Gluten and migraine: What is the link?

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Gluten is a type of protein that occurs naturally in wheat, barley, and rye. Products that are made from these grains, such as many breads, pasta, and baked goods, contain gluten.

Most people do not experience problems if they eat gluten, but some do. There are a variety of reasons this can happen:

• Celiac disease: Celiac disease is an autoimmune disorder that causes the immune system to attack the lining of the small intestine when someone eats food that contains gluten, or that has been in contact with gluten. There are over 200 known symptoms, one of which is migraine. Other symptoms can include diarrhea, abdominal pain, a rash, and fatigue.
• Wheat allergy: Another potential reason a person might experience symptoms after eating baked goods or pasta is a wheat allergy. Headaches are a potential wheat allergy symptom, along with sneezing, a stuffy or runny nose, an itchy rash, and digestive symptoms.
• Nonceliac gluten sensitivity (NCGS): NCGS, or nonceliac wheat sensitivity (NCWS), causes similar symptoms to celiac disease, but affected individuals test negative for celiac disease. It is unclear whether NCGS/NCWS is caused by gluten or by other compounds present in wheat, barley, or rye, such as amylase-trypsin inhibitors or fructans.

In people with celiac disease, yes – there is a link between gluten and migraine.

In a 2019 study, 32.5% of people who had celiac disease experienced migraine without aura, while 15.4% experienced migraine with aura. Aura are temporary sensory disturbances that can occur before a migraine attack.

These percentages are higher than migraine prevalence in the general population. Researchers believe the link is due to celiac disease’s impact on the gut-brain axis. Other studies have also found unusual changes to the white matter of the brain in people with both conditions.

More research is necessary to understand how gluten contributes to migraine in people with and without celiac disease.

While migraine is more common in people with celiac disease, research on whether it directly causes migraine episodes is inconsistent.

A 2020 review states that some studies have found a gluten-free diet reduces migraine headache frequency in people with celiac disease. However, a 2021 review notes that other studies found a gluten-free diet only led to significant improvements in some people.

It is not clear whether a gluten-free diet has any effect on migraine in people who do not have celiac disease.

Migraine triggers are complex. They make migraine headaches more likely, but they are not guaranteed to cause one. Sometimes, it depends on how much of a trigger food someone eats, or whether they have been exposed to multiple triggers that day.

Another complication is that gluten-containing foods can also contain other ingredients that are potential migraine triggers. For example, breads, cakes, pizza, or pastries can also contain:

• nitrates and nitrites
• preservatives
• artificial sweeteners, such as aspartame or sucrose
• ingredients that contain or release histamine, such as olives, tomato, cheese, cured meat or fish, nuts, or citrus fruit

There are also many other potential migraine triggers. Some of the most common include:

• stress
• alcohol
• caffeine
• sleeping too little or too much
• skipping meals
• weather changes
• hormonal changes
• allergies
• sleep apnea and snoring
• chronic pain conditions
• medication overuse

What contributes to migraine attacks is different from person to person. According to the American Migraine Foundation, there is no one dietary change or plan that will work for everyone.

Furthermore, removing multiple foods from the diet unnecessarily has risks. It is best to seek help from a doctor or dietitian if specific foods seem to be linked with migraine episodes.

If a person suspects their migraine episodes are related to any specific food, particularly gluten, they should speak with a doctor. It is possible for people to have celiac disease without knowing it, so getting a diagnosis is important.

Doctors perform blood tests to help diagnose celiac disease. However, this only works if someone is not already on a gluten-free diet, and there is a small risk of a false positive or negative.

Other tests may include a genetic test, tissue biopsy, or capsule endoscopy, which involves swallowing a very small camera that travels through the digestive tract.

If the results of tests for celiac disease are negative, a person may have NCGS/NCWS. Alternatively, they may not have a sensitivity to gluten.

In those who do not have celiac disease or gluten sensitivity, it may be helpful to try and identify other migraine triggers. There are several ways of doing this, including:

Keeping a migraine diary

A migraine diary is a way of recording when symptoms occur, how severe they are, and the factors that may have triggered or worsened the episode. This can help people identify patterns and potential triggers. People can download a free migraine diary template here.

Elimination diet

Elimination diets involve removing one food from the diet for a length of time before reintroducing it again. This may allow people to see if a particular food has been causing symptoms.

A 2019 review notes that a few small studies on personalized elimination diets have shown they reduce migraine frequency. However, another study found no difference between the elimination diet and a “sham” diet, which acted as a placebo. Overall, more research is necessary to confirm whether elimination diets can be helpful.

It is important to consult a dietitian before trying an elimination diet. If a person does one incorrectly, it may lead to weight loss or nutritional deficiencies.

Learn more about elimination diets.

Managing migraine is a 2-step process that involves lifestyle changes and the use of medications to prevent episodes, as well as other medications to stop the progression of symptoms when they occur.

Prevention

One of the easiest ways to prevent migraine episodes is to avoid triggers wherever possible. This may involve:

• maintaining a regular sleep schedule
• staying hydrated
• managing stress
• eating meals at the same time and not skipping any
• avoiding caffeine

The Food and Drug Administration (FDA) has approved the use of the medication erenumab (Aimovig) for the prevention of migraine in adults. Erenumab works by blocking the activity of a molecule associated with migraine episodes.

lasmiditan (Reyvow) and ubrogepant (Ubrelvy) are also FDA-approved for the prevention of migraine in adults.

Symptom reduction

Medications that can stop the progression of migraine episodes and reduce symptoms include:

• over-the-counter pain medications, such as ibuprofen or aspirin
• triptans, such as sumatriptan
• antiemetics, which reduce nausea and vomiting

Learn more about migraine and its treatment.

Many people with celiac disease and NCGS also have migraine. It is less clear whether gluten consumption can cause migraine episodes in people without celiac disease or NCGS. People who suspect they may have a gluten intolerance or wheat allergy should speak with a doctor.