S1557 Migraine Disorder Occurs More Often in Celiac Disease Patients: A Nationwide Population-Based Cohort Study

Introduction: Migraine disorder is a relatively common condition affecting nearly 15 percent of the general population. This disorder has been linked to multiple gastrointestinal diseases including celiac disease (CD), an autoimmune enteropathy characterized by immune-mediated damage resulting from gluten exposure. We aimed to further characterize the risk and epidemiologic association between CD and migraine disorder with this study. Methods: We queried a multi-institutional database (Explorys Inc., Cleveland, OH); an aggregate of electronic health record data from 26 major US health systems. We formed cohorts of patients with CD and migraine disorder using Systemized Nomenclature of Medicine – Clinical Terms (SNOMED – CT). Migraine disorder was defined as SNOMED terms for “Migraine disorder” with prescribed migraine treatment (drug class: “migraine treatment”). Patients with diagnoses of cluster or tension headaches were excluded. Univariate and multivariate analyses were performed on the data, and associations were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using IBM SPSS Statistics version 25. Results: Of 30,142,740 adult patients in the database between 2017-2022, 91,390 (0.30%) carried a celiac disease diagnosis. Among celiac disease patients, 6,360 (6.9%) carried a migraine disorder diagnosis compared to 474,360 (1.6%) of the non-CD patients (P < 0.0001). After multivariate analysis, celiac disease was associated with an increased odds of migraine disorder (aOR = 1.49; 95% CI 1.42-1.57; P = < 0.0001) (Figure, Table). Conclusion: This large population-based cohort study demonstrated significantly higher odds of migraine disorder among patients with celiac disease compared to patients without the disease. Our findings are in line with those from previous observational studies showing the same. Larger prospective studies would be beneficial in identifying the role of gluten exposure in this association.Figure 1.: Risk factors for development of migraine disorder Table 1. - Prevalence of risk factors among celiac disease patients with respective adjusted odds ratios (aORs) by multivariate analysis. Celiac Disease With Migraine Disorder (n [%]) Without Migraine Disorder (n [%]) Multivariate Analysis (aOR [95% CI])* Total 6360 85030 1.45 (1.42-1.57) Risk factor Alcohol use 240 (3.77) 1590 (1.87) 0.87 (0.84-0.89) Obesity 2230 (35.1) 18230 (21.4) 1.43 (1.41-1.45) Diabetes mellitus 390 (22.3) 17680 (20.8) 0.82 (0.81-0.83) Male 560 (8.81) 18780 (22.1) 0.70 (0.69-0.70) Smoker 720 (11.3) 5040 (5.93) 1.21 (1.19-1.23) Caucasian 5720 (89.9) 56830 (66.8) 1.25 (1.24-1.27) Senior (Age >65) 920 (14.5) 19550 (23.0) 0.61 (0.60-0.62) Depression 3850 (60.5) 24840 (29.2) 1.71 (1.70-1.73) *P < 0.0001 for all aORs.