Migraine is a debilitating and complex neurological disorder thought to affect 10% of people worldwide. While it’s not entirely clear exactly how or why migraine occurs, research has shown that migraine develops in response to certain triggers, one of those being diet. In this post I will discuss how diet relates to migraine, common migraine food triggers, how to identify dietary triggers and what you can do if diet is responsible for your migraine.

How does diet relate to migraine?

While high-quality studies providing evidence for diet’s effect on migraine are limited, there is research suggesting a relationship between diet and migraine, a summary of which I’ve outlined below:

Food triggers and migraine

Commonly reported as a symptom of diet, it’s generally accepted that migraine can be triggered by certain food chemicals most of which are found in everyday foods (1).

Not to be confused with a food allergy, a food chemical sensitivity does not involve the immune system, but instead is a multi system condition which triggers reactions by irritating nerve endings in different parts of the body (2). Chemicals in foods (either natural or added) can affect various parts of the body, including the nervous system which is responsible for the throbbing pain experienced by migraineurs.

The degree to which an individual reacts to dietary triggers depends on factors such as the types of symptoms they are prone to, the particular chemicals they are sensitive to and their threshold for reacting. Dietary triggers can affect one or more systems (e.g. skin, airways, gastro intestinal, nervous system) and appear to have a genetic component, usually affecting the same system across generations (2).

Another possible link between diet and migraine may be the quantity of fats, carbohydrates and caffeine in the diet, high levels of which have been shown to cause activation of the sympathetic nervous system or parasympathetic withdrawal, and may contribute to the onset of migraine (3). Low-fat vegan diets, ketogenic diets (low carb, high fat) and low glycemic index diets were all reported to be beneficial in people with certain types of migraine (4)(5)(6).

Alcohol and migraine

Alcohol, especially red wine (7), is a common trigger reported by migraineurs. While some studies showed a positive correlation between the two, other studies showed an inverse relationship between alcohol and migraine risk (3). This could be due to the fact that some individuals due to genetic factors (18) have a lower chemical threshold than others, making them more susceptible to alcoholic beverages.

Meal timing and migraine

One study (8) exploring the effects of eating behaviours on migraine showed that eating a meal late in the day or consuming a snack before bed could reduce the odds of a migraine. Nighttime snacking was associated with a 40% reduction in headache incidence. Eating a late dinner was associated with a 21% reduction in the odds of headache when compared to no additional food, but this association was not statistically significant. While no causal relationship can be derived from this study alone, it offers insight into the possibility for eating behaviours to be manipulated for migraine management.

Scientific literature (9) has also indicated that migraines can be triggered by fasting and hypoglycemia (low blood sugar). It’s been hypothesised that diets that promote a steady source of glucose / minimise fluctuations in blood sugar levels may aid in the prevention of migraine.

Microbiome and migraine

According to research, the microbiome of migraineurs differ from non-migraineurs. Studies suggest that the intestinal microbiome plays an important role in health and that diet plays a big part in shaping the microbiome (19). When dysbiosis of the gut occurs, gut permeability is increased, and it’s been proposed that this may allow proinflammatory substances to reach the trigeminovascular system and trigger migraine (18). Thus it’s been hypothesised that changes to the gut microbiome based on diet (e.g increased fiber consumption, low GI diet, vitamin D supplementation, etc.) and possibly probiotics, may have a positive impact on migraine.

Jury is still out

It’s also important to note that one study (10) reported no unfavourable impact of diet on migraine, highlighting the need for more research in order to confirm the link between what you eat and migraine symptoms that ensue.

How does diet trigger migraine?

One of the ways dietary triggers cause reactions is by irritating nerve endings in different parts of the body (2). For a detailed explanation on what happens to the brain during a migraine, see this blog post. Dietary factors can also affect how the brain uses glucose, influence the release of chemicals such as serotonin (decreased levels of which have been observed in migraineurs (11)), and cause inflammation and vasodilation (3).

The degree to which an individual reacts to food chemicals depends largely on their threshold for reacting so when it comes to migraine attacks, it’s helpful to think of their relation to foods in terms of the “bucket theory”. Eating a lot of food high in an offending chemical might fill up your bucket straight away, whereas eating smaller amounts of triggering foods over many days may not be enough to produce a migraine, but instead accumulate in your body until your dose threshold is finally exceeded and a migraine ensues.

People with migraine can also suffer from other symptoms if they’re sensitive to a certain chemical as chemical sensitivity is a systemic disorder and can impact different target organs in the body (e.g. skin, gut, central nervous system, respiratory tract, etc.). While some people will suffer from only one condition (e.g migraine), others may also get gut problems and/or skin problems at the same time.

What are the main food triggers associated with migraine?

Food chemicals are well documented as being migraine triggers (12). The following is a summary of the main food culprits implicated in migraine:

Salicylates: migraine is a commonly reported symptom of salicylate consumption (13,14). A chemical made by plants, salicylates act as the plant’s immune system, reducing the risk of pathogens invading. The natural chemical is found in most fruits and vegetables, as well as herbs, spices, most nuts and seeds, honey, tea and coffee. The amount of salicylate varies according to the type of food and can also be found in non-food items such as mint toothpaste, cleaning products and fragrances (a possible reason why lots of migraneurs are triggered by strong perfumes).

Glutamates: an amino acid which can be a trigger for some sensitive people when it isn’t bound up in protein but is instead in its free form. This chemical is used to enhance flavour so it is commonly found in foods such as sauces, stocks, cheeses and many savoury snack foods (think flavoured chips and rice crackers).

Amines: include histamine, tyramine, dopamine and phenylalanine. Commonly found in chocolates, aged or overcooked meat, fruits and vegetables, yogurt, aged cheeses, and wines. Because amine formation comes about due to the natural breakdown of protein over time, aged or ripened rather than fresh foods are generally higher in amines.

Nitrates/Nitrites: certain foods, such as processed meats, leafy vegetables, chocolate and food additives consist of nitrate/nitrite-containing compounds. These dietary nitrates/nitrites, naturally occurring chemicals containing nitrogen and oxygen, significantly contribute to nitric oxide formation in the body, a chemical which has been linked to the development of migraine (15).

Wheat, milk and soy: during the elimination diet, wheat and milk are often removed for people who suffer gut issues. This is not necessarily because of the gluten or proteins in the products, but because they contain added chemicals which could be triggering the symptoms. When it comes to soy, it’s not generally the soy itself that is the problem, it’s that when it’s broken down, the soy protein releases natural glutamate, potentially triggering symptoms in sensitive individuals. 

It’s important to note that due to the lack of well-designed placebo controlled studies, evidence-based advice for removing the above food chemicals from the diet to improve migraine symptoms is limited. That being said, efficacy has been observed where certain migraine-triggering foods have been eliminated (16). Thus, until the underlying mechanisms of how dietary triggers influence migraine are further explored, a limited removal of ‘high risk’ foods in adults might be a good first step to determine whether diet plays a role in their migraine onset.

How can you identify if food is a migraine trigger for you?

The elimination diet is currently the only useful diagnostic tool health care professionals have in investigating whether food is triggering your migraine. The diet, developed by the Royal Prince Alfred Hospital (RPAH) involves cutting down on a range of food chemicals that are known to cause symptoms in some people. Due to its restrictive nature, the elimination diet should only be applied short-term so as not to starve the body of essential nutrients.

After being on the elimination diet for at least 3-6 weeks and once migraine symptoms have settled for at least 5 days in a row, the next step is introduced, which involves identifying which particular food chemicals are tolerated by the individual, and which ones are not. This food challenge process involves testing each food chemical one by one, usually done by eating foods that provide a high dose of each particular chemical. If no migraine symptoms are experienced during the period where the food chemical is introduced, it’s assumed that foods containing that chemical are safe to eat. However, if migraine symptoms are experienced, then a food trigger is considered to have been successfully identified and it’s now a matter of discovering what an individual’s threshold is for that chemical.

The next step is to liberalise the diet by adding back foods containing chemicals that you didn’t react to in the challenges, just to make sure you got the process right (i.e. you can eat more foods and no migraine occurs).

Finally you’re encouraged to find your threshold by adding back in small amounts of the chemicals that you reacted to on the challenges to find out how much you can tolerate before symptoms ensue. Once your detective work is completed, preventing future migraines comes down to learning how to balance your diet and lifestyle so symptoms don’t ensue.

What to do if diet is responsible for your migraine?

Firstly, if you suspect your diet may be responsible for your migraine, it’s highly recommended you seek the advice of a health care professions (e.g. GP and/or dietitian) to both rule out any other health conditions as many of the symptoms of food intolerance/sensitivity overlap with other disorders. They will also be able to give you expert guidance in navigating the often tricky detective work that is involved in establishing the cause of your migraine.

Other general diet tips for managing your migraine include:

• Eat a balanced diet void of consistently high levels of sugar and fat. Also make sure to stay hydrated throughout the day.
• Try not to skip meals. If you aren’t a three meals a day kind of person, you can eat smaller meals throughout the day to ensure your blood sugar levels do not decrease significantly.
• Eat fresh and avoid eating leftovers. Leaving foods in the fridge or sitting out for a while means the proteins break down and lead to higher levels of food chemicals (e.g. amines and glutamates), which help food taste great but not so good if you’re sensitive to these chemicals.
• Though coffee is high in certain food chemicals associated with triggering migraine, there is also evidence to suggest that caffine consumption may be helpful in treating acute migraine when used in combination with other pain medication (17). 
• Identify food triggers and know your chemical threshold so you don’t overflow your “bucket”.
• Undertaking the elimination diet? Here are my top tips from seeing it through from start to finish.
• Be wary of any diets that claim to be a migraine “cure”. Unfortunately science isn’t there yet. Eliminating large food groups from your diet unnecessarily may be detrimental to your health (your gut microbes love food diversity).
• Diet is just one piece of the migraine puzzle. In fact, it’s often the case that a combination of several triggers are involved in setting off a migraine attack. Other triggers for migraine include stress, sleep, hormones and changes in weather, something to keep in mind when looking to reduce your migraine load.

Conclusion

While there is a large body of anecdotal evidence highlighting the link between diet and migraine, science has a way to go in proving not only that diet indeed causes the adverse reactions experienced by susceptible individuals, but also why these people have a decreased ability to properly metabolize and excrete certain food chemicals from their bodies in the first place. Given that diet is a modifiable aspect of migraine, it’s hoped that in the future the relationship between food and migraine will be better understood so sufferers may obtain a level of control over a condition that so often feels out of our hands.

Brigid xx

 

References

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