Can the gluten-free diet help the painful experience of a migraine?ýThe Gut-Brain LinkýDiet DebateýIs It Migraine?
[Updated May 22, 2015]
Karen Schmucker knows when a migraine is coming. Flashing specs of white light suddenly appear, gradually crowding her entire field of vision. This light show—known as an aura—ends after 15 minutes. Then the pain hits. “It feels like someone is slowly pulling on a nerve inside my head,” says Schmucker, a graphic designer from Bellevue, Washington. “It’s not the worst pain in terms of intensity but I feel like I’m going to lose my mind if I can’t stop it. And then there’s the nausea.” Smells, light and noise exacerbate the pain and nausea, forcing her to ride it out in a dark room with an ice pack pressed to her head.
Schmucker has suffered from migraines—both with and without aura—since she was 12. Now 61, she’s tried every pharmaceutical, diet and lifestyle intervention doctors have recommended. In 2006, on the advice of a naturopathic physician, Schmucker cut out gluten.
“After a few months off gluten, I realized it had been a long time since I’d had a migraine with aura—and for me, those are the worst,” she says. Still gluten-free today, Schmucker suffers far fewer debilitating migraines, although she’s not completely migraine-free.
Integrative medicine physician Amy Burkhart, MD, RD, frequently sees patients who’ve tried the gluten-free diet for migraine. “There’s a lot of interest in it,” she says. “I don’t typically say to a patient, ‘Because you have migraine let’s try a gluten-free diet.’ But it can be a component of migraine management for some individuals.”
Indeed, a growing body of research supports a link between gluten and neurological disorders like migraine, chronic headache and ataxia (a balance disorder). A 2013 study showed 21 percent of celiacs and a whopping 40 percent of those with non-celiac gluten sensitivity suffer from migraine. By comparison, just 6 percent of healthy volunteers (the control group) reported migraine.
Inflammation, more generally, may be to blame, says study author and celiac expert, Peter Green, MD, director of the Celiac Disease Center at Columbia University Medical Center. To his surprise, patients in the study with inflammatory bowel disease (they were included as a second GI control group) also had a high rate of migraine. Studies have implicated inflammation with migraine, although the exact cause or causes of migraine remain unknown.
“Perhaps those with chronic inflammation in the gut have different processes going on in their brains,” says Green. “We know the gut and brain are linked by nerves and possibly also hormones, as well as inflammatory proteins called cytokines.”
“In a way it’s very exciting,” Green adds. “It’s a window into the gut-brain axis—the concept that there’s back-and-forth interaction between intestinal functions and brain functions. We’re just starting to appreciate, although not fully understand, this gut-brain axis.”
Green’s study didn’t home in on whether the gluten-free diet helps with migraine. However, several of his patients say that it reduces migraine frequency or intensity. Green and colleagues have plans for additional studies to help answer whether the gluten-free diet could be used as a viable treatment for migraine in those with celiac disease, as well as those without it.
Heather Heffner, 31, tried the gluten-free diet for her frequent migraines but found it didn’t help. After eight weeks of eliminating gluten, her doctor said she probably would have noted a benefit if there was to be one.
“I really wanted it to help,” she says, “but even when I went back on gluten, I didn’t notice a difference.” The only food that seems to set off her migraines is red wine.
“Food triggers are a widely discussed subject in the migraine community but there are very few foods unequivocally established as triggers,” says migraine expert and neurologist Peter Goadsby, MD, PhD, director of the UCSF Headache Center. Two exceptions are nitrates (chemical food additives found in hot dogs and other cured meats) and alcohol.
What’s increasingly clear is that there’s a premonitory phase that starts 4 to 24 hours before migraine pain hits, says Goadsby. During this time, Goadsby has shown that areas of the brain, namely, the hypothalamus, key in hunger and eating, become more active. Patients may experience food cravings for chocolate or perhaps something salty. Sometimes patients experience food aversions.
“If the premonitory phase has already started and you eat chocolate, it’s not a trigger but part of the migraine itself,” he says. “We think these premonitory changes may be the basis for what some consider food triggers.”
However, Goadsby does not raise issue with those who claim gluten is linked with migraine.
“In any condition that changes one’s physiology, for example, thyroid disease or diabetes, you can expect to see more migraine. It’s the same argument with gluten-related disorders. It doesn’t mean gluten causes migraine as much as it triggers the propensity for migraine.”
If people want to use the gluten-free diet as an avenue to help with migraine, be sure to get screened for celiac disease first, stresses Amy Burkhart. Doctors can’t accurately test for the autoimmune disorder once gluten has been removed from the diet.
“There’s no harm in trying the gluten-free diet for migraine,” says Burkhart. “We just don’t want to miss any celiac patients.”
Migraine is not just headache, says migraine expert and neurologist Peter Goadsby, MD, PhD, director of the UCSF Headache Center. “It’s a complex disorder that results in the brain misunderstanding messages so patients can’t function normally. Sound, movement and normal things happening in the brain are interpreted as pain.”
- Migraine features include:
- Pain on one side of the head
- Pounding or throbbing
- Nausea and/or vomiting
- Sensitivity to light, sounds and/or smells
- More debilitating than headache
There are no specific blood tests for migraine. Diagnosis is based on a detailed headache history. (Neurological examination should be normal.) Keeping a headache journal can help doctors determine if you have migraines and how best to treat them.