By Donald W. Lewis, MD
Children’s Hospital of The King’s Daughters, Norfolk, Virginia

One of the more common questions posed to us by parents is whether a child’s diet is causing headaches. A huge mythology has developed surrounding diet and headache. The internet is replete with a host of recommendations–enough to confuse anyone! Furthermore, many pediatric specialists don’t exactly see eye to eye.

So what is the “truth”?

The role of dietary measures has been researched, but the topic remains controversial. About 7% to 44% of children and adults who have frequent migraine headaches are able to report that a particular food or drink seems to trigger a migraine attack. In children, the principal dietary triggers are cheese, chocolates and citrus fruits. Other dietary precipitants include processed meats, yogurt, fried foods, monosodium glutamate (MSG), aspartame and alcoholic beverages. Interestingly, for chocolate, the median time interval from ingestion to the onset of headache was 22 hours (3.5 – 27 hours).

This being said, only about one third of children with migraine may report a dietary association, so condemning each and every child or adolescent to a wholesale dietary elimination program of an arbitrary list of foods is not recommended. When I was in training to be a physician, virtually every kid with headache was put on a special diet: no cheeses, processed meats, chocolates, nuts, MSG and so on. Elimination diets are now judged to be excessive. In fact, if a child is put on a diet against his or her will, it generally sets the stage for a battleground at home when a well-meaning parent attempts to inflict a restrictive diet upon an unwilling adolescent; the ultimate result is heightened tensions at home.

A much more prudent and reasonable approach is to review the list of foods traditionally linked to migraine with the patient and then invite him or her to maintain a headache diary to try to determine if any relationship exists between eating any one, or more, of those foods and the development of headache. If a link is found, common sense dictates avoidance of the offending food substance. Once they understand the connection between eating something and a wicked, nauseating headache, they will stop! Placing the patient in control of this experiment will aid in implementation of any dietary changes and keep the parent out of the fray.

Perhaps more important than what kids eat, is the importance of regular meals and drinking plenty of fluids. Many teenagers routinely skip breakfast. Missing meals is a common precipitant of migraine and has been identified by adolescents and children as one of the leading triggers for migraine. Therefore, an appropriate recommendation would be that every patient with frequent migraine eats three meals per day, which includes breakfast, and that they drink plenty of water.

Caffeine warrants special mention. A link between caffeine and migraine has been established. Not only does caffeine itself seem to have an influence on headache; caffeine may disrupt sleep or aggravate mood, both of which may exacerbate headache. Furthermore, caffeine withdrawal headache, which begins one to two days following cessation of regular caffeine use, can last up to a week. Every effort must be made to moderate caffeine use.