Picture this: there’s a small man inside your head. He has an ice pick in his left hand and he’s jabbing it into your right temple. Over and over again, he won’t stop. Then he moves behind your eye. Jab jab jab. You’re trying to work but the sharp, debilitating pain won’t stop. You start to feel nauseated. You can’t bear the light. Noises make your head throb even more. You leave work to go home and sit in a dark, cold room to avoid getting physically sick. In my experience, this is how many people describe the intensity of a migraine: unbearably painful as if somebody’s drilling an ice pick into their brain. Sounds awful, right? Right.
The exact cause of migraine is unknown but many sufferers can identify triggers including stress, weather changes, lack of sleep, hormone fluctuations, dehydration, and certain foods. In this article, I will be focusing on food, important nutrients for migraine sufferers and three different dietary approaches for migraine management.
First, what exactly is a migraine?
According to JAMA, a migraine is a recurrent headache disorder with intense pain that may be one-sided and accompanied by other physical symptoms. Many people think that migraine is just a headache, but there are important differences.
Yes, they both cause pain but migraines may cause nausea and vomiting as well as sensitivity to light and sound. Migraines affect 18% of American women, 6% of men and 10% of children. In fact, migraines are the third most prevalent illness in the world.
Common migraine food triggers
According to Cleveland Clinic, most of the information about food triggers come from patient self-reports and not from randomized scientific studies. Some migraine sufferers have zero food triggers and others have multiple food triggers. It’s very much individualized. With that said, here’s a list of the most commonly reported migraine food triggers:
- Cheese (specifically aged cheese like cheddar, swiss and parmesan)
- Citrus fruits
- Nitrates/nitrates (found in processed meats, hot dogs, pepperoni, salami, and other cured meats)
- Monosodium glutamate (MSG) (commonly found in Asian cuisine, bouillon cubes, and soy sauce)
- Onions and garlic
- Tomato-based products
- Fatty foods
- Fermented foods like sauerkraut, yogurt, and kombucha
- Alcoholic drinks, especially red wine and beer
This list can be intimidating as it contains commonly consumed foods in the American diet, and the thought of elimination is overwhelming for many people. However, a 6-week trial elimination diet can be life-changing. I suggest working with a registered dietitian or your medical provider to help establish a good plan for you.
If you’re uninterested in an elimination diet, consider simply tracking your food and beverage intake in a daily headache diary or an app like Migraine Buddy. If you have a headache within 20 minutes to 2 hours after eating, you could have a sensitivity to a specific ingredient and further investigation might be warranted. Again, I suggest working with a registered dietitian or medical provider to help identify triggers.
Important nutrients for migraines
Although every vitamin and mineral is important for health, there are specific nutrients to highlight when discussing migraines. For brevity, let’s focus on vitamin B2 (riboflavin), vitamin D, magnesium and coenzyme Q10.
Vitamin B2, commonly referred to as riboflavin, may help prevent migraines. A study published in the European Journal of Neurology analyzed the effect of 400mg dose daily riboflavin with migraine frequency. Headache hours and intensity did not change over a 6 month period. However, the frequency of migraines reduced from 4 migraines/month at baseline to 2 migraines/month after 3 and 6 months.
A well-balanced diet can offer a hefty dose of riboflavin naturally. Common food sources include mushrooms, almonds, eggs, quinoa, yogurt, and fortified cereals. Adding more riboflavin to the diet via whole foods might be enough for some, but not others. Please consult with your doctor and pharmacist before adding a supplement to your routine.
Vitamin D is a fat-soluble vitamin found in few foods (like cod liver oil, swordfish, and salmon) and added to others (like orange juice). It’s also available in supplement form. Vitamin D is important for many reasons including bone health, immune function, and fighting inflammation.
A deficiency is associated with chronic pain, depression and neurological disorders, including migraines. This study found that supplementing with vitamin D3 was associated with a decrease in migraine days among patients. Speak to your doctor about assessing your vitamin D status.
Magnesium is a mineral that’s important for many physiologic reasons including energy production, muscle and nerve contraction and regulating blood sugar and blood pressure. It also binds to receptors in the brain involved with migraines.
Low brain magnesium has been connected to migraines, more specifically migraines with an aura. Supplemental magnesium is an option under the supervision of your doctor and pharmacist. It is also highly recommended to eat a balanced diet rich in magnesium. You can find magnesium naturally in many foods including beans, legumes, nuts, seeds, and green leafy vegetables.
Coenzyme Q10, commonly referred to as CoQ10, is an antioxidant produced in the body. It’s also found in fish, meat and whole grains.
A study published in 2018 showed that 400mg CoQ10 supplementation significantly reduced migraine frequency and intensity by lowering a compound called CGRP in the brain. CGRP stands for calcitonin gene-related peptide. Speak to your medical doctor and pharmacist about adding a CoenzymeQ10 supplement to your routine.
Eating for migraines
There are a variety of ways to approach your diet for managing your migraines. An elimination diet is a great place to start as food can trigger migraines, and simply removing a specific food can be life-changing. However, people see success on many different diets. Let’s highlight three common diets for migraine: Mediterranean diet, ketogenic diet, and low histamine.
According to Mayo Clinic, a Mediterranean Diet is a way of eating based on the cuisines of the countries bordering the Mediterranean Sea. It’s plant-centric with a heavy focus on fruits, vegetables, nuts, seeds, and olive oil. It also includes the consumption of whole grains, seafood, poultry, beans and eggs, moderate portions of dairy (mainly cheese and yogurt) and minimal red meat.
This is a realistic approach for migraine sufferers who want to adjust their dietary patterns without restriction or eliminating whole food groups. The American Migraine Foundation recommends a Mediterranean type approach which includes 5 small meals per day with a focus on fruits, vegetables, and healthy fat intake.
A ketogenic diet is a high-fat, low-carb, moderate-protein diet that switches the body’s fuel source from glucose to ketones. It’s a well-known therapeutic diet to help with refractory pediatric epilepsy and has gained momentum in mainstream media as a weight loss solution. There is some evidence to show that the high-fat, low-carb eating style might help relieve migraines, although the precise mechanism is unclear. One hypothesis is that the ketogenic diet restores brain excitability and reduces inflammation. This small study showed that 15 out of 18 migraine sufferers had a significant reduction in pain at the end of a 12-week keto diet trial period.
There’s limited research to show the efficacy of long-term keto, and because of it’s low-carb high-fat ratio, compliance might not be realistic for most people. It’s very important to work under medical supervision before attempting a ketogenic diet. Please consult with your doctor and dietitian if you’re interested in this eating style for migraines.
Low histamine diet
According to Harvard Health, certain foods, like alcohol, cured meats, aged cheeses, and tomatoes, contain chemicals that are broken down into histamines. For most people, the histamines are deactivated by an enzyme called diamine oxidase (abbreviated DAO). However, some individuals don’t make enough of the DAO enzyme due to genetics, an illness or certain prescription medications. This can result in what’s called a “histamine sensitivity.” Symptoms include flushing, hives, diarrhea, and of course – headaches/migraines.
A low histamine diet might be helpful for individuals who experience the above symptoms; however, more research is needed in this area. Speak to your doctor and dietitian if you’re interested in experimenting with a low histamine eating style for your migraines.
Migraine management is multifaceted and complex. Unfortunately, there’s no universal diet that helps all migraine sufferers; however, we know that a western diet of ultra-processed foods and refined sugars is a recipe for inflammation and other health challenges. For most people, a good place to start is to simply focus on whole foods, hydration, and sleep. If you or someone you love is a migraineur, consider speaking to your doctor and dietitian about creating a personalized nutrition plan.
Do you have any dietary recommendations to help manage migraines? Please share them in the comments below!