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Headache Disorders

Migraine, Celiac Disease and Intestinal Microbiota

Authors:

Hakim Rahmoune ,

Pediatrics Department, Setif University Hospital; Setif-1 University, Algeria; Genetic & Nutritional Diseases Laboratory; Setif-1 University, Algeria
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Nada Boutrid

Pediatrics Department, Setif University Hospital; Setif-1 University, Algeria; Genetic & Nutritional Diseases Laboratory; Setif-1 University, Algeria
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Abstract

Investigators from four European tertiary care hospitals (in Paris, France; Milan, Udine and Perugia, Italy) performed a case-control study of children and adolescents aged 6 to 17 years diagnosed with primary headaches in the emergency department by a pediatric neurologist using the validated ICHD-3 criteria.
How to Cite: Rahmoune, H. and Boutrid, N., 2017. Migraine, Celiac Disease and Intestinal Microbiota. Pediatric Neurology Briefs, 31(2), p.6. DOI: http://doi.org/10.15844/pedneurbriefs-31-2-3
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  Published on 01 Feb 2017
 Accepted on 28 Jan 2017            Submitted on 19 Jan 2017

Investigators from four European tertiary care hospitals (in Paris, France; Milan, Udine and Perugia, Italy) performed a case-control study of children and adolescents aged 6 to 17 years diagnosed with primary headaches in the emergency department by a pediatric neurologist using the validated ICHD-3 criteria. They enrolled 648 controls and 424 cases (257 patients with migraine and 167 with tension-type headache). Investigators masked to a patient’s group allocation diagnosed functional gastrointestinal disorders using the Rome III diagnostic criteria. Eighty-three (32%) children and adolescents in the migraine group were diagnosed with functional gastrointestinal disorders compared with 118 (18%) in the control group (p<0·0001). Multivariable logistic regression showed a significant association between migraine and three gastrointestinal disorders: functional dyspepsia, irritable bowel syndrome and abdominal migraine. The authors concluded that correct recognition would have an impact on the diagnosis and therapeutic management of these pediatric gastrointestinal disorders. [1]

COMMENTARY. This well conducted multicenter trial included all functional gastrointestinal disorders defined according to ROME III criteria. However, among digestive afflictions, celiac disease (CD) deserves particular attention. CD patients may exhibit a myriad of extra-intestinal symptoms, which includes neurological symptoms such as migraine. Studies report a high frequency of migraines in patients with CD and vice versa, and describe the beneficial effect of a gluten-free diet in these cases [2]. Also, the prevalence of CD among children with irritable bowel syndrome (IBS) is reported to be 4 times higher than among the general pediatric population [3]. Using the Rome III diagnostic criteria of functional gastrointestinal disorders would help to distinguish CD from the broad pool of IBS, with a potential consequent relief of migraine upon initiation of the appropriate diet.

On the other hand, recent findings regarding the role of the gastrointestinal microbiota in the gut-brain axis suggests that an unbalanced gut flora (i.e. dysbiosis) can be associated with neurological diseases like migraine. Enhanced pro-inflammatory immune responses have been reported with intestinal disorders associated with dysbiosis and increased intestinal permeability (just like IBS and celiac disease) as well as in migraine patients [4]. Evidence suggests that alterations in gut microbiota could be a potent mediator in migraine [5]; this might explain, at least partly, the current study results. We are, definitely, what we eat!

Disclosures

The author(s) have declared that no competing interests exist.

References

  1. Le Gal, J Michel, JF Rinaldi, VE Spiri, D Moretti, R Bettati, D et al. (2016). Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. The Lancet Gastroenterology & Hepatology Oct 20161(2): 114–21, DOI: https://doi.org/10.1016/S2468-1253(16)30038-3 

  2. Mormile, R (2014). Celiac disease and migraine: is there a common backstage?. Int J Colorectal Dis Dec 201429(12): 1571.DOI: https://doi.org/10.1007/s00384-014-1923-x [PubMed]  

  3. Cristofori, F Fontana, C Magistà, A Capriati, T Indrio, F Castellaneta, S et al. (2014). Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study. JAMA Pediatr Jun 2014168(6): 555–60, DOI: https://doi.org/10.1001/jamapediatrics.2013.4984 [PubMed]  

  4. van Hemert, S Breedveld, AC Rovers, JM Vermeiden, JP Witteman, BJ Smits, MG et al. (2014). Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol Nov 20145: 241.DOI: https://doi.org/10.3389/fneur.2014.00241 [PubMed]  

  5. Hindiyeh, N and Aurora, SK (2015). What the Gut Can Teach Us About Migraine. Curr Pain Headache Rep Jul 201519(7): 33.DOI: https://doi.org/10.1007/s11916-015-0501-4 [PubMed]  


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