Mast Cells and Headache in Crohn's Disease

Abstract

SYNOPSIS Four patients with vascular headaches of remarkable severity and chronicity not responding to usual therapies brought attention to their families in which at least two members each also have Crohn's disease. Hitherto an association of Crohn's disease with vascular headache of the migrainous type has not been recognized.One patient suffered bouts of extreme constipation at age four years. When eight years old he developed “screaming, pounding headaches”. During headaches, intermittent crampy periumbilical pain and diarrhea appeared. Subsequent radiologic and surgical evidence resulted in a diagnosis of Crohn's disease. His 11‐year‐old brother was seen for headaches which were intractable over a period of at least six months, but bowel symptoms has not appeared as yet. Their father has Crohn's disease.A 19‐year‐old woman with Crohn's disease presented with headaches of the migrainous type of eight months duration, resistent to all therapies. Her mother has Crohn's disease and migraine and a sister has peptic ulcers, “gaseous colon” and migraine.Resected bowel of three of these patients showed large numbers of mast cells. We suggest that vasoactive substances, including histamine released from mast cells, could cause headache. Moreover, impaired sulfate conjugation of monamines, or decreased monoamine oxidase in diseased bowel could facilitate the absorption and increase the circulation of vasoactive substances causing headache.

Is the Cluster Headache Local Mastocytic Diaethesis?

“…1,2 An associaton between bowel disease and mast cell changes has also been noted. 3 Our data would suggest, in support of others, 1,2,3 that indeed, mast cell activity may be related to the cluster headache process, by virtue of similar changes possibly occurring in deeper tissues. In other words, cluster headache may be characterized by a local mastocytic diaethesis.…”

Extraintestinal Manifestations in Children With Gastrointestinal Food Allergy

“…The difference between both groups is the only one in our study that is not significantly higher in the GIFA group, although it is significant in the atopic subgroup compared with the IBD group. Headache has been associated with FA (21,28), atopy (21), and IBD (29) previously, which could explain the lack of statistically significant difference between the GIFA group and IBD group.…”

Mixed organic brain syndrome as a manifestation of systemic mastocytosis.

“…One important problem with the systemic hypothesis is that histamine does not penetrate the blood-brain barrier to any significant degree (13). Parenteral injections of histamine do not usually produce any evident effects on the CNS except emesis relating to its effect on the chemoreceptor trigger zone (13) and vascular headache (14). Direct administration of histamine into certain regions of the brain and/or intraventricularly are associated with some observable effects such as arousal, altered neuronal firing, and desynchronization of the EEG (15).…”