Ask the Migraine Expert: Should I Try a Gluten-Free Diet?

Welcome to Ask the Migraine Expert, a column about managing life with migraine from Deena Kuruvilla, MD. Dr. Kuruvilla is a board certified neurologist and Director of the Westport Headache Institute in Fairfield County, Connecticut. Got a question for the migraine expert? Submit your question via this form.

Dear Migraine Expert,

Will going gluten free help my migraine or even daily headaches?

— Sarah, Bezzy Migraine community member

The interest in gluten-free diets has been steadily rising among the general population, as well as those living with migraine.

Gluten is a type of protein which is found in wheat, rye, and barley.

Wheat is commonly found in bread, soups, pasta, cereal, and different sauces. Barley is commonly found in malt, which is used to make milkshakes and other syrups, food coloring, beer and yeast. Rye is commonly found in cereals and bread such as pumpernickel.

Whether cutting these foods from your diet will improve your migraine is a little complicated.

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Celiac disease, gluten sensitivity, and migraine

About 1 in 100 Americans have celiac disease, and up to 6 in 100 people have non-celiac gluten sensitivity.

People with either condition may experience bloating, abdominal pain, fatigue, diarrhea, weight loss, and constipation when eating foods with gluten.

These conditions shouldn’t be confused with true allergies to wheat or gluten, as these are separate conditions that can result in anaphylaxis and can be a medical emergency.

With celiac disease, a tiny amount of gluten can cause a person’s immune system to attack the lining of the small intestine, resulting in inflammation and difficulties with nutrition.

A biopsy of the small intestine is the gold standard for diagnosing celiac disease. There are also blood tests which can be checked, such as tissue transglutaminase and endomysial and deamidated gliadin peptide antibodies. The only treatment for celiac disease is a gluten-free diet.

The term “non-celiac gluten sensitivity” is used for people who report symptoms when they eat gluten. Research has shown that non-gastrointestinal symptoms of non-celiac gluten sensitivity include:

• headache
• anxiety
• memory loss
• numbness in the arms and legs
• joint and muscular pain
• depression
• anemia
• skin issues

It’s estimated that 26 percent of people with celiac disease experience headaches. Headache may also be a presenting symptom of celiac disease. The most common headache type seen in celiac disease is migraine.

According to the third edition of the International Classification of Headache Disorders, chronic migraine is seen in those who experience 15 or more headache days each month for more than 3 months and migraine features on at least 8 days each month.

Chronic migraine affects 2 to 4 percent of the U.S. population, is associated with higher levels of disability, and is 2 times more likely in people with celiac disease and gluten sensitivity.

A gluten-free diet can be an effective treatment for headaches associated with celiac disease and should be monitored closely with the help of a healthcare professional.

A survey study showed that people with celiac disease who stuck to a gluten-free diet were able to reduce their headache frequency by 48 percent.

There’s not enough evidence in the scientific literature to currently recommend a gluten-free diet to people without celiac disease for the treatment of headache disorders.

Possible risks

Studying gluten sensitivities can be challenging because there can be a lot of variability within one’s diet and other possible gastrointestinal conditions, such as irritable bowel syndrome (IBS).

Gluten-free diets have a few possible downsides, such as expensive grocery costs and a lack of certain vitamins and minerals such as zinc, calcium, phosphorus, B vitamins, iron, and fiber.

If you’re considering a gluten-free diet, it’s important to have an extended discussion with a dietitian about how to make up for some of the nutrients you may be missing while on the diet.

Research has also found that the body mass index (BMI) may increase as a result of a gluten-free diet. Women with migraine have a higher risk of cardiovascular disease. Increasing your BMI from a gluten-free diet may further increase this cardiovascular risk. Studies have shown that a higher BMI can also result in worsening migraine disease.

The bottom line

A gluten-free diet is most helpful for people diagnosed with celiac disease. If that’s you, then it’s possible that your migraine frequency and severity may improve with a gluten-free diet.

If you’re considering a gluten-free diet, speak with a gastroenterologist to first solidify your diagnosis and confirm your need for the diet. It’s also key to meet with a nutritionist to discuss the pros and cons of the diet.

If you don’t have celiac disease, cutting gluten may not be worth the effort and possible side effects. There’s limited evidence about the use of a gluten-free diet for the management of migraine in those with non-celiac gluten sensitivity.