Gluten Intolerance and Migraine

Did you know that gluten intolerance, also known as celiac disease, is more common in migraine sufferers?  Celiac disease was once thought to be due to an allergy to the gluten protein found in wheat and other grains.  It is now known to be an autoimmune disorder, with an inherited tendency.

Symptoms of Celiac Disease

These are the symptoms of full-blown celiac disease, but you could experience only some, or even almost none except migraine.  (Almost no one has all of them.)

  • Abdominal pain or bloating
  • Gas
  • Diarrhea
  • Constipation
  • Joint pains
  • Fatigue
  • Mood change or depression
  • Weight loss or weight gain
  • Muscle cramps
  • Anemia
  • Osteoporosis
  • Tingling due to neuropathy (nerve damage)
  • Missed menstrual periods
  • Infertility or miscarriages
  • Behavioral changes
  • Delayed growth in children and failure to thrive in infants
  • Itchy skin rash
  • Tooth discoloration and loss of enamel

As if that list wasn’t scary enough, researchers are finding that untreated celiac disease is found more commonly in conjunction with other autoimmune disorders such as Hashimoto’s thyroiditis, type I diabetes, and Addison’s disease. 

Lactose intolerance is also more common in people who have gluten intolerance or sensitivity.

Gluten Intolerance and Gluten Sensitivity

There is a difference between being gluten intolerant and being gluten sensitive.  Gluten intolerant individuals have had an autoimmune process triggered early in life, and over time, the continued exposure to the gluten protein results in flattening of the normal hills and valleys in the intestine (villi) .  The symptoms are due, in part, to a degree of malnutrition due to malabsorption of nutrients.

Gluten intolerance affects between 1 in 133 and 1 in 250 individuals, depending on which study one wishes to read.  Gluten sensitivity affects about 5% of the population. Why might this be?  There are some interesting theories about the probable origins of gluten intolerance historically.

Gluten sensitivity is less severe, and results in fewer symptoms. There is some evidence to suggest that the symptoms that have been attributed to gluten sensitivity might not be due to gluten at all, but may be due to fructan exposure, and may actually be better approached via the FODMAP diet than a gluten-free diet.

If you suspect you might have gluten intolerance, there are blood tests to look for antibodies.  If present, these are pretty reliable.  But it doesn’t mean nothing is wrong if the blood test is negative.  Sometimes, it’s necessary to get a biopsy of the small bowel. If you are concerned about possible gluten sensitivity, see a gastroenterologist, who can help pin down the nature of your problem.

While avoiding wheat, barley, and rye is an obvious strategy, it may be more difficult to avoid gluten when it hides in unusual places like vitamins, medications, communion wafers, cosmetics, and the glue on older envelopes.  Be aware that beer contains gluten as well.

If you are concerned that you might have a gluten sensitivity or intolerance, talk to your doctor about getting tested or referred to a gastroenterologist.

Concerned About Gluten in Medications?

How can you know if your medication contains gluten or not?  Here are some phone numbers for pharmaceutical companies:

Abbott products – 1-800-441-4987, option 1

GlaxoSmithKline products – 1-888-825-5249

Pfizer products- 1-800-438-1985

Teva generic drug products 1-800-545-8800

Or ask your pharmacist. 

Nutritional supplements should list the company phone number and/or website on the label-contact them and ask.  Since gluten is not an active ingredient, it is not required to be listed on the label, and may simply be referred to as an “inert ingredient”, or the technical term for this is, which is “excipient.”

Irritable Bowel Syndrome

Irritable Bowel Syndrome is also comorbid with migraine, and affects about 15% of the general population.  The symptoms of IBS can be very similar to the GI tract symptoms of gluten sensitivity and intolerance—the two disorders can be confused. And for those sensitive to fructans, avoiding them with the FODMAP diet may alleviate symptoms. A gastroenterologist can help.

Resources for gluten sensitivity and celiac disease:

http://celiac.nih.gov/

http://www.celiac.com/

http://www.glutenfreely.com/glutenfreely/nonceliacglutenintolerance.aspx

http://well.blogs.nytimes.com/2014/10/06/when-gluten-sensitivity-isnt-celiac-disease/

by Christina Peterson, M.D.

updated 11/15/2016