Headache in pediatric patients with celiac disease and its prevalence as a diagnostic clue.
OBJECTIVE
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.
Lionetti
Elena
E
Department of Paediatrics, University of Catania, Catania, Italy. elenalionetti@inwind.it
Francavilla
Ruggiero
R
Maiuri
Luigi
L
Ruggieri
Martino
M
Spina
Massimo
M
Pavone
Piero
P
Francavilla
Teresa
T
Magistà
Anna Maria
AM
Pavone
Lorenzo
L
D000293:Adolescent; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000209:etiology*; D006306:Health Surveys; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D007070:Immunoglobulin A