“Every now and again I find myself buying chocolate and I always get a migraine headache the next day, which never happens when I haven’t eaten chocolate”

“On a Friday night we always have a take-away. My migraines tend to start on Saturday mornings, ruining the weekend. But changing from Chinese, to Indian or pizza, hasn’t helped”

It’s tempting to blame diet for illness. I am what I eat. I change what I am, by changing what I eat. The major culprits reported as headache triggers are alcoholic drinks, chocolate, cheese, citrus fruit and additives.

Migraine has many triggers; a change in the brain’s pattern of activity, such as a day off, the let-down from stress, a lie-in or an early start can trigger migraine. Sometimes these things associate with dietary change and the diet is wrongly blamed.

Should I give up alcohol?

The most common “dietary” migraine trigger is alcohol. In one study, 29% percent of people with migraine reported alcohol as a trigger for attacks, compared to 19% reporting chocolate, and 18% reporting cheese. Certain types of alcohol contain chemicals that can, in sufficiently large doses, cause headache in anyone: which leads to migraine in those who are predisposed to migraine. Alcohol hangover is very similar to migraine. Some alcoholic drinks such as vodka or champagne contain fewer chemicals; matching each alcoholic drink, with an equal amount of water can help avoid dehydration, which contributes to alcohol-related headache and migraine.

What about caffeine?

Abandoning regular high dose caffeine can trigger headache. Caffeine may have some value in treating migraine. Some experts advise zero caffeine, which can be worth trying, though most allow moderate caffeine intake. Some decaffeinated” drinks contain a little caffeine – check the label.

Is migraine due to food allergy?

Allergy has been suggested as trigger for migraine. Allergy technically means a particular type of immune response, which has not been found in scientific migraine studies. Some use the word allergy more loosely, where scientific medicine might use the words intolerance or sensitivity. It follows that allergy testing is not helpful in migraine patients; furthermore, skin testing can show allergies which are not clinically relevant.

Should I follow a ‘Migraine Diet’?

Absolutely, yes. The right diet for migraine is a fibre-containing breakfast within an hour of getting up, before leaving home for work; with lunch and evening meal spaced relatively evenly through the day. Eat little and often. Avoid dehydration. It seems sensible to prefer natural (whole) foods, though there is no scientific evidence for this advice.

Cutting pills out of the diet can also be helpful: see the fact sheet on medication overuse.

Elimination diets have been tested by several research groups, with some limited success. But the diets are so restrictive that many people can’t maintain them. In one study, 4 out of 10 patients had dropped out within the first six weeks and by the end of the study only 1 in 10 had improved, with a similar number unchanged or worse. Such diets do not therefore form part of modern evidence-based migraine treatment.

So, what should I do?

If you think specific foods might be triggers, you need to keep a diary. Do not look only at the hours or day before a migraine attack – you need to look up 3 days before the attack. This is because migraine actually starts a long time before the headache; sometimes causing a craving for certain foods, especially chocolate.

If your diary suggests a certain food is triggering your migraine, keep a diary for long enough to record at least three attacks, then completely abolish that food from your diet for as long as it took to have those three (or more) attacks, and see if there is a change in the migraine.

Strict elimination diets should only be done under medical supervision by an appropriate doctor or dietitian. Such diets can cause malnutrition, and may be socially disabling.

Make time to eat and drink

The most important dietary triggers are lack of food and insufficient fluid, rather than specific foods. Delayed or missed meals often result in a relative drop in blood sugar, triggering migraine. Eating fibre helps avoid peaks and troughs of blood sugar – among other important health benefits. Most people get most of their fibre at breakfast.

Diet is often a more important trigger in children than in adults, particularly when they are going through a growth spurt or involved in strenuous exercise. This is why many children come home from school with a headache – they have not had enough to eat or drink, often enough. If your evening meal is early, “breakfast at bedtime” can help (but have breakfast again in the morning!).

Many people with migraine find that they need to eat frequent small snacks every few hours or so during the day to avoid the peaks and troughs in blood sugar.

Drink plenty of water – tap water is fine!

What if I need to lose weight?

It’s tempting to save on calories by skipping meals. In fact it is less difficult to diet, if you have small meals, frequently; compared with larger meals, infrequently.

Cutting down on fat in the diet actually helps migraine. A low fat diet is a good way to lose weight.

People with migraine should avoid unusual or trendy diets that rely on unnatural food combinations e.g. zero carbohydrates, or combinations of a small number of foods (the “egg and orange diet” – of course you lose weight, it’s so boring to eat only eggs and oranges!).

In essence…

ā  In between migraine attacks, enjoy your food and drink.

ā  Aim for a natural diet, taken at least three times a day starting within an hour of waking, spread relatively evenly through the 24 hour day.

ā  Drink plenty of water, aiming for 2 litres a day.

ā  Enjoy coffee tea and other caffeinated drinks in moderation (up to 3 cups of coffee, or up to 6 cups of tea a day).

ā  If you drink alcohol, choose a smaller quantity of good quality, not lots of cheap booze. Match your alcoholic drinks with glasses of water. Don’t mix different types of alcoholic drink. Fits or blackouts

ā  Avoid intoxication. Prefer purer drinks (white wine, weak lager, vodka) to more complex flavours (red wine, strong beers, rum, tequila).

ā  It’s OK to eat junk food occasionally!

Don’t cut from your diet things that you enjoy, unless you are one of the small minority of people with migraine who can prove that doing this, makes a measurable difference to your migraine attacks.

 

This information is provided as a general guide only and is not a comprehensive overview of prescribing information. If you have any queries or concerns about your headaches or medications please discuss them with your GP or the doctor you see at the National Migraine Centre