Food and migraine

The relationship between food and migraine does exist but it’s not crystal clear. Many foods can act as triggers and certain dietary interventions may decrease the frequency and severity of migraine attacks.

What is migraine

Migraine is a disabling headache disorder (1) which may present with symptoms such as extreme sensitivity to light, sound and smell, nausea, vomiting and movement sensitivity (1, 2). Both genetic and environmental factors influence migraine (2).

Food triggers of migraine

Some foods are commonly reported as migraine triggers, including:

• chocolate (1, 2, 3)
• citrus fruits (1, 2, 3)
• some vegetables such as tomatoes (2, 3) and onions (2)
• nuts (1, 2)
• dairy products such as cheese, milk and ice cream (1, 2, 3)
• alcohol (1, 2, 3) such as red wine (3)
• coffee (1, 2, 3) and caffeine (1, 2)
• monosodium glutamate (MSG) (1, 2)
• sweeteners such as aspartame (1, 2) and sucralose (2)
• processed meats (1)
• fatty foods (1)
• leavened products (e.g. yeast bread) (3)
• gluten-containing foods (2)

Furthermore, some of the food chemicals commonly identified as triggers are:

• histamine (2)
• tyramine (2)
• phenylethylamine (2)
• nitrites (2)

It is important to note that triggers are different for different individuals and that evidence is, in some cases, contradictory.

Gut health and migraine

The connection between the gut and the brain is called the gut-brain axis. The communication happens in both ways. The gut microbiome act on the brain indirectly by signalling through neurotransmitters, inflammatory cytokines and hormones, and directly by stimulating the vagus nerve. On the other hand, the central nervous system modulates the gut microbiome (4). Some inflammatory cytokines (e.g. TNF-α, IL-1β and IL-6) (3, 4) and neurotransmitters (e.g. glutamate) are associated with migraine prevalence (4).

In addition, there are gut symptoms and conditions associated with migraine to different extents (2, 4). These include diarrhoea, constipation, reflux, helicobacter pylori infection, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and Coeliac Disease (4).

Metabolic syndrome and migraine

There is also an association between metabolic syndrome and migraine (2, 3). Of course, this does not mean that insulin resistance or any of the other features of metabolic syndrome cause migraine or the other way around. However, it is safe to say that a healthy lifestyle is likely to prevent both conditions.

Dietary interventions and migraine

There are a number of interventions that have been studied as potentially beneficial for migraine. However, none of them has undisputed supporting evidence. Interventions that have shown some success include:

• probiotic supplementation (2, 4)
• high folate diet (1)
• low glycemic index diet, which is also high fibre (2, 3, 4)
• high omega-3 and/or low omega-6 intake (1, 2, 3, 4)
• low fat diet (1, 2, 3, 4) although there is no consensus definition of the percentage of energy from fat, nor the breakdown per type of fat
• low carbohydrate diets (e.g. ketogenic and Atkins) (1, 2, 3)
• low sodium intake such as Dietary Approaches to Stop Hypertension (DASH) (1, 3)
• gluten-free diet (2)
• vitamin D supplementation (2, 4)
• increased consumption of healthy wholefoods instead of processed foods (1)
• elimination of foods that trigger IgG antibodies in the individual, which are a sign of inflammation (1, 3)
• weight loss/low energy diet (2, 3)

Other factors

Other factors that may worsen migraine attacks include:

• overweight and obesity (2, 3, 4)
• smoking (1)
• fasting (1)
• pollen allergies (1)

Summary and recommendations

Migraine is a complex condition that is affected by multiple factors. There is a number of commonly suspected triggers and some interventions that have proven to be helpful but no universal recipe for all migraine sufferers. Based on the literature, it seems that avoiding common triggers, performing an IgG test and adopting a generally healthy (i.e. whole food based) eating pattern can prevent or reduce migraine symptoms.

Some dietary interventions can result in nutrient deficiencies, so please talk to a dietitian before making any changes to your diet.

References

1. Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache. 2020 Jul;60(7):1300–16.
2. Gazerani P. Migraine and Diet. Nutrients. 2020 Jun;12(6).
3. Razeghi Jahromi S, Ghorbani Z, Martelletti P, Lampl C, Togha M. Association of diet and headache. J Headache Pain. 2019 Nov;20(1):106.
4. Arzani M, Jahromi SR, Ghorbani Z, Vahabizad F, Martelletti P, Ghaemi A, et al. Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain. 2020 Feb;21(1):15.

[Photo by Nik Shuliahin on Unsplash]

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