Can Headache Be a Symptom of Celiac Disease?: A University Hospital Experience

Öz

Aim: The purpose of this study was to determine the prevalence of Celiac disease in pediatric patients presenting with headache. However, little is known about the co-morbidity of Celiac disease and headache. To our knowledge, this is the first prospective pediatric study that systematically reviews this topic. Method: Two hundred forty four patients referred to the Pediatric neurology clinic of Adıyaman University Training and Research Hospital between January 2021 and November 2022 were examined. Gender, age, type of headache, Celiac serology, and other laboratory parameters of the cases meeting the inclusion criteria were recorded. Upper gastrointestinal endoscopy was performed on patients with positive Celiac serology. Patients whose results were compatible with Celiac disease were placed on a gluten-free diet. Results: The study group consisted of 202 patients, 123 girls (60.9%). The patients’ mean age was 12.67±3.524 years. Tension-type headache was determined in 121 (59.9%) of the patient group, and migraine type in 81 (40.1%). Celiac disease was detected in 5.4%. Vitamin B12 were 211±79.1 pg/ml, ferritin 19.5±13.9 ng/mL, and vitamin D 17.6±9.86 ng/ml (n=193). Interestingly, all patients who were diagnosed with Celiac disease reported that headache complaints decreased with the diet, However, no statistically significant correlation was found between any laboratory finding and headache type. Conclusion: Although it is still controversial whether headache is common in children with celiac disease, the results of our study showed that neurological symptoms improved after gluten-free diet in children presenting with headache and diagnosed with celiac disease. Celiac disease should be investigated in persistent headache despite pharmacological treatment.

Anahtar Kelimeler

• Celiac
• Child
• Migraine
• Tension

Baş Ağrısı Çölyak Hastalığının Belirtisi Olabilir mi?: Bir Üniversite Hastanesi Tecrübesi

Öz

Amaç: Bu çalışmanın amacı, baş ağrısı ile başvuran çocuk hastalarda Çölyak Hastalığı prevalansını belirlemektir. Çölyak hastalığı ve baş ağrısı birlikteliği hakkında henüz çok az şey bilinmektedir. Bildiğimiz kadarıyla bu çalışma, bu konuyu sistematik olarak gözden geçiren ilk prospektif pediatrik çalışmadır. Metod: Ocak 2021 ve Kasım 2022 tarihleri arasında Adıyaman Üniversitesi Eğitim ve Araştırma Hastanesi Çocuk Nörolojisi kliniğine başvuran iki yüz kırk dört hasta incelendi. Çalışmaya dahil edilme kriterlerine uyan olguların cinsiyet, yaş, baş ağrısı tipi, Çölyak serolojisi ve diğer laboratuvar parametreleri kaydedildi. Çölyak serolojisi pozitif olan hastalara üst gastrointestinal endoskopi yapıldı. Sonuçları Çölyak Hastalığı ile uyumlu olan hastalara glutensiz diyet uygulandı. Bulgular: Çalışma grubu 123'ü kız (%60.9) olmak üzere 202 hastadan oluşmaktaydı. Hastaların yaş ortalaması 12.67±3.524 yıl idi. Hasta grubunun 121'inde (%59.9) gerilim tipi, 81'inde (%40.1) migren tipi baş ağrısı saptandı. Çölyak hastalığı %5,4 oranında tespit edildi. B12 vitamini 211±79,1 pg/ml, ferritin 19,5±13,9 ng/mL ve D vitamini 17,6±9,86 ng/ml idi (n=193). İlginç bir şekilde, Çölyak Hastalığı tanısı konan tüm hastalar diyetle birlikte baş ağrısı şikayetlerinin azaldığını bildirmiş, ancak herhangi bir laboratuvar bulgusu ile baş ağrısı tipi arasında istatistiksel olarak anlamlı bir korelasyon bulunmamıştır. Sonuç: Çölyak hastalığı olan çocuklarda baş ağrısının yaygın olup olmadığı hala tartışmalı olsa da, çalışmamızın sonuçları baş ağrısı ile başvuran ve çölyak hastalığı tanısı alan çocuklarda glutensiz diyet sonrası nörolojik semptomların düzeldiğini göstermiştir. Farmakolojik tedaviye rağmen inatçı baş ağrısında Çölyak hastalığı araştırılmalıdır.

Anahtar Kelimeler

• Çölyak
• Çocuk
• Migren
• Gerilim

Kaynakça

1. 1. Headache Classification Committee of the International Headache Society The International Classification of Headache Disorders. Cephalalgia 2018; 38 (3rd edition): 1-211
2. 2. Bonthius DJ, Hershey AD. Headache in children: Approach to evaluation and general management strategies. Drutz JE, Patterson MC, Swanson JW, ed. Up To Date. 2022
3. 3. Galland L. The gut microbiome and the brain. J Med Food 2014;17(12):1261-72.
4. 4. Arzani M, et al. School of Advanced Studies of the European Headache Federation (EHF-SAS). Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain 2020;21(1):15.
5. 5. Sabino L, et al. Celiac disease and headache in children: a narrative state of the art. Acta Biomed 2020;7;91(3):e2020056.
6. 6. Krogh AB, Larsson B, Linde M. Prevalence and disability of headache among Norwegian adolescents: A cross-sectional school-based study. Cephalalgia 2015;35(13):1181-91.
7. 7. Wöber-Bingöl C, et al. IHS criteria and gender: a study on migraine and tension-type headache in children and adolescents. Cephalalgia 1996;16(2):107-12.
8. 8. Yımaz D, Gökkurt D, Tayfur AÇ. Çocuk Nöroloji Polikliniğine Baş Ağrısı Nedeni ile Başvuran Hastaların Değerlendirilmesi. Türkiye Çocuk Hast Derg/Turkish J Pediatr Dis 2016;3:162-5.

9. 9. Mishra D, et al. Recurrent headache in pediatric outpatients at a public hospital in Delhi. Indian Pediatr 2013;50:775-8.
10. 10. Ahmad SR, Rosendale N. Sex and Gender Considerations in Episodic Migraine. Curr Pain Headache Rep 2022;26(7):505-516.
11. 11. Talebian A, Soltani B, HajiRezaei M. Causes and associated factors of headaches among 5 to 15-year-old children referred to a neurology clinic in Kashan, Iran. Iran J Child Neurol 2015;9:71-5.
12. 12. Burch R. Migraine and Tension-Type Headache: Diagnosis and Treatment. Med Clin North Am 2019;103(2):215-33.
13. 13. GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018;17:954–76.
14. 14. Deuschl G, et al. The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017. Lancet Public Health 2020;5(10):e551-e567.
15. 15. GBD 2017 US Neurological Disorders Collaborators. Burden of neurological disorders across the US from 1990-2017: a Global Burden Of Disease Study. JAMA Neurol. JAMA Neurol 2021;78(2):165-76.
16. 16. Saylor D, Steiner TJ. The global burden of headache. Semin Neurol 2018;38(2):182–90.
17. 17. Woldeamanuel YW, Cowan RP. The impact of regular lifestyle behavior in migraine: a prevalence case-referent study. J Neurol 2016;263(4):669–76.
18. 18. Hagen K, et al. Lifestyle factors and risk of migraine and tension-type headache. Follow-up data from the Nord-Trøndelag Health Surveys 1995-1997 and 2006-2008. Cephalalgia 2018;38(13):1919-26.
19. 19. Smitherman TA, et al. Cognitive-Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis. Headache 2018;58(7):1052-9.
20. 20. Kaniecki RG. Tension-type headache. Continuum 2012;18(4):823–34.
21. 21. Durazzo M, et al. Extra-Intestinal Manifestations of Celiac Disease: What Should We Know in 2022? J Clin Med 2022;4;11(1):258.
22. 22. Calvani M Jr, et al. Latent coeliac disease in a child with epilepsy, cerebral calcifications, drug-induced systemic lupus erythematosus and intestinal folic acid malabsorption associated with impairment of folic acid transport across the blood brain barrier. Eur J Pediatr 2001;160:288–92.
23. 23. Parisi P. The relationship between mucosal damage in celiac disease and the risk of neurological and psychiatric conditions is much more complex than previously thought. Eur J Neurol 2018;25:797–8.
24. 24. Cicarelli G, et al. Clinical and neurological abnormalities in adult celiac disease. Neurol Sci 2003;24(5):311-7.
25. 25. Lionetti E, et al. Headache in pediatric patients with celiac disease and its prevalence as a diagnostic clue. J Pediatr Gastroenterol Nutr 2009;49(2):202-7.
26. 26. Nenna R, et al. Celiac disease in a large cohort of children and adolescents with recurrent headache: A retrospective study. Dig Liver Dis 2016;48(5):495-8.
27. 27. Assa A, et al. Large population study shows that adolescents with celiac disease have an increased risk of multiple autoimmune and nonautoimmune comorbidities. Acta Paediatr 2017;106:967–72.
28. 28. Zis P, Julian T, Hadjivassiliou M. Headache Associated with Coeliac Disease: A Systematic Review and Meta-Analysis. Nutrients 2018;6;10(10):1445.