Your Diet as a Migraine Therapy

Why is it that certain foods (or a combination of foods) seem to provoke your migraine attacks? Would eliminating them from your diet be helpful?

The science behind whether foods can truly trigger migraines is still fuzzy. Regardless, it's convincing enough that more and more headache specialists are recommending dietary changes as migraine therapies. 

Do Diet Changes Actually Work?

Designing and implementing studies on diet interventions for migraines is tricky for a number of reasons.

For one, it's hard to truly assess whether a person adheres to a particular diet. In addition, there are so many potential migraine-triggering foods that are unique to each person.

That being said, one study in The Journal of Headache and Pain sought to determine whether a low-fat vegan diet (which naturally eliminates many common migraine food triggers) would reduce the number and severity of migraine attacks.  

In the study, 42 participants with migraines were randomized to one of two groups:

• a change in diet—which consisted of 4 weeks of a low-fat vegan diet followed by 12 weeks of a "common migraine trigger food" elimination diet (in addition to the low-fat vegan diet)
• a placebo supplement (very low doses of omega-3 and vitamin E) with no diet changes—these doses were way too low to have any sort of therapeutic effect. 

The low-fat vegan part of the diet means that the participants ate no animal products—so no animal meat, fish, milk, eggs, or honey.

During the elimination part of the diet the participants avoided consuming common migraine-triggering foods. The patients did eventually reintroduce these foods back into their diets, although slowly, and one at a time. The eliminated foods included:

• Coffee, tea, alcohol
• Chocolate
• Sugar
• Nuts and seeds
• Certain grains (e.g., corn, barley, wheat rye)

• Certain legumes (e.g., soybeans, chickpeas, peanuts)
• Certain fruits (e.g., all citrus fruits, bananas, apples)
• Certain vegetables (e.g., sweet potatoes, yams, celery, potatoes, eggplant, pepper, onion, garlic, tomatoes)

There were a few problems with the study, mostly limited to diet adherence and the somewhat complex design of the study. Still, results were promising in that while undergoing the dietary change, most of the participants reported their headache pain was better. In the supplement group, half of the participants reported their head pain was better, and half reported it was not better. 

In addition, in the first 16 weeks of the study (when participants were most adherent to their diet), those in the diet group had less intense headaches than those in the supplement group.

This all being said, there was not a significant difference between the number of headaches experienced between the two groups. Also, when reporting improved pain for the diet period, we don't quite know if it was the vegan diet that was beneficial, or the elimination diet, or both.

 All in all, this study highlights the difficulties in determining the true benefit of dietary interventions in treating migraines. Still, these results do suggest some benefit, which is encouraging.

How Does Food Trigger Migraines?

Foods may trigger migraines through an allergic process, in which a person's immune system is activated and an antibody is produced, or through a mechanism called food intolerance, in which no antibody is produced but the body still reacts—a sensitivity not an allergy

In the above study, a low-fat vegan diet encourages the consumption of plant-based foods, many of which have anti-inflammatory properties. Likewise, meat and dairy products could be pro-inflammatory, so by avoiding them, a person with migraines may have decreased pain. 

In fact, this inflammatory effect of certain foods is supported by scientific evidence. One study in Cephalalgia showed that some migraineurs have abnormally high levels of the antibody IgG in their bloodstream when exposed to different foods, especially spices, nuts and seeds, seafood, starch, and food additives. This study supports the role of food allergies in triggering or worsening migraines. 

So it's possible that certain foods (or a combination of foods) creates a pro-inflammatory state in a migraineur's body, which then lowers the migraine threshold, allowing for other triggers to induce a migraine attack—like a perfect storm coming together.

Of course, there may be other reasons why elimination or restricted diets help ease or reduce a person's migraines attacks. For instance, elimination diets could lead to weight loss, and we know that calorie reduction and weight loss (especially in those who are obese) can improve the pain of migraines.

The Bottom Line

While the role of food as migraine triggers is a controversial and complex topic—especially when it comes to the science behind it—the truth of the matter is that you should do what makes sense. If a food (or group of foods) seems to be the culprit behind your migraines, eliminating it from your diet is prudent, regardless of what any scientific research suggests or has (or has not) proven. 

In other words, listening to your gut is probably wise here. Just be careful to change your diet under the guidance of your physician, to ensure you are getting appropriate nourishment. 

Also, be aware too that your dietary approach to your migraines may be very different from another person with migraines. This is why being proactive and identifying your own triggers through a headache diary is important.

That being said, don't be too hard on yourself if you slip up and eat a piece of migraine-triggering chocolate or miss the MSG in your dinner—this is a journey, so be good to yourself. 

_Sources:

_{Alpay K, Ertas M, Orhan EK, Üstay, DK, Lieners C, Baykan N. Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised cross-over trial. Cephalalgia. 2010;30(7):829-37.}

_{Aydinlar El, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome.Headache. 2013;53(3):514-25.} 

_{Bond DS, Vithiananthan S, Nash JM, Thomas JG, Wing RR. Improvement of migraine headaches in severely obese patients after bariatric surgery. Neurology. 2011;76(13):1135-1138.}

_{Bunner AE, Agarwal U, Gonzales JF, Valente F, Barnard ND. Nutrition intervention for migraine: a randomized crossover trial. J Headache Pain. 2014;15(1):69.}

_{Rocket FC, de Oliveira VR, Castro K, Chaves ML, Perla Ada S, Perry ID. Dietary aspects of migraine trigger factors. Nutr Rev 2012;70(6):337-56.}