Griauzdaitė K, Maselis K, Žvirblienė A, Vaitkus A, Jančiauskas D, Banaitytė-Baleišienė I, Kupčinskas L, Rastenytė D
Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eivenių g. 2, Kaunas, Lithuania.
Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eivenių g. 2, Kaunas, Lithuania.
Med Hypotheses. 2020 Sep;142:109738. doi: 10.1016/j.mehy.2020.109738. Epub 2020 Apr 11.
Recent reports reveal a close relationship between migraine and gastrointestinal disorders (GI), such as celiac disease (CD) and non-celiac gluten sensitivity (NCGS). CD is a genetic autoimmune disorder, which affects the mucosa of the small intestine. Gluten, found in various grains, not only plays a major role in the pathophysiology of CD and NCGS, but also aggravates migraine attacks. Another common food component, which can induce migraine headaches, is histamine. Diamine oxidase (DAO) is an enzyme, which degrades histamine. Reduced activity of DAO means reduced histamine degradation, which can cause histamine build-up and lead to various symptoms, including headaches and migraine. In this paper we propose a hypothesis, that in pathogenesis of migraine, low serum DAO activity is related to CD and NCGS. We also conducted our own pilot study of 44 patients with severe migraine in efforts to evaluate the co-presence of decreased serum DAO activity and celiac disease/NCGS in patients. 44 consecutive migraine patients were divided into 2 groups: decreased DAO activity (group 1; n = 26) and normal DAO activity (group 2; n = 18). All patients were screened for celiac disease. The diagnosis of NCGS was made after exclusion of CD, food allergies and other GI disorders in the presence of gluten sensitivity symptoms. Furthermore, dietary recommendations were given to all participants and their effects were assessed 3 months after the initial evaluation via the MIDAS (Migraine Disability Assessment) questionnaire.
Only 1 patient fit the criteria for celiac disease, rendering this result inconclusive. Pathological findings of the remainder of patients were attributed to NCGS (n = 10). 9 of 10 patients with NCGS belonged to the decreased serum DAO activity group (group 1; n = 26), suggesting a strong relationship between reduced serum DAO activity and NCGS. MIDAS questionnaire revealed, that patients with decreased serum DAO activity were more severely impacted by migraine than those with normal DAO activity, and this remained so after our interventions. Dietary adjustments significantly reduced the impact of migraine on patients' daily activities after 3 months in both groups. We argue, that migraine, celiac disease and NCGS may benefit from treatment with a multidisciplinary approach, involving neurologists, gastroenterologists and dietitians.
近期报告显示偏头痛与胃肠道疾病（GI）之间存在密切关系，如乳糜泻（CD）和非乳糜泻麸质敏感（NCGS）。CD是一种遗传性自身免疫性疾病，会影响小肠黏膜。存在于各种谷物中的麸质不仅在CD和NCGS的病理生理过程中起主要作用，还会加重偏头痛发作。另一种可诱发偏头痛的常见食物成分是组胺。二胺氧化酶（DAO）是一种降解组胺的酶。DAO活性降低意味着组胺降解减少，这会导致组胺蓄积并引发包括头痛和偏头痛在内的各种症状。在本文中，我们提出一个假设，即在偏头痛的发病机制中，血清DAO活性降低与CD和NCGS有关。我们还对44例重度偏头痛患者进行了自己的初步研究，以评估患者血清DAO活性降低与乳糜泻/NCGS的共存情况。44例连续的偏头痛患者被分为两组：DAO活性降低组（第1组；n = 26）和DAO活性正常组（第2组；n = 18）。所有患者均接受了乳糜泻筛查。在排除CD、食物过敏和存在麸质敏感症状时的其他胃肠道疾病后，做出NCGS的诊断。此外，向所有参与者提供了饮食建议，并在初次评估3个月后通过MIDAS（偏头痛残疾评估）问卷评估其效果。
只有1例患者符合乳糜泻标准，因此该结果尚无定论。其余患者的病理结果归因于NCGS（n = 10）。10例NCGS患者中有9例属于血清DAO活性降低组（第1组；n = 26），这表明血清DAO活性降低与NCGS之间存在密切关系。MIDAS问卷显示，血清DAO活性降低的患者比DAO活性正常的患者受偏头痛影响更严重，并且在我们的干预后仍是如此。3个月后，两组的饮食调整均显著降低了偏头痛对患者日常活动的影响。我们认为，偏头痛、乳糜泻和NCGS可能受益于多学科方法的治疗，涉及神经科医生、胃肠病学家和营养师。
