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The Bowel and Migraine: Update on Celiac Disease and Irritable Bowel Syndrome

  • Migraine Headache (F Taylor, Section Editor)
  • Published:
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Abstract

This article explores possible relationships between migraine, irritable bowel syndrome (IBS), celiac disease (CD), and gluten sensitivity. These seemingly distinct medical entities curiously share many common epidemiological, psychosocial, and pathophysiological similarities. Considerable evidence is emerging to support a concept that experiencing significant threatening adverse events creates a state of hypervigilance in the nervous system, which associates with exaggerated response to future threats and episodic attacks of migraine and IBS. While this sensitizing response is generally considered to reside in the central nervous system, it may be possible that the initiation resides in the enteric nervous system as well. What appears to link migraine, IBS, and CD is a disease model of a genetically sensitive nervous system transformed into one that is hypervigilant, and that over time can often develop disabling and pervasive disease.

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References

Papers of particular interest, published recently, have been highlighted as: • Of Importance •• Of Major Importance

  1. Bedell AW, Cady RK, Diamond ML, et al. Patient-centered strategies for effective management of migraine. Springfield: Primary Care Network; 2000.

    Google Scholar 

  2. Mathew NT, Stubits E, Nigam MP. Transformation of episodic migraine into daily headache: analysis of factors. Headache. 1982;22:66–8.

    Article  PubMed  CAS  Google Scholar 

  3. Scher AI, Stewart WF, Ricci JA, et al. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain. 2003;106:81–9.

    Article  PubMed  CAS  Google Scholar 

  4. Bigal ME, Lipton RB. The epidemiology, burden, and comorbidities of migraine. Neurol Clin. 2009;27(2):321–34.

    Article  PubMed  Google Scholar 

  5. Stewart WF, Wood C, Reed ML, Roy J, Lipton RB, AMPP Advisory Group. Cumulative lifetime migraine incidence in women and men. Cephalalgia. 2008;28(11):1170–8.

    Article  PubMed  CAS  Google Scholar 

  6. Porta-Etessam J, García-Cobos R, Cuadrado ML, et al. Neuro-otological symptoms in patients with migraine. Neurologia. 2011;26(2):100–4.

    Article  PubMed  CAS  Google Scholar 

  7. Evans RW, Evans RE, Kell HJ. A survey of family doctors on the likeability of migraine and other common diseases and their prevalence of migraine. Cephalalgia. 2010;30(5):620–3.

    PubMed  CAS  Google Scholar 

  8. Cady RK, Dodick DW, Levine HL, et al. Sinus headache: a neurology, otolaryngology, allergy, and primary care consensus on diagnosis and treatment. Mayo Clin Proc. 2005;80(7):908–16.

    Article  PubMed  Google Scholar 

  9. Boivin M. Socioeconomic impact of irritable bowel syndrome in Canada. Can J Gastroenterol. 2001;15(Suppl B):8B–11.

    PubMed  Google Scholar 

  10. Quigley EM, Locke GR, Mueller-Lissner S, et al. Prevalence and management of abdominal cramping and pain: a multinational survey. Aliment Pharmacol Ther. 2006;24(2):411–9.

    Article  PubMed  CAS  Google Scholar 

  11. Danese A, McEwen BS. Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav 2011, Aug 25. [Epub ahead of print].

  12. • Tietjen GE, Peterlin BL. Childhood abuse and migraine: epidemiology, sex differences, and potential mechanisms. Headache. 2011;51(6):869–79. This article provides epidemiological evidence supporting the possible neurobiological role of early life stress in the pathogenesis of migraine..

    Article  PubMed  Google Scholar 

  13. Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome—a meta-analysis. Am J Gastroenterol. 2006;101:1894–9.

    Article  PubMed  Google Scholar 

  14. Ruigomez A, Garcia Rodriguez LA, Panes J. Risk of irritable bowel syndrome after an episode of bacterial gastroenteritis in general practice: influence of comorbidities. Clin Gastroenterol Hepatol. 2007;5:465–9.

    Article  PubMed  Google Scholar 

  15. Spiller RC. Is IBS caused by infectious diarrhea? Nat Clin Pract. 2007;4:642–3.

    Google Scholar 

  16. • Seminowicz DA, Labus JS, Bueller JS, et al. Regional gray matter density changes in brains of patients with irritable bowel syndrome. Gastroenterology. 2010;139:48–57. The changes in density of gray matter among regions involved in cognitive/evaluative functions are specifically observed in patients with IBS..

    Article  PubMed  Google Scholar 

  17. •• Myers B, Greenwood-Van Meerveld B. Role of anxiety in the pathophysiology of irritable bowel syndrome: importance of the amygdala. Auton Neurosci. 2009;3:47. This article identified the impact of anxiety and affective disorders on the gastrointestinal tract..

    Google Scholar 

  18. Mazzone L, Reale L, Spina M, et al. Compliant gluten-free children with celiac disease: an evaluation of psychological distress. BMC Pediatr. 2011;11:46.

    Article  PubMed  Google Scholar 

  19. Hadjivassiliou M, Sanders DS, Grünewald RA, et al. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010;9(3):318–30.

    Article  PubMed  CAS  Google Scholar 

  20. Mayer EA. Spinal and supraspinal modulation of visceral sensation. Gut. 2000;47 Suppl 4:iv69–72.

    PubMed  Google Scholar 

  21. Gershon MD. The second brain: a groundbreaking new understanding of nervous disorders of the stomach and intestine. New York: Harper Collins; 1998.

    Google Scholar 

  22. Zhang R, Zou N, Li J, et al. Elevated expression of c-fos in central nervous system correlates with visceral hypersensitivity in irritable bowel syndrome (IBS): a new target for IBS treatment. Int J Colorectal Dis. 2011;26(8):1035–44.

    Article  PubMed  Google Scholar 

  23. Yunus MB. Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum. 2008;37(6):339–52.

    Article  PubMed  Google Scholar 

  24. Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009;137(1):88–93.

    Article  PubMed  Google Scholar 

  25. Tajuddin T, Razif S, Dhar R, et al. Clinical presentation of adult coeliac disease. Ir Med J. 2011;104(1):20–2.

    PubMed  CAS  Google Scholar 

  26. Zelnik N, Pacht A, Obeid R, et al. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004;113:1672–6.

    Article  PubMed  Google Scholar 

  27. Jadallah KA, Khader YS. Celiac disease in patients with presumed irritable bowel syndrome: a case-finding study. World J Gastroenterol. 2009;15(42):5321–5.

    Article  PubMed  Google Scholar 

  28. •• Kahn WI, Ghia JE. Gut hormones: emerging role in immune activation and inflammation. Clin Exp Immunol. 2010;161:19–27. This article provides better understanding of the role of gut hormone in the pathogenesis of both GI and non-GI inflammatory diseases..

    Google Scholar 

  29. Li Z, Chalazonitis A, Huang Y-Y, et al. Essential roles of enteric neuronal serotonin. J Neurosci. 2011;31:8998–9009.

    Article  PubMed  CAS  Google Scholar 

  30. Wang S-J, Chen P-K, Fuh J-L. Comorbidities of migraine. Front Neurol. 2010;1:16.

    PubMed  Google Scholar 

  31. Silverthrom DU. Human physiology. San Francisco: Pearson Education Inc; 2007.

    Google Scholar 

  32. Benarroch EE. Enteric nervous system: functional organization and neurologic implications. Neurology. 2007;69(20):1953–7.

    Article  PubMed  Google Scholar 

  33. Maslowski KM, Mackay CR. Diet, gut microbiota and immune responses. Nat Immunol. 2011;12(1):5–9.

    Article  PubMed  CAS  Google Scholar 

  34. Bartley J. Could glial activation be a factor in migraine? Med Hypotheses. 2009;72:255–7.

    Article  PubMed  CAS  Google Scholar 

  35. Hadjivassiliou M, Gibson A, Davies-Jones GAB, et al. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996;347:369–71.

    Article  PubMed  CAS  Google Scholar 

  36. Hadjivassiliou M, Grunewald RA, Lawden M, et al. Headache and CNS white abnormalities associated with gluten sensitivity. Neurology. 2001;56:385–8.

    PubMed  CAS  Google Scholar 

  37. Teschemacher H. Opioid receptor ligands derived from food proteins. Curr Pharm Des. 2003;9:1331–44.

    Article  PubMed  CAS  Google Scholar 

  38. Millichap JG, Yee YM. The diet factor in pediatric and adolescent migraine. Pediatr Neurol. 2003;28:9–15.

    Article  PubMed  Google Scholar 

  39. Alpay K, Ertas M, Orhan EK, et al. Diet restriction in migraine based on IgG against foods. Cephalalgia. 2010;30(7):829–37.

    Article  PubMed  Google Scholar 

  40. Pascual J, Oterino A. IgG mediated allergy: a new mechanism for migraine attacks. Cephalalgia 2010;1–3.

  41. Lionetti E, Francavilla R, Maiuri L, et al. Headache in pediatric patients with celiac disease. J Pediatr Gastroenterol Nutr. 2009;49:202–7.

    Article  PubMed  Google Scholar 

  42. Marks J, Shuster S, Watson AJ. Small bowel changes in dermatitis herpetiformis. Lancet 1966;1280–1282.

  43. Cooke WT, Thomas-Smith W. Neurological disorders associated with adult coeliac disease. Brain. 1966;89:683–722.

    Article  PubMed  CAS  Google Scholar 

  44. Verdu E. Editorial: can gluten contribute to irritable bowel syndrome? AJG. 2011;106:516–8.

    Article  PubMed  CAS  Google Scholar 

  45. Fan X, Sellin JH. Small intestinal bacterial overgrowth, bile acid malabsorption and gluten intolerance as possible causes of chronic watery diarrhoea. Ailment Pharmacol Ther. 2009;29:1069–77.

    Article  CAS  Google Scholar 

  46. Biesiekierski JR, Sci BA, Newnham ED, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind, randomized, placebo-controlled trial. Am J Gastroenterol 2011;106(3):508–514.

    Google Scholar 

  47. • Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritable bowel syndrome: the “no man’s land” of gluten sensitivity. Am J Gastroenterol. 2009;104(6):1587–94. The authors discuss predictors in gluten sensitive (GS) pathophysiology and made the connection, which supports increasing evidence that GS is a real entity in some patients..

    Article  PubMed  Google Scholar 

  48. Alehan F, Ozçay F, Erol I, et al. Increased risk for coeliac disease in paediatric patients with migraine. Cephalalgia. 2008;28(9):945–9.

    Article  PubMed  CAS  Google Scholar 

  49. Ford AC, Chey WD, Talley NJ, et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009;169(7):651–8.

    Article  PubMed  Google Scholar 

  50. Wahnschaffe U, Ullrich R, Riecken EO, et al. Celiac disease like abnormalities in a subgroup of patients with irritable bowel syndrome. Gastroenterology. 2001;121:1329–38.

    Article  PubMed  CAS  Google Scholar 

  51. Wahnschaffe U, Schulzke JD, Zeitz M, et al. Predictors of clinical response to gluten-free diet in patients diagnoses with diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2007;5(7):844–50.

    Google Scholar 

  52. • Versino M, Franciotta D, Colnaghi S, et al. Cerebellar signs in celiac disease. Neurology. 2009;72:2046–8. This article supports the possibility that a gluten-sensitive diet might be cause for discussion. There is a mention of gluten ataxia..

    Article  PubMed  CAS  Google Scholar 

  53. Thom S, Longo BM, Running A, et al. Celiac disease: a guide to successful diagnosis and treatment. JNP 2009;243–53.

  54. American Dietetic Association. Celiac Disease. Available at: http://www.eatright.org/Public/content.aspx?id=5542. Accessed December 23, 2011.

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Acknowledgment

The authors thank Candace Shade and Scott Farmer for their assistance.

Disclosures

No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Headache Care Center, 3805 South Kansas Expressway, Springfield, MO, 65807, USA

    Roger K. Cady, Kathleen Farmer & J. Kent Dexter

  2. Banyan Group, Inc, 3805 South Kansas Expressway, Springfield, MO, 65807, USA

    Jessica Hall

Authors
  1. Roger K. Cady
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  2. Kathleen Farmer
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  3. J. Kent Dexter
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  4. Jessica Hall
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Correspondence to Roger K. Cady.

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Cady, R.K., Farmer, K., Dexter, J.K. et al. The Bowel and Migraine: Update on Celiac Disease and Irritable Bowel Syndrome. Curr Pain Headache Rep 16, 278–286 (2012). https://doi.org/10.1007/s11916-012-0258-y

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  • DOI: https://doi.org/10.1007/s11916-012-0258-y

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