Eat to Minimize Your Migraines

How what you eat can affect your headaches

By Elaine Magee, MPH, RD
WebMD Weight Loss Clinic - Expert Column

The worst headache you could possibly imagine? That would be the description of a migraine.

More than 45 million Americans get severe or chronic headaches, but the subgroup that specifically suffers from migraines is thought to be around 18 million. If you don't personally have migraines, odds are that you know someone who does.

So can what and how you eat and drink really help to improve your migraines? Thankfully, yes.

While stress is considered the No. 1 migraine trigger, food and beverages may be responsible for up to 30% of migraines, according to some estimates. If you consider that some other migraine triggers can have a connection to diet (things such as hormonal changes, stress, sleeping habits, and depression), it's possible the percentage is actually higher.

Your diet can affect your headache risk in two ways:

  • Certain foods are thought to trigger headaches.
  • Dietary habits, like skipping meals and not drinking enough fluids, may also play a role.

What happens when migraine sufferers learn more about their food triggers and change their diets accordingly? In a recent study, headache patients were given one hour or more of diet counseling by a registered dietitian, who discussed things such as dietary triggers for headaches and label reading. The patients later reported a significant reduction in the number of migraines per week. At the same time, they reported they were consuming fewer migraine-trigger foods.

A Complicated Relationship

The more you learn about migraines and diet, the more you realize how complicated the relationship is. First off, "a suspected food may not be a trigger 100% of the time," explains Frederick Freitag, MD, of the Diamond Headache Clinic in Chicago.

Here are some of the complicating factors:

  • Often, foods are triggers only when they are combined with other triggers. For example, they may act as triggers only when stress or hormonal changes are also at work.
  • Whether you get a migraine from a food or beverage may depend on how much you consume. You might not have a problem with a small amount of cheese or wine, for example. But it might be a different story when you enjoy a larger portion.
  • You may not get a headache for several hours to several days after eating a trigger food. This makes it harder to find the connection between migraines and certain foods or beverages.

Most-Wanted List of Migraine Triggers

Why do some foods cause migraines? Certain substances in food may cause changes in blood-vessel tone, bringing on migraines in susceptible people. Some experts believe an allergic-type reaction may occur; others say that's not likely.

Either way, it's a good idea to know what the possible offenders are so you can eliminate them from your diet to see if it helps. It's a good idea to start by charting your consumption of these items and any headache response.

Here is my list of the five most likely culprits.

1. Chocolate. Some who suffer from migraines list chocolate as a possible trigger food. Some neurologists say it is a migraine trigger because it contains the amino acid tyramine (see No. 4). But the connection could be that women tend to crave chocolate during stress and hormonal changes, both of which also may trigger headaches. The amount of chocolate can be an issue, too. Experiment to see if you can eat a small, but satisfying amount of chocolate without triggering a headache.

"A study found that migraine patients with the diets highest in fat tended to have more frequent headaches."

2. Caffeine. Both too much and too little caffeine have consistently been shown to trigger migraines. Cutting out caffeinated beverages may help your headache situation. The good news is that decaffeinated options abound.

3. Red wine/alcohol. Researchers used to suspect that wine was a headache trigger because it contains the amino acid tyramine (see below). But newer research shows that phytochemicals called phenols, which are found in red wine, may be the real triggers. For some people, drinking any kind of alcohol can bring on a migraine. Other compounds in beer, whiskey, and wine that deplete levels of serotonin ("the happy hormone") in the brain could also be triggering migraines.

4. Tyramine. Tyramine is an amino acid that has been thought to trigger headaches by reducing serotonin levels in the brain and affecting the dilation of blood vessels. Some experts now doubt that tyramine-containing foods are important triggers, because their connection to migraines is based on older research. But, just in case, we're including them in our most-wanted list. Tyramine may be found in:

  • Aged cheeses
  • Red wine
  • Alcoholic beverages, such as beer
  • Some processed meats
  • Avocados
  • Overripe bananas
  • Chocolate
  • Nuts
  • Seeds
  • Pork
  • Venison
  • Soy-based foods

5. Food additives such as nitrites/nitrates and MSG. Some consider certain food additives, including nitrites/nitrates and MSG (monosodium glutamate), to be common headache triggers. These additives may increase blood flow to the brain, causing headaches in some people.

Another Reason to Avoid a High-Fat Diet

Believe it or not, changes in the level of certain fats circulating in your bloodstream coincide with the triggering of migraine headaches. The bottom line is that you want to lower the levels of blood lipids and free fatty acids in your bloodstream -- and you can do this by eating a lower-fat diet.

A study showed that migraine patients with the diets highest in fat tended to have more frequent headaches than those with lower-fat diets. Cutting fat intake led to significant decreases in headache frequency, intensity and length, as well as the amount of medication these patients took.

What to Drink and Eat During a Migraine

Freitag has four-step plan he recommends to his patients. If you have already vomited or are extremely nauseated, follow these steps:

Step 1. Drink clear soda (regular 7-Up, Sprite, or ginger ale -- this is not the time for diet drinks) that has been allowed to go flat (leave it in an open glass for half an hour). Drink no more than 1/2 ounce at time. Do this every five minutes for the first hour.
Step 2. If you're tolerating that, start drinking 1 ounce of the flat soda every five minutes for the next hour.
Step 3. If this works, you may consume clear liquids as tolerated.
Step 4. After four hours, you may add soft, non-fat foods (maybe something like bananas or applesauce). Eat no more than 4 ounces in 15 minutes. And for the first 24 hours, eat solid foods no more often than every four hours. Consume no dairy products or fats for 24 to 48 hours. If vomiting recurs at any point, rest for one hour, then go back to Step 1.

Elaine Magee, MPH, RD, is the author of Tell Me What to Eat If I Have Headaches and Migraines.

SOURCES: Journal of the American Dietetic Association, September 1998; Suppl vol 98: No 9. Journal of Women's Health, June 1999.

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