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Do you need to be gluten free for your migraines?

If you’re one of the 1 billion people on the planet who have migraines, you’ve probably tried almost everything to feel better. You avoid well-known triggers such as chocolate, MSG, red wine, citrus fruits and aged cheeses.

You even cut out gluten, a protein found mainly in wheat, barley and rye. But does skipping sourdough bread help relieve your symptoms?

Migraine and celiac disease

Many patients ask the question, says Lauren Natbony, MD, an assistant clinical professor of neurology specializing in headache medicine on Mount Sinai in New York.

There is a clear link between migraine and stomach diseases, including celiac disease.

“Patients with diagnosed celiac disease who switch to a gluten-free diet usually have less and less severe migraine attacks.”

In celiac disease, gluten causes the immune system to attack the body, damaging the small intestine. But if you have psoriasis but not celiac disease, it will not help to skip gluten.

What if you are gluten sensitive?

Your doctor may call you ‘gluten sensitive’ if you do not have celiac disease but still respond to gluten. It is unclear how many people fall into this category.

Natbony says she has seen a handful of patients with non-celiac disease whose headaches have improved after quitting gluten. She adds that these good effects apparently do not last, and that patients struggle to stick to the diet.

Yet, she says, gluten can cause intestinal inflammation that leads to migraines in gluten-sensitive people.

Maria Vazquez-Roque, MD, a gastroenterologist at the Mayo Clinic in Jacksonville, FL, says that some people who look gluten-sensitive may actually be sensitive to FODMAPS (short for fermentable oligosaccharides, disaccharides, monosaccharides, and polio).

These are carbohydrates found in many healthy foods that some people cannot digest, leading to bloating, diarrhea and headaches. She suggests that people with migraines that are negative for celiac disease work with a dietitian to try a low-FODMAP diet for a month or two.

Gluten free?

Natbony does not test every migraine patient for celiac disease. She does investigate the symptoms of gluten sensitivity, such as diarrhea, smelly stools and more than normal gas. She usually does not recommend a gluten-free diet for people who do not need it.

“Gluten-free products usually contain fat, carbohydrates and sodium, and they can be expensive,” she says.

In addition, it is difficult to avoid gluten altogether. It is not just in obvious foods like bread, pasta and cake. It contains hundreds of products you would never think of, including soy sauce, canned soups and salad dressings – even toothpaste.

Yet she says dietary changes are an important part of treatment. People can make many changes on their own, such as avoiding known food generators such as caffeine, nitrates in meat and aspartame.

Natbony says it can be stressful to chase after headaches, which can also cause migraines. Here is what she suggests:

  • Keep a headache diary and a food diary to see if there is a connection between what you eat and a migraine attack. A food-related migraine can occur immediately after eating or up to 48 hours later.
  • If there seems to be a connection, cut the food out of your diet for about 4 weeks and see if you feel better.
  • Add the food slowly – not too much at first. If it causes migraines or has more headaches, it is best to stop eating it completely.

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