effects of gluten
Comparing a “gluten-free diet” with a “normal diet” is not really a rigorous test, because there are are many differences in food composition between these two diets, not just the presence or absence gluten. A preferred trial might be one in which everyone starts out on a gluten-free diet, and then testing the effect of adding back a known amount of gluten (or a placebo). Ideally, neither the patient nor clinician should be aware of who was receiving the trigger substance (a placebo-controlled, double-blind trial). No such trial has been performed yet, so any weak association with gluten is still very tentative.
Ethical problems arise when performing clinical trials on celiacs, because deliberately administering gluten to a patient with celiac disease will almost certainly cause intestinal damage, and healing can be slow. In contrast, trials studying the effect of diet on people with gluten sensitivity or migraine should be easier to accomplish.
Conclusion: The current evidence suggesting that gluten causes migraine headache is very tentative
While the studies so far suggest that there may be an association between celiac disease and migraine, we still do not have enough data to draw a firm conclusion that one causes the other. In addition, the evidence for the benefits of an elimination diet are weak, at best.
Once they have been diagnosed, most celiacs, of course, go on a gluten-free diet (or should); so, if anything, if gluten were an important trigger for their migraine, then celiacs might actually have a lower incidence of migraine than the general public! There is certainly no evidence for this.
While there have been many speculative articles in newspapers and on the internet that gluten is a trigger for migraine, the actual research results so far are much more tentative, and it is too early to conclude that a gluten-free diet will be helpful. This field is still in its infancy, and much larger, well-controlled clinical trials will be required before we can draw firm conclusions.
References
Ref. 1: Hadjivassiliou, et al. Gluten sensitivity: from gut to brain. Lancet Neurol (2010) 9:318-330.
Ref. 2: Zelnik, et al. Range of neurological disorders in patients with celiac disease. Pediatrics (2004) 113:1672-1676.
Ref. 3: Roche-Herrero, et al. The prevalence of headache in a population of patients with coeliac disease. Rev Neurol (2001) 32:301-309.
Ref. 4: Burk, et al. Neurological symptoms in patients with biopsy proven celiac disease. Mov Disord (2009) 16:2358-2362.
Ref. 5: Gabrielli, et al. Association between migraine and Celiac disease: results from a preliminary case-control and therapeutic study. Am J Gastroenterol (2003) 98:625-629.
Ref. 6: Alehan, et al. Increased risk for coeliac disease in paediatric patients with migraine. Cephalagia (2008) 28:945-949.
Ref. 7: Inaloo, et al. A comparative study of celiac disease in children with migraine headache and a normal control group. Turk J Gastroenterol (2011) 22:32-35.
My daughter was diagnosed wtih celiacs last year and I have had migraines for years - they kept getting worse and my 9 Treximet every 26 days was not enough to combat them. Someone mentioned the possible connection between gluten and migraines, so I gave it a try right away - always desparate for a solution to these horrible headaches. I can say that it has made a huge difference for me. I still get headaches, but they are a very specific kind that seem to come from back and neck spasms. These only last one day and can be taken care of with one Treximet and do not recur. This past Wednesday I had a bowl of soup at a resrtaunt that I thought was gluten-free. Turns out it was thickened with flour - this is the first gluten I have had since Christmas. It is now Saturday morning, I just took my fourth and last Treximet (and have been enduring the pain in between doses).
The headache came on wihtin two hours of eating the soup, and it is a very specific pain in the upper right side of my head then moves all over. I would recommend that anyone who suffers migraines just give it a try - it is worth it! I don’t eat a lot of expensive “gluten-free” food (although Pamela’s baking mix makes excellent waffles) we just eat foods that are naturally wheat free - rice, beans, corn, fruit veggies, Kix, yogurt, etc. It reallly helps keep me away from lots of things I shouldn’t be eating anyway : )
I am a doctor. I am trained to be skeptical. I can say with 100% certainty that ingesting gluten-containing food contributed to my severe chronic headaches and migraines.
I had intermittent migraines (2-3 per month) and daily moderate headaches for over 20 years. I visited multiple neurologists and chronic pain specialists, had 2 MRIs and was on nearly every migraine treatment or preventive out there with minimal to no improvement (and a LOT of side effects!). I started having intestinal upset at age 34 and was diagnosed with Celiac disease. I have been eating “gluten-free” for 3 years, and have been migraine-free for 3 years. I can’t imagine how that could be co-incidental; especially when on the rare occasions I get “glutened” when dining out, there is usually a 2-5day long moderate headache that follows. My headache frequency has decreased from daily to once every 3-4months. Just the thought of getting headaches again keeps me from ever cheating on the diet… no piece of cake or cookie is worth that amount of pain!
I would love to know the pathophysiology of the connection between gluten and headaches (is it the gluten molecule? is it another molecule that happens to be in the same food as the gluten? is it the immune systems response to gluten?), but I am sure that in *sensitive individuals* there is a definate correlation. Not every person with migraines has gluten sensitivity, nor do all people with gluten sensitivity / Celiac disease get migraines. But there is clearly a subset of the population where adopting a gluten-free diet results in elimination of severe headaches and migraines. Some day, scientists will be able to explain the mechanism by which gluten, or the body’s response to gluten-containing food, triggers headaches in certain individuals.
Not a day goes by that I don’t silently thank my wonderful gastroenterologist for helping me find a way to live a pain-free, medication-free life.
Ashley Lee, thank you for commenting, and I am going to try a gluten-free diet for my 10-year-old son, who is the only member of the family who suffers from migraines, but he suffers terribly. Thank you so much for sharing your experience, and I wish you wonderful health.
Hi Heather, I too am gluten sensitive and when finally finding out what was causing all my problems and going gluten free my headaches have disappeared as well.
Only when I go on vacation or eat out do I slip up and get a headache.
I never got a “professional medical” diagnosis, my nutrition and fitness instructor monitored my food intake and we discovered it that way.
I am really curious to know if your 10 year old son is better after trying the gluten free diet?
Thanks
I, too, have suffered chronic migraines nearly my entire life. I believe they started in high school and I am now 43. About two months ago, I was at my wits end and knew I couldn’t live much longer with the daily pain I was having. I am a teacher and my life was miserable! I really thought about suicide. My mom watches Dr. Oz and he mentioned something about gluten on his show. She suggested I try going gluten-free to see what happens. Within two days, my headaches were gone! At first I was afraid to believe it and was really skeptical, but I kept going, actually feeling really, really hungry from not eating gluten. I hung on, though. After two month, I have lost 20 pounds, only have migraines during menstrual times, and certain weather patterns and have only taken Imitrex a couple times in two months!! I am amazed. Even the neck pain is gone! I am still taking the Topamax because I am a little afraid of stopping it yet, but will discuss it with the doctor at my next visit.
Yes! Gluten can cause migraines! I eliminated gluten from my diet 2 years ago because I have a friend with Celiac that told me that people have conditions which can be caused by gluten even if they don’t have Celiac. I did validation testing of this theory by going GF for 1 week and then eating gluten and then for 2 weeks and eating gluten. Every time I ate the gluten I woke up at 4:30 in the morning with a knife going thru my head! If you have migraines you know what that means!
Now after suffering with debilitating migraines for 12 years I finally found the cause! I still get an occasional migraine from weather changes but not nearly as severe and only about once a month instead of 3 or 4 times a week! It can be daunting at first to go GF but more and more places offer GF and it is now easy to avoid. Congratulations to all of you that are GF and loving life!!
Thanks for sharing your experience, Kathy. It’s great that you tried an experiment to help confirm your suspicion.
You didn’t mention it, but have you definitely ruled out that you aren’t celiac? This is important, since celiac disease can lead to several hidden problems, in addition to the more obvious symptoms.
I suffered with migraines which became progressively more frequent for 20 years. A year ago I was getting them up to twice a week. I have been gluten free for almost a year now, and Thank God, the migraines have stopped. I knew I also had a few other triggers, like shell fish and aspartame, but couldn’t get them under control until I removed gluten from my diet. It’s not always easy, but I agree with Ashley Lee, just the thought of having those headaches again stops me from cheating! I have inadvertently eaten gluten when it was “hidden” in something, and within an hour I the headache begins on the left side of my forhead. Needless to say I have learned to be extremely careful when eating out!
Thanks, Valerie.
As I mentioned to Kathy, above, if you haven’t already done so, make sure that you don’t have celiac disease. If you are celiac, you may also be suffering from a number of nutritional deficiencies.
I grew having many symptoms from sharp knifs going through my body, anemia, “IBS” gas constipation, ect, migrains, pain in joints, spasms, numbness tingling in my neck and down my arms. I decided to go GF when my sister and mom were diagnosed with having a gluten alergy and they both get very different symptoms from eachother. Mine were mixed however even with bloodwork my drs could not diagnose an allergy or celiac. I avoid gluten but occasionally when I get cross Contamination all the symptoms come back. Of all the symptoms the Migrains are what I hate the most. Diarrhea goes away, sharp pai.s I can live through but migranes that last up to 4 days is the wost. It’s hard to drive or do anything.
I have experimented and can prove to myself and family and friends that gluten is what affects my system.
I have never been allergic or even “sensitive” to anything. Around the age of 31 or 32 I started getting unexplainable headaches. Although very painful I would not call them migraines. It got so bad that the pain in my head was constant. I woke in the morning with a head ache I had a headache all day long (particularly bad in the afternoon) and I went to bed with a headache every night. This went on for about 6 weeks. I had a 6 week long headache. Then a friend suggested to me cutting gluten out of my diet. I did though it was very difficult at first. Ten days into the gluten free diet my headaches were gone. I couldn’t believe it but it worked. I’ve never gone back. A few times I experimented by eating a croissant once and something else I can’t remember what and each time 30 -60 minutes later that same old familiar headache would come creeping back. So I am three years now gluten free and happy as can be. I encourage anyone having headache problems to try this. It’s difficult to change your diet at first but so worth it. After a while you don’t even miss the gluten foods and definately not the headaches.
Thanks, Angela.
Given your experience, I strongly encourage you to go to your doctor and get properly tested for celiac disease, especially since celiac disease can cause other problems which may not have such obvious symptoms as the headache you were experiencing. Unfortunately, celiac testing typically requires that you consume gluten prior to the tests, but your doctor will advise you about this.
Likewise, prolonger headache can be caused by a variety of other things—again, it’s best to get professional advice.
I have suffered from migraine headaches since I turned thirty years old. They have confined throughout my life with, on average, one migraine a month lasting three days. Then I turned 48 years old and starting getting 2 or3 a month lasting three days. I was miserable and starting to become depressed about my situation. I too would wake up @ 4:30 in the morning with that sharp pain stinging the right side of my head. I became at my wits-end when my doctor just prescribed me MORE immitrex with no solutions in sight.
I decided to see a holistic doctor and she suggested trying a gluten free diet. I figured what have I got to lose?! My entire life has changed for the better. It has been six months, and I have had a couple of mild migraines lasting a couple of hours and no nausea. I believe they were caused after dining out and eating hidden gluten. This diet has changed my lfe. :-)
I suffered from Ocular Migraines for nearly 9 years before I heard of the connection between migraines and gluten. I was getting 4-5 headaches a month, and they had increasingly gotten worse over the years. I was desperate for and sort of remedy however taking beta-blockers for the rest of my life didn’t seem like a logical option. I have been gluten free for 16 months now and I have had no migraines. It has been a big lifestyle change but being without the worry of migraines is priceless.
I have have migraines all my life, and at many points in my life I have only had 10 “ok” to good days a month - the rest of the month in bed suffering various symptoms. I have recently entered menopause - that helped some - but controlling my diet has helped even more. I have not noticed a correlation between gluten and migraines, but i have noticed a correlation between glutamates and migraines. Glutamates are impossible to totally avoid but migraines seem to be triggered by an excess of them. Avoiding processed foods has been key. Coincidentally, oftentimes a “gluten-free” choice is also a less processed choice, particularly at restaurants, and so I will opt for those choices. But avoiding wheat hasnt been necessary. In fact, if I couldnt have white pasta which is made from durum wheat, i would not get to have a satisfying lunch about 4 times a week. Another thing that has helped reduce migraines has been increasing the amount of kale, broccoli, and cucumbers I consume, to increase minerals, and increasing the omega3′s (I eat tuna nearly everyday.) Most meats contain glutamates in too high of a level for me to tolerate, although the results are sometimes 24-hours in the making - deceptive sometimes. Anyway that’s my two cents. I will have to continue to monitor the idea of gluten and maybe try some more hard-core tests. Right now I take Imitrex every 7 - 10 days, but the symptoms are much milder, they just dont go away without Imitrex. But they are much more responsive to treatment than they used to be. My four cents worth.
I too went gluten free and eliminated migraines from my life….along with skin rashes and joint pain, bloating… I have my life back! In addition to relief from all of these symptoms….my hypothyroidism is stable for the first time in almost 10 years!
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