Jill Dehlin—RN, board member, National Headache Foundation, Chicago—identifies potential dietary triggers that induce a migraine attack for her, including monosodium glutamate (MSG), aspartame and alcohol, especially red wine.
“When I was newly diagnosed with chronic migraine disease, I was cognizant of several things that, if ingested, a migraine attack would certainly follow. Ultimately, I did a 2-month elimination diet to rule out all triggers, but did not find any others—just the ones of which I was already aware,” she explains.
Indeed, “Diet and Headache,” a two-part article in the 2016 journal, Headache, reveals that “certain foods, beverages, and ingredients within food may trigger migraines in susceptible individuals. Elimination diets can prevent headaches in subgroups of persons with headache disorders,” it surmises.
Vandana R. Sheth—RDN, CDE, registered dietician nutritionist, certified diabetes educator, and spokesperson for the Academy of Nutrition and Dietetics, Chicago—says that “while no foods universally trigger migraines, some more commonly reported include red wine and beer, aged cheeses, processed/cured meats, chocolate, corn, nuts, nut butters, citrus, onions, artificial sweeteners, and MSG.”
Caffeine Causes Dietary Migraine
Kassidy Holtzman—a recent graduate of Vance-Granville Community College, Henderson, NC—says “Too much caffeine can trigger (migraine), especially lots of soda.” Holtzman, who underwent a thyroidectomy as a teenager, limits her coffee consumption to one cup a day and drinks “lots of water to help with my weight.”
According to “The Role of Diet in Migraine Headaches” from the American Nutrition Association (ANA), Hinsdale, IL, regularly consumed stimulant drinks contain caffeine ranging from 35 to 150 milligrams for a 12-ounce can of cola and 5-ounce cup of coffee, respectively. Headache pain relievers also contain caffeine that causes cerebral blood vessels to constrict, states the ANA, which links the stimulant to migraine.
“Caffeine addiction and withdrawal, common among consumers of excess coffee, can be associated with severe throbbing headache and migraine exacerbation. Fasting or skipping meals is also a common reason for headache recurrence in migraine sufferers,” it states.
“Fasting can bring a headache about if you fast for 8 or 12 hours. People who undergo surgery in the morning will often have headaches the next day. If your brain cells are devoid of glucose that can make them develop a headache,” comments Dr. Vincent Martin who notes that “Caffeine withdrawal triggers headaches when the caffeine gets out of your bloodstream.
“If you consume caffeine irregularly, that can be a problem. If you consume high quantities of caffeine, like 3 cups a day that can make you anxious,” he says.
Adds Sheth: “Caffeine affects the activity of adenosine, a substance found in our brain that attaches to specific receptors in our brain cells. Caffeine can block receptor activity and the effects of adenosine,” she says.
Dehlin calls caffeine “a double-edged sword for people with migraine disease. For some, it can actually abort an attack. For others, it’s a definite trigger. I try to maintain consistency in my use of caffeine, limiting my intake to no more than 2 cups of coffee per day, usually fewer than that,” she relates.
Martin agrees. “If you’re going to consume caffeine, you should probably consume it consistently. Small quantities, a couple of times a day, rather than one big one in the morning,” he suggests.
Food Chemicals Cause Dietary Migraine
Sheth warns that “Tyramine in cheeses—such as bleu cheese, brie, cheddar, Feta—can be a trigger for migraines. Nitrites and nitrates—typically found in processed meats, such as hot dogs, bacon and deli meat—can cause blood vessels to swell up and cause headaches,” she adds.
ANA information confirms this. Patients with dietary migraine lack the blood/liver enzyme, monoamine oxidase, to metabolize tyramine or any amine. “Elimination of the offending food and chemical from the diet should prevent or lessen the number and severity of migraine attacks,” it states.
“I’m not convinced that tyramine triggers headaches. Tyramine can raise your blood pressure and reduce pulse rate. So, there are neurologic effects,” notes Martin who advises against fatty foods, such as processed meat or bacon that induce, what he calls, a “hot dog headache.”
The ANA also speculates that chemicals in chocolate (phenylethylamine, theobromine, and caffeine) cause headaches by altering the cerebral blood flow and releasing the brain chemical, norepinephrine.
“I know many women have food cravings with their menstrual cycles. So, if chocolate is a trigger and you crave chocolate around your menses, this could definitely play a role in exacerbating migraine attacks,” comments Dehlin who identifies estrogen as the “culprit for menstrual migraine.
“Studies have shown some women, on consistent low doses of estrogen, do well. Some women find that their migraine disease improves after menopause. For others, they get worse,” she says.
Martin says, “Most people get better after menopause, but it depends on whether your brain likes low estrogen or not. If your brain chemistry doesn’t like it, then you get migraines,” says Martin who suggests that neurologic processes before menses, not chocolate, trigger a headache.
“If you look at the few days before and after menstruation, that’s a vulnerable time for headaches. We theorize that if you drink a glass of wine, you’re adding a dietary trigger on top of a trigger that might push you over to migraine attacks,” he warns.
Food Diaries Track Dietary Migraines
“I am a big believer in keeping a migraine diary. It is one of my first recommendations to people who have migraine disease. Keeping a diary can help identify, not only the frequency, duration, and intensity of migraine attacks but time of the month, dietary or other triggers. It also helps people track their use of abortive and rescue medications. A printed diary or an app both work well. You just have to remember to use it every day,” explains Dehlin.
Sheth says, “Anytime you track something, it may provide clues and patterns you can use to make decisions and avoid attacks. It’s best to maintain an ongoing diary for 2 to 2 months to really see patterns.”
“There’s no definition of how to interpret a food diary. It’s helpful for physicians to collect data,” says Martin who adds, “We try to get patients to keep diaries as much as we can. The problem with food diaries is most people don’t know what to do with them.”
Holtzman says, “My doctor asked me to take pictures because I hate to write stuff down. If you take a picture and come back a couple of weeks later and see you gained a few pounds, maybe you can change that,” she mentions.
An Ounce of Prevention
To control her thyroid and migraine symptoms, Holtzman takes supplements. “I take the B12 three times a week and D3 every day.”
Exercise also helps Holtzman keep her weight down and migraine symptoms at bay. “I have this “Just Dance 2019” videogame and I walk a lot,” she says.
Dehlin says, “Regular exercise is a must.
“The migraine brain likes homeostasis. Overdoing exercise, getting dehydrated, missing meals, can all trigger migraine attacks,” says Dehlin who lists vitamins and minerals that can control migraine disease.
“There are some supplements that have evidence for efficacy for people with migraine disease. They include: melatonin for sleep, magnesium, vitamin B2, Boswellia, vitamin D3 and CoQ10. There is also evidence for feverfew and butterbur,” she says.
Sheth notes, “There is some evidence that certain supplements may help with migraine disease although food is your best source for nutrition. A few key nutrients to consider: Magnesium to help nerves and blood vessels function appropriately. Spinach, nuts, whole grains are good sources of magnesium.
“Riboflavin—vitamin B2—plays an important role in metabolism and how our body converts energy. There is some evidence that people with migraine can benefit from B2 found in eggs, meat and nuts. CoQ10 has shown a positive impact in reducing migraines. It plays a role in metabolism and is naturally found in whole grains and oily fish like salmon.”
Sheth suggests that individuals experiencing migraine disease, “Keep your diet as expansive as possible to avoid over-restricting your food choices. Maintain a detailed food/ triggers/symptoms record to help you understand your migraine attacks. Enjoy regular meals and snacks. They maintain good blood glucose levels and avoid triggering a headache from low blood sugar. Get enough sleep and rest. Consider supplements. Meet with a registered dietitian for education and guidance to better meet your needs,” she notes.
Martin thinks “A healthy lifestyle counts for about half of migraine disease management but getting on appropriate medications or seeing a headache doctor can work as well,” he adds.
Holtzman agrees. “Speak to your doctor. Don’t be ashamed to tell them what’s going on. Otherwise, they won’t be able to help you. They can fix something with medication or diet,” she says.