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Headache in pediatric patients with celiac disease and its prevalence as a diagnostic clue
Elena Lionetti1, Ruggiero Francavilla, Luigi Maiuri
1Department of Paediatrics, University of Catania, Catania, Italy. elenalionetti@inwind.it
Insights
Headaches are common in children with celiac disease (CD). A gluten-free diet significantly improves headaches in these children, suggesting CD screening for pediatric headache patients.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Immunology
Background:
- Headache is a common symptom in children.
- Celiac disease (CD) is an autoimmune disorder triggered by gluten.
- The relationship between CD and headache in pediatric populations requires further investigation.
Purpose of the Study:
- To determine the prevalence of headaches in children diagnosed with celiac disease (CD).
- To assess the impact of a gluten-free diet on headaches in children with CD.
- To evaluate the prevalence of CD in children presenting with headaches.
Main Methods:
- A retrospective analysis of 354 children with CD using questionnaires on headache history before and after a gluten-free diet.
- A prospective screening of 79 children with headaches for CD using antitransglutaminase IgA and duodenal biopsy.
- Brain positron emission tomography (PET) studies were conducted before dietary intervention.
Main Results:
- Children with CD reported headaches more frequently (24.8%) than controls (8%).
- A gluten-free diet led to significant headache improvement in 77.3% of children with CD, with 27.3% becoming headache-free.
- CD was diagnosed in 5% of children with headaches, a significantly higher rate than the general population.
Conclusions:
- Headaches are highly prevalent in children with celiac disease.
- A gluten-free diet demonstrates a beneficial effect on headaches in pediatric CD patients.
- Screening for celiac disease should be considered in the diagnostic work-up for children experiencing headaches.
Objectives:
To establish the prevalence of headache in children with celiac disease (CD), the response to a gluten-free diet, and the prevalence of CD in children affected by headache.
Methods:
This hospital-based study included 2 steps. In the retrospective part, 354 children with CD answered a questionnaire investigating the presence of headache before and after the gluten-free diet. The same questionnaire was administered to 200 healthy children matched for sex and age. In the prospective part, 79 children affected by headache were screened for CD by antitransglutaminase IgA. Diagnosis of CD was confirmed by duodenal biopsy; before starting a gluten-free diet patients underwent a brain positron emission tomography study. After 6 months of follow-up children were reevaluated for the presence of headache.
Results:
Overall, 88 patients with CD complained of headaches before the diagnosis of CD as compared with 16 in the control group (24.8% vs 8%, P < 0.001). After the institution of a gluten-free diet, the headaches significantly improved in 68 children (77.3%), of whom 24 (27.3%) were headache-free during the study period. Four of 79 (5%) headache patients were found to have CD compared with 0.6% of the general population (P = 0.005). The brain positron emission tomography studies did not show any anomalies. During the follow-up, headaches improved in all 4 children with CD.
Conclusions:
We recorded -- in our geographical area -- a high frequency of headaches in patients with CD and vice versa with a beneficial effect of a gluten-free diet. Screening for CD could be advised in the diagnostic work-up of patients with headache.
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