Migraine is a multidimensional and complex disorder, which is influenced by genetic and environmental factors. is a relatively common neurological disorder characterized by strong headaches and other somatosensory and transient motor disturbances. It occurs in episodic or chronic forms, with and without aura.
Many trigger factors may be present in one patient, and the identification of a single trigger might be difficult. Also, some factors may potentiate each other.
The most likely triggers to cause an attack other than diet are:
• Fatigue or over exertion.
• Depression, anxiety.
• Raised blood pressure.
• Menstruation.
• Over the counter cold and pain relief preparations.
• Loud noises, glaring lights, e.g. spending long periods on computer or games console.
• Oral contraceptives.
Scientifically it is accepted that migraines are sensitive to diet meaning that some dietary ingredients may trigger attacks such as chocolate, citrus fruits, nuts, ice cream, tomatoes, onions, dairy products, processed meats, alcoholic beverages, coffee, caffeine, monosodium glutamate (MSG), histamine, tyramine, phenylethylamine, nitrites, aspartame, sucralose, and gluten.
Interestingly some food may trigger headache, while others may cause headache upon withdrawal (e.g., caffeine) and the amount of food or the time of exposure might largely influence the outcome.
Note that this list does not apply to all individuals and for most of those foods the scientific evidence is insufficient.
Caution—do NOT restrict all possible trigger foods from your diet for an extended period of time. This is not likely to be helpful, and too much concern about avoiding foods may be another stress, as well as decrease your enjoyment of mealtime. Also, these diets specially without supervision may prevent adequate nutrition.
Try to avoid long periods of fasting, missing or delaying meals or not eating enough.
Avoid fried or very fatty foods.
Ensure you have a starchy snack before playing sport or vigorous activity.
Ensure you drink enough fluid.
"Healthier" diets, meal regularity, and weight loss are associated with decreased headaches.
Diets including the ketogenic diet, the low-glycemic index diet, and the DASH diet are supported for the prevention of migraine but with modest evidence. For other diets such as a gluten-free diet (in patients without celiac disease), or elimination diets there is not enough evidence.
Elimination diets
This diet requires the person to identify the dietary ingredients that may cause migraine and eliminate them. This approach must be personalized to each individual who should notice a high frequency of headache or migraine upon exposure to a dietary trigger. A diary is useful
Folic acid
Folate is essential for DNA methylation, and it has been suggested that folic acid supplementation is beneficial for migraine. and its presence in the diet has been reported to exert a beneficial effect on migraine.
Magnesium
Deficits in magnesium are related in the pathogenesis of migraine, thus, magnesium has been extensively used in migraine prophylaxis and treatment. Magnesium has been categorized as a suggested macroelement in the prevention of migraine headaches by the United States Headache Consortium (USHC) with rare side effects (abdominal pain, nausea, and diarrhea). Based on the references of Canadian Ministry of Health, the maximum oral dose of Magnesium should not be exceeded from 350 mg/day. Note that, clinical trials have reported controversial results for the possible efficiency of oral Magnesium in migraine prevention
Bibliography
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Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache. 2020 Jul;60(7):1300-1316. doi: 10.1111/head.13836. Epub 2020 May 25. PMID: 32449944; PMCID: PMC7496357.
Gazerani P. Diet and migraine: what is proven? Curr Opin Neurol. 2023 Dec 1;36(6):615-621. doi: 10.1097/WCO.0000000000001204. Epub 2023 Sep 19. PMID: 37865855.
Nowaczewska M, Wiciński M, Kaźmierczak W, Kaźmierczak H. To Eat or Not to Eat: A Review of the Relationship between Chocolate and Migraines. Nutrients. 2020 Feb 26;12(3):608. doi: 10.3390/nu12030608. PMID: 32110888; PMCID: PMC7146545.
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