Whole-food Gluten-free Diet
Summary:
A gluten-free diet excludes wheat, barley, and rye, and in its whole-food form, focuses on naturally gluten-free, unprocessed foods. There is strong evidence for migraine reduction in those with celiac disease. There is considerable anecdotal evidence for benefit in those who are gluten sensitive (which may be a substantial proportion of the population), but trial data is limited.
Biological Plausibility
Celiac disease and non-celiac gluten sensitivity are associated with both migraine and white matter abnormalities. Gluten enhances gut permeability and immune activation in susceptible individuals—both are linked to migraine pathophysiology.
Evidence
Marked clinical improvement in migraine has been observed in celiac patients who adopt a gluten-free diet. Some small studies and case reports suggest similar benefit in non-celiac gluten sensitivity, though large RCTs are lacking.
Effect Size
In individuals with gluten sensitivity or celiac disease, migraine frequency may drop by 50–75% over weeks to months.
⚠️ Risk
Low risk when based on whole foods. Poorly formulated diets that rely on processed substitutes may be low in fiber, B vitamins, and iron.
Cost
$
Scores
- Benefit: 2
- Burden: 2
- Ratio: 1.0
Clinical Takeaways
- Best suited for patients with GI symptoms, IBS, or known gluten sensitivity.
- Should emphasize nutrient-dense whole foods, not gluten-free substitutes.
- A trial of 4–6 weeks is typically sufficient to gauge benefit.
Key References
- Rodrigo L, et al. *Headache in celiac disease and its response to a gluten-free diet.* Eur Neurol. 2013.
- Ayyagari R, et al. *Headache and gluten sensitivity: Clinical and pathophysiological relationships.* Nutrients. 2020.