Celiac disease and migraine – is there a connection?
Celiac disease and migraine – is there a connection?
When people think of celiac disease symptoms, they often first consider gastrointestinal issues like diarrhea or abdominal pain. However, we now know very well that the range of symptoms for this condition is very broad, which is why it is often referred to as the "chameleon of medicine." Almost every organ system in our body can show signs of celiac disease.
One facet of these many complaints can be headaches. In the following post, I would like to explain the connection between celiac disease and various types of headaches as well as migraines, and how often this is to be expected. And I will explore the question of whether a gluten-free diet has an effect on this symptom complex.
Isn't a headache always just a headache?
Headaches are among the most common neurological conditions—meaning those originating from the nervous system—in both adults and children. They can have a significant impact on everyday life and be associated with major limitations in professional and school life, as well as in leisure activities. This results in a clear reduction in the quality of life for those affected.
Tension headaches, which feel like a band around the head and tend to be dull and pressing in nature, and migraines, characterized by paroxysmal, often pulsating pain that is accompanied by other symptoms such as light sensitivity and nausea in many sufferers, are among the most common types of headaches. For example, 30-70% of children and adolescents complain of regular tension headaches, and about 10% suffer from migraines. According to a U.S. study, one in 6 adults reports migraines or severe headaches, with the proportion even higher among women (about one in 5).
How common are headaches and migraines in people with celiac disease?
Numerous studies consistently confirm the trend that people with celiac disease experience headaches and migraine attacks more frequently than other individuals. This applies not only to celiac disease but also to other gastrointestinal disorders: One study showed a prevalence of 30% for celiac disease patients suffering from regular headaches, with migraine pain being the most frequent, followed by tension headaches. For chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis), the prevalence was 23%, and in cases of gluten sensitivity, 56% reported regular complaints—in comparison, 14% of all individuals in a control group reported headaches.
Women were affected significantly more often. If additional mental illnesses such as depression and anxiety were present, there were more complaints of migraine headaches. Conversely, individuals over the age of 65 reported these symptoms less frequently.
A current review study from 2025 found a celiac disease prevalence of approximately 2% among migraine patients, which is twice as high as among non-migraine sufferers. This applies to adults as well as children and adolescents. The observation that celiac disease and migraines occur together more frequently than average is confirmed by numerous studies. Overall, there is a tendency toward an increased incidence of migraines in people with autoimmune diseases.
What are the explanations for why migraines occur more frequently with celiac disease?
The most obvious explanation would be a common genetic basis. However, corresponding studies have not been able to prove a genetic link between the two conditions. Therefore, one must take a closer look at the processes that occur in the body during migraines and celiac disease: Pain signals in a migraine originate in the area of the trigeminal nerve. This cranial nerve transmits all sensations from our face via its three facial branches at the forehead, the upper jaw/cheek area, and the lower jaw, and is also responsible for supplying the masticatory muscles. If external influences lead to an increased occurrence of pro-inflammatory messengers (such as interleukin 1ß and TNF a), a specific protein, Calcitonin Gene-Related Peptide (CGRP), is activated and produced in greater quantities. This mediates the pain signals in the ganglia of the trigeminal nerve, which spread via nerve endings in the meninges. However, these inflammatory messengers are produced not only in migraines but also, for example, in celiac disease. In celiac disease, one sees an increase in TNF-a and IF-gamma, which also control and promote the synthesis of CGRP. An active case of celiac disease can therefore lead to migraine attacks.
Another factor in the disease process is the gut flora. A microbial imbalance in the gut additionally promotes the formation of inflammatory messengers. Changes in the microbiome can therefore be effective triggers for migraine attacks.
Stress is another exacerbating factor, as it leads to an increased release of cortisol. This stress hormone, in turn, affects the microbiome. In this case as well, additional pro-inflammatory messengers are released. This leads to an increased susceptibility to inflammatory diseases, and the pain perception in the trigeminal area is stimulated more intensely along the path already described. Stress can thus worsen a migraine.
The gut and brain are more closely linked than is apparent at first glance. Our gut has its own (enteric) nervous system that stores information and triggers reactions. There is also feedback to our central nervous system, the brain and spinal cord. The gut-brain axis runs in both directions: in the brain, gut movements and digestive processes are controlled via hormonal regulation. Conversely, the gut also influences the brain in terms of perception, behavior, and pain sensitivity. If there is a state of increased alertness or excessive sensitivity, as is also suspected in irritable bowel syndrome, messages from the gut are transmitted earlier than in other people, and a stronger or altered perception of pain arises. This aspect also plays a role in the development of migraine attacks.
Is screening for celiac disease advisable for patients with headaches and migraines?
There are a number of conditions so frequently associated with celiac disease that people with these conditions should be specifically screened for it. As previously explained, celiac disease is also more common among migraine patients. Nevertheless, recommendations for broad screening for celiac disease are not so definitive that every migraine patient must necessarily be tested. The same applies to other types of headaches: while celiac disease is more common in headache patients and headaches are more common in those with celiac disease, this also results in a large overlap purely by chance, without there always having to be a causal relationship.
Nevertheless, one must clearly state: an antibody test for celiac disease is a very simple measure and, taking into account the recommendations on which tests should be used, the examination is also not expensive. This is countered by the fact that good treatment is available for celiac disease. And the sooner celiac disease is treated, the sooner further effects and complications can be prevented. The German celiac disease guideline also states that testing should be carried out.
Headache and migraine patients often have numerous doctor visits due to their symptoms, and a multitude of examinations are initiated. These opportunities should be used to rule out celiac disease as a possible cause once and for all.
Do migraines improve on a gluten-free diet?
Many studies show a reduction in migraine symptoms while on a gluten-free diet. A clear correlation is seen between the decrease in migraine attacks and how strictly the gluten-free diet is followed. A 2003 study showed a very significant reduction in migraine attacks in migraine patients after just 6 months of a gluten-free diet. This study also used very specific imaging techniques to detect organic changes associated with migraines. These also showed regression after the change in diet.
Between one-quarter and one-fifth of those affected by celiac disease report headaches as a symptom at the time of diagnosis. Three out of four of these individuals then experience a decrease in the severity and frequency of their headaches.
Important!
Even if you are reading this now and have not yet undergone celiac disease testing, and suffer from frequent headaches or migraine attacks – please do not tentatively switch to a gluten-free diet! On a gluten-free diet, diagnostic indicators such as elevated antibodies and mucosal changes gradually recede. While this is ultimately the goal, it may mean they are no longer clearly detectable, making it impossible to reliably diagnose celiac disease. As a result, you will not have a definitive diagnosis!
Therefore: FIRST get tested for celiac disease to gain clarity, then switch to a gluten-free diet if necessary.
In a nutshell
The connections between celiac disease and migraine or other types of headaches are very diverse, so I would like to summarize them briefly:
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Migraine and other types of headaches occur more frequently in people with celiac disease than in other individuals.
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However, celiac disease also occurs somewhat more frequently in people with migraines or tension headaches. Headaches are therefore among the most common neurological signs of celiac disease.
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There are overlaps in the pathogenesis of celiac disease and migraine that explain their frequent co-occurrence. The increased production of inflammatory mediators plays a central role in this. These trigger the transmission of pain signals in the brain via other proteins such as CGRP, thereby triggering a migraine attack.
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Due to the frequent co-occurrence, screening for celiac disease should be considered in patients with migraine and headache, especially when therapies do not respond well.
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In cases of confirmed celiac disease, headaches and migraine attacks often improve within just a few months of following a gluten-free diet.
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Nevertheless, the following also applies here: we strongly advise against a trial gluten-free diet without prior diagnosis for celiac disease!
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Dr. Stephanie Baas
Ärztin und Zöliakie-Expertin