You’re sitting there, calm and relaxed, and all of a sudden, you feel a familiar sensation of a migraine coming on. The light hurts your eyes, you feel nauseated, and then boom, a blinding head-banger of a headache. Through the pain, you manage to wonder: What brought this on? What was the trigger? Was it that glass of wine or that chocolate cake? Well, it’s possible …
Is there a link between migraines and food?
It’s known that food can trigger a migraine in some people, but science hasn’t totally figured out the mechanism of how or why that happens. And it can be super-hard to suss out exactly what foods are causing your problem, or if food is even a factor.
One reason why it can be hard to figure out what your triggers are: The same food won’t always bring on a migraine — and how much of it you eat and even the timing of when you chow it down can have an impact. Also, the headache may develop hours after you eat, making it even more difficult to pinpoint the trigger. Another thing that can complicate your detective work is that a migraine may be triggered by multiple factors — including the weather, stress, exercise, whether you’re dehydrated, and more — including how these things interplay with each other. And your genetic makeup can play a role as well.
“Trying to figure out if there is a food trigger can be very daunting,” says Lauren R. Natbony, M.D., neurologist and headache specialist at the Icahn School of Medicine at Mount Sinai. “Migraine patients are told to avoid a whole slew of foods — however, not all of those foods will trigger a migraine attack in every person with migraine.”
What foods can trigger a migraine?
There are a number of foods that are suspected to trigger migraines in some people — but, as Dr. Natbony pointed out, studies haven’t found these triggers to be universal. The list of suspected triggers you’ll find online includes:
- Citrus fruits
- Cured meat
Other lists of potential migraine-trigger foods you’ll see mentioned online include nuts, ice cream, onions, and dairy foods. Plus, foods that include MSG, histamines, nitrites, gluten, and artificial sweeteners like aspartame and sucralose.
That’s a lot of foods, yes? So it’s clear to see why it might be tough to figure out exactly what may be triggering the pain.
“Patients often want to find potential food triggers but, in reality, food often is not a contributing factor,” says Dr. Natbony. “I’ve found that searching for a food trigger can be stressful for patients, and the overall yield is quite low.”
She continues: “The most common food triggers are caffeine, MSG, nitrites (for example, cured meats), alcohol (especially red wine), artificial sweeteners (mainly aspartame), citrus fruits, and aged cheese. However, the evidence is overall quite poor. And triggers are specific to each person and not universal,”
In terms of chocolate, the evidence is conflicting, adds Dr. Natbony. “Some studies have shown it to be a possible trigger. However, other studies have shown that chocolate can potentially benefit migraine.”
What is an elimination diet and can it help migraines?
Elimination diets have been popularized as a way to figure out food triggers for migraines; with these diets, you cut out possible triggers until you pinpoint the ones that may be contributing. There’s mixed research, though, concerning whether elimination diets work in helping to determine a food-migraine link.
“Elimination diets require the identification of provocative foods, beverages, or ingredients, and eliminating them from the diet,” says Dr. Natbony. “Patients may notice that a migraine attack occurs upon exposure to a clear dietary trigger. In this case, avoidance of that particular trigger can be recommended. For most people, however, it’s difficult to establish a clear association between dietary triggers and headache.”
But if you’d like to try it, it’s best to keep a food diary combined with a headache diary, says Dr. Natbony. “If you think a food is triggering migraine attacks, I recommend cutting out the food for about 4 weeks. Monitor symptoms for improvement. You can then add the food back to your diet and monitor the effect. The timing of a migraine attack in relation to food intake may vary, from immediate upon eating it to 24 to 48 hours after ingestion. If the food triggers a migraine attack, then of course it would be reasonable to eliminate it from your diet.”
Dr. Natbony continues, “Another approach that I sometimes use is to eliminate the top eight most common triggers [the ones she listed above] for 8 weeks. Then gradually add back one food at a time and see if it triggers a migraine. If it does, it’s reasonable to eliminate it from your diet.”
Are there other diets that can help a migraine?
Many specific diets have been proposed as solutions to migraines, but research hasn’t consistently backed them up.
- Some research has said that the ketogenic diet (high fat, low carb) may help by reducing oxidative stress and neuro-inflammation. One study of 96 people showed less frequent migraines among those following a keto diet. “There have been a handful of studies on this diet for migraine,” says Dr. Natbony, “and though the evidence is limited, it is plausible for a ketogenic diet to impact migraines positively.”
- Other research suggests that focusing on increasing omega-3 fatty acids and decreasing omega-6s in your diet may help, by decreasing inflammation in the body. “This is one diet that has the most robust evidence,” says Dr. Natbony.
- In one study, a low glycemic diet was also shown to potentially reduce the intensity of migraines, “though more studies are needed,” Dr. Natbony says. In this type of diet, foods with a high glycemic index (such as white bread, sweets, fruit juices, and more) are eliminated.
- Some have reported that following a Mediterranean diet may help. “There’s no evidence, so this isn’t one that I recommend for migraine specifically,” says Dr. Natbony. That said, this diet — with its focus on fruits, vegetables, whole grains, nuts, healthy fats, and lean protein — is one of the healthiest ways to eat, so it’s certainly not going to hurt you to try it.
- There’s been some chatter that eating foods rich in probiotics may help migraines as well, but so far there have been no large-scale evidence-based studies, and the research on the link has been inconsistent. And finally, some evidence suggests that changing the gut microbiome via one’s diet may improve migraines by lessening inflammation, but again, the research is still new and any findings aren’t universal.
So what does Dr. Natbony suggest? “My clinical approach is to first recommend a diet that is wholesome, fresh, and as unprocessed as possible, as this already eliminates a bunch of potential food triggers,” she says. “If a patient wants a more specific diet, I will recommend one of the three with the most evidence — high omega 3/low omega 6 diet, low fat [keto] diet, and the elimination diet.”
Getting help for migraines:
So what’s the ideal approach when migraines are knocking you for a loop? “Seeing a headache doctor is the best thing to help figure out your unique migraine pattern,” says Dr. Natbony. “Food triggers are only one small piece of the puzzle, and in some people, they may be impossible to identify. A headache doctor will take a comprehensive approach and find the migraine treatment that works best for you.”
In the future, there’s hope that a more personalized approach to medicine — in which a person’s biomarkers, age, sex, and other things are taken into account — could eventually lead to specific food recommendations to help prevent and lessen migraines. A future with fewer of those awful, debilitating headaches? That’s something to look forward to.
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