Headache as initial manifestation of celiac disease

Celiac disease is an immune-mediated disorder due to gluten ingestion in genetically predisposed individuals. It can be shown with gastrointestinal or extra digestive symptoms, as headache. We report the case of a 3-year-old child who had presented a one-month history of daily headache, without severity or neurological complications. We detected low iron level in blood tests, so we prescribed an oral iron treatment. Two months after, the headache persisted, so we sent child to the Neurological Paediatrics Unit (the magnetic resonance study was normal). A new blood test was performed with 128 IU/ml IgA anti-transglutaminase antibodies level. Afterwards, an intestinal biopsy was performed, confirming the presence of Marsh type I-II villous atrophy, and a HLA low resolution typing which showed a celiac cis susceptibility DQ2 haplotype. After the withdrawal of gluten from the diet, the symptoms disappeared. In conclusion, headaches are possible atypical presentations of celiac disease in children, so we must consider this disorder in patients that suffer persistent headache.