Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1371 (doi:10.1542/peds.2004-1337)
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Celiac Disease in Children With Migraine

Caterina Borgna-Pignatti, MD
Elisa Fiumana, MD
Monia Milani, PhD
Marisa Calacoci, MD
Stefano Soriani, MD
Clinical and Experimental Medicine-Pediatrics
Ferrara University
44100 Ferrara, Italy

To the Editor.

In an interesting article, Zelnik et al1 recently investigated the presence of neurologic disorders in patients with celiac disease (CD). They found those disorders to be more common in children with CD (51.4%) than in controls (19.9%). The authors also demonstrated therapeutic benefit with gluten-free diet only in patients with hypotonia or migraine. On the other hand, Gabrielli et al2 reported positive serology for CD in a significantly higher percentage of patients with migraine than in a control group (4.4% vs 0.4%).

In an attempt to verify if CD could be considered among the causes of migraine in children, we studied a total of 87 patients (54% females) followed by the Migraine Clinic of the Pediatric Department of the University of Ferrara, diagnosed according to the criteria of the International Headache Society.3 Median age was 11.5 ± 2.6 years. Informed consent was obtained by the children's guardians, and the study was approved by the University of Ferrara Ethics Committee. Concentrations of serum IgG antitransglutaminase (TgA) were measured in all patients. TgA antibodies were assessed by enzyme-linked immunosorbent assay (Eurospital, Trieste, Italy). Titers >7 arbitrary units were considered positive. Used as historical controls were 543 children (52% females) of the median age of 13.5 years attending local schools. They had been examined as part of a previous study on the prevalence of CD in Northern Italian children by means of IgA and IgG antigliadin and IgA antiendomysial antibodies. The different tests used in the 2 groups of patients are comparable. In fact, a recent study found the overall accuracy of TgA and of antiendomysial antibodies to be 92.8% and 93.4%, respectively.4

One of the children with migraine, a 9-year-old girl, was found to be positive (1.1%). She was affected by migraine without aura. Positivity was confirmed by IgA antiendomysial antibodies and by jejunal biopsy. Discontinuation of gluten from the diet decreased the number of monthly migrainous attacks from 3 to 1. Among controls, 2 children (0.037%) were found to be positive: diagnosis was histologically confirmed in 1, and the family of the other child declined additional work-up. Although the sample of children with migraine is small, our results suggest that an association between migraine and CD might exist and that larger studies should be performed. If these data are confirmed, serology for CD should probably be included in the work-up of migraine.

ACKNOWLEDGMENTS

This work was supported by a grant from the Ministero dell'Istruzione e della Ricerca, PRIN 2001.

REFERENCES

  1. Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004;113 :1672 –1676[Abstract/Free Full Text]
  2. Gabrielli M, Cremonini F, Fiore G, et al. Association between migraine and celiac disease: results from a preliminary case-control and therapeutic study. Am J Gastroenterol. 2003;98 :625 –629[CrossRef][ISI][Medline]
  3. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl 1) :9 –160
  4. Scoglio R, Di Pasquale G, Pagano G, Lucanto MC, Magazzu G, Sferlazzas C. Is intestinal biopsy always needed for diagnosis of celiac disease? Am J Gastroenterol. 2003;98 :1325 –1331[CrossRef][Medline]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics




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