Migraine and diet

Martin VT, Vij B. Diet and Headache: Part 1. Headache. 2016 Oct;56(9):1543-1552.

Abstract

BACKGROUND:

The role of diet in the management of the headache patient is a controversial topic in the headache field.

OBJECTIVES:

To review the evidence supporting the hypothesis that specific foods or ingredients within foods and beverages trigger attacks of headache and/or migraine and to discuss the use of elimination diets in the prevention of headache disorders METHODS: This represents part 1 of a narrative review of the role of diet in the prevention of migraine and other headache disorders. A PubMed search was performed with the following search terms: "monosodium glutamate," "caffeine," "aspartame," "sucralose," "histamine intolerance syndrome," "tyramine," "alcohol," "chocolate," "nitrites," "IgG elimination diets," and "gluten." Each of these search terms was then cross-referenced with "headache" and "migraine" to identify relevant studies. Only studies that were written in English were included in this review.

RESULTS:

Caffeine withdrawal and administration of MSG (dissolved in liquid) has the strongest evidence for triggering attacks of headache as evidenced by multiple positive provocation studies. Aspartame has conflicting evidence with two positive and two negative provocation studies. Observational studies provide modest evidence that gluten- and histamine-containing foods as well as alcohol may precipitate headaches in subgroups of patients. Two of three randomized controlled trials reported that an elimination diet of IgG positive foods significantly decreased frequency of headache/migraine during the treatment as compared to baseline time period.

CONCLUSIONS:

Certain foods, beverages, and ingredients within foods may trigger attacks of headache and/or migraine in susceptible individuals. Elimination diets can prevent headaches in subgroups of persons with headache disorders.

Martin VT, Vij B. Diet and Headache: Part 2. Headache. 2016

Oct;56(9):1553-1562.

Abstract

BACKGROUND:

Comprehensive diets do not require the exclusion of a specific provocative food or ingredient, but regulate the quantities of core components of foods such as vitamins, ions, proteins, carbohydrates, and fats.

OBJECTIVES:

To review the evidence supporting the use of comprehensive diets in the prevention of migraine and other headache disorders and to discuss the mechanisms through which food, and ingredients within foods and beverages might trigger attacks of headache METHODS: This represents Part 2 of a narrative review of the role of diet in the prevention of migraine and other headache disorders. A PubMed search was performed with the following search terms: "folate," "vitamin D," "low fat diet," "omega-3 and omega-6 fatty acid diet," "ketogenic diet," "Atkins diet," and "sodium." Each of these search terms was then crossreferenced with "headache" and "migraine" to identify relevant studies. Only studies that were written in English were included in this review.

RESULTS:

Low fat and high omega-3/low omega-6 fatty diets decrease the frequency of attacks of migraine and/or other headache disorders as demonstrated in two separate randomized controlled trials. A ketogenic diet was more effective than a standard diet in reducing the frequency of migraine in a single nonrandomized clinical study. An observation study found that dietary consumption of folate was inversely associated with the frequency of migraine attacks in persons with migraine with aura that have the C variant of the methylene tetrahydrofolate reductase gene. The mechanisms though which diets may precipitate headache include their effects on neuropeptides, neuro-receptors and ion channels, inflammation, sympathetic nervous system, release of nitric oxide, vasodilation, and cerebral glucose metabolism.

CONCLUSIONS:

Evidence exists to support the use of comprehensive diets in the prevention of migraine and other headache disorders. However, the results of these studies should be considered preliminary until replicated in larger randomized controlled clinical trials.

For individuals battling migraines, a morning cup of coffee or extra glass of wine can act as devastating headache triggers. Rather than excess caffeine, the true migraine trigger culprits are nitrites and monosodium glutamate (MSG).  

However, saying an abrupt goodbye to foods and beverages that contain high concentrations of these components can be more than a little difficult.   To better understand this situation, Vincent Martin, MD, professor in the Department of Internal Medicine at the University of Cincinnati (UC) College of Medicine, assessed different approaches to preventing headaches with diet: 

 

1.     An elimination diet that avoids foods and drinks known to trigger headaches

2.     A comprehensive diet whose composition can prevent headaches 

 

According to Martin’s two-part review of more than 180 research studies on the subject of migraine and diet, “One of the most important triggers for headache is the withdrawal of caffeine. Let’s say you regularly pound three or four cups of coffee every morning and you decide to skip your morning routine one day, you will likely have full-fledged caffeine withdrawal headache that day.” Martin did report that drinking more than 400 milligrams daily (one cup is 125 milligrams), can even activate symptoms beyond migraines, like anxiety and depression.  

The other migraine trigger, MSG, is often a central part of diet as a flavor enhancer in processed foods, soups, international foods, snacks, salad dressing, seasoning salts, ketchup, barbeque sauce, and heavy Chinese cooking. Naturally, according to Martin, you can only eliminate MSG by eating fewer processed foods, and switching to more natural items like fresh vegetables, fruits, and meats. 

 

Nitrites are also threats, as the preservatives are found in processed meats (bacon, sausage, ham, and lunch meat) to preserve color and flavor. Research indicated that approximately 5% of migraine patients were likely to experience an attack on the days they consumed nitrite-filled foods. On a positive note, stronger government regulations on labels have reduced the use of nitrites.  

Tailoring weight-loss diets to prevent migraines might seem daunting, but experts have outlined a promising diet option for those suffering more frequent migraine attacks. Researchers suggest boosting omega-3 fats while decreasing omega-6 levels.  

This means replacing polyunsaturated vegetable oils – corn, sunflower, safflower, canola, and soy – with flaxseed oil. Additionally, Martin suggested consuming flaxseed, salmon, halibut, cod, and scallops, while avoiding peanuts and cashews.  

Healthy diets are always key to maintaining overall health, and now research has suggested new ways for migraine patients to control their dietary triggers.  

 - See more at: http://www.hcplive.com/medical-news/people-prone-to-migraines-should-watch-their-diets?utm_source=Informz&utm_medium=HCPLive&utm_campaign=Trending%20News_SUN_AM_11-6-16#sthash.osLjo1c0.dpuf