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Risk of Headache‐Related Healthcare Visits in Patients With Celiac Disease: A Population‐Based Observational Study
Author(s) -
Lebwohl Benjamin,
Roy Abhik,
Alaedini Armin,
Green Peter H.R.,
Ludvigsson Jonas F.
Publication year - 2016
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12784
Subject(s) - medicine , headaches , population , incidence (geometry) , gastroenterology , disease , observational study , retrospective cohort study , serology , pediatrics , surgery , immunology , antibody , physics , environmental health , optics
Background and Aims Patients with celiac disease (CD) are reported to be at increased risk for headaches, though large studies are lacking. We aimed to examine the risk of headache‐related healthcare encounters in patients with CD in a nationwide population‐based setting. Methods In this population‐based retrospective cohort study, we searched all (n = 28) pathology departments in Sweden and identified patients with CD based on the presence of villous atrophy (VA). Each patient was matched to up to 5 controls, by age, gender, calendar period, and region. Using Cox proportional hazards, we tested for an association between CD and subsequent headache‐related visit. We also tested this association for those with intestinal inflammation but normal villi, and subjects with positive CD serologies but normal histology. Results Among 28,638 patients with CD and 143,126 controls, headache‐related visit occurred in 1,337 (4.7%) and 4,102 (2.9%), respectively. The incidence of headache‐related visit was 423 per 100,000 person‐years in CD patients and 254 per 100,000 person‐years in controls (HR 1.66; 95% CI 1.56–1.77; P < .0001). Individuals having inflammation without VA on small intestinal biopsy (n = 12,898; HR 2.08; 95% CI 1.90–2.27; P < .0001) and those with normal mucosa but positive CD serology (n = 3,617; HR 1.83; 95% CI 1.57–2.12; P < .0001) were also at increased risk for headache‐related visit. Conclusions In this population‐based study we found a significantly increased risk of headache‐related visits in patients with CD; this increase was also present in patients with intestinal inflammation and those with positive CD serology but with normal mucosal architecture on small bowel biopsy. Though limited by surveillance bias, this study indicates that headache‐related visits are more common in these populations.