Migraine

Migraine is one of a number of chronic conditions in which food is not the underlying cause, but may exacerbate or trigger symptoms in some sufferers.

True food allergy is rare and normally causes classic allergic symptoms such as rashes, itching, sneezing, wheezing and gut symptoms. It is unlikely to be a cause of migraine.

Food intolerance is more common, and has a number of possible causes (see the factsheet Food allergy and intolerance).

The identification of dietary triggers can be difficult as the trigger food may not cause symptoms for some hours (even into the next day). It is also possible to confuse the cravings that are a feature of migraine in some people, with a cause of the attack. For example, one of the warning signs of an impending attack can be the craving for sweet things. A sufferer may then eat chocolate to satisfy this craving and a migraine ensues. It is easy to see how the sufferer could well believe that the chocolate had triggered the attack when in fact the craving was part of the pre-attack.

Keeping a daily diary of your diet and any symptoms may help to identify potential triggers.

A Study of 494 migraine sufferers has identified the commonest food triggers:-

ALCOHOL (29%) Different drinks affect different people. Some can drink white wine, but not red, some can only drink champagne!

CHOCOLATE (19.2%) Migraine can be provoked by quite small amounts of chocolate - a bar for a snack, or even the chocolate in a sauce or pudding.

CHEESE (18.2%) Mature cheese (Stilton, Brie, Emmental and Camembert) seem more likely to produce attacks. Cottage cheese is often safe.

CITRUS FRUITS (11.1%) Citrus fruits appear to cause migraines more commonly than other fruits, although unripe green apples can sometimes cause attacks.

OTHER FOODS Many other foods have been incriminated. Indigestible fried and fatty foods can start a migraine through their effect on the stomach. Among vegetables, onions are often cited; pork is more frequently implicated than other meats: pickled herring and Marmite can also precipitate headaches.

MISSING OR DELAYING MEALS AND SLIMMING Missed or delayed meals, or insufficient food can initiate attacks which come on during a period of fasting, soon after eating, or the following morning. Thus if someone who normally eats breakfast fails to do so, he or she may feel 'heady' by mid - morning. The average person eats something and the headache goes; the migrainous subject appears to start off a chain reaction that food will not stop. Similarly missing an evening meal may result in a migraine the following morning. Just eating a sandwich or salad lunch may produce a migraine whereas a cooked meal can not only prevent an attack occurring but may even abort one.

A patient on a strict diet may suffer an increase in migraine. Conversely gaining weight or developing diabetes, when the blood sugar is elevated, can diminish or stop attacks. This could be why some migraine ceases with middle-age spread!

How Food Precipitates an Attack

There is some evidence that amines and organic chemical compounds containing the amine group play an important role in migraine provocation.

It was observed that patients on certain drug treatments with monoamine oxidase inhibitors who ate cheese, Marmite, or other tyramine containing foods developed severe headaches. From this Dr Edda Hanington postulated that the tyramine found in cheese affects the blood vessels in the head, giving rise to the throbbing quality associated with severe migraine attack.

Chemical analysis of chocolate, however, revealed no tyramine but large quantities of another amine,
betaphenylethylamine. Red wines contain similar compounds. It has not been possible to demonstrate any deficiency in monamine oxidase in patients with dietary migraine although there is evidence that levels of another enzyme that is involved with amines may be reduced. Other chemicals that been considered include 5 hydroxytriptamine and catechol amines and their antagonists that counteract and neutralise blood vessels reactivity. All these amines provide the basis for much biochemical and pharmacological research.

For most sufferers, other non-dietary factors are of importance, and are often easier to control than food triggers. In a study at the City of London Migraine Clinic, 79 percent of the patients questioned were aware of precipitating factors, the most common being stress, hormones, overtiredness and missing meals. Most patients noted that several factors, acting in conjunction, were necessary to initiate attacks.

Environmental Triggers can include:

Self Help

• Keep a record of your dietary intake and the day and time when attacks begin. Remember that
  attacks can be triggered by a food eaten many hours earlier.
• Do not miss breakfast! If you do not normally eat breakfast, be sure to eat and drink by mid morning.
• Avoid sandwich and salad lunches, especially while continuing to work. Go for a cooked meal
  if possible, even only a small one.
• If lunch was early, eat something at tea time.
• Always eat something before going out for the evening.
• If going to a party, remember that excitement, hurry, insufficient calories in snacks, alcohol and a
  hot noisy atmosphere could all precipitate an attack.
• Avoid alcohol that disagrees with you.
• During an attack try to drink and to eat something that contains carbohydrate such as pasta, rice
  or bread. Lack of food makes headaches worse.

In conclusion, if you think that a particular food provokes a migraine, avoid that food for a definite length of time. For example if you have one attack a week, forget cheese for a month. If the attacks cease then the answer is clear. If attacks continue with the same frequency then reintroduce cheese and try the next month without chocolate.

Most importantly remember that unless a very clear and definite cause of attacks is proven, go back to a normal healthy diet. If no improvement occurs during an elimination diet then the cause is probably not dietary or is due to a combination of triggers.

Good luck, but remember that food does not play a role in every migraine patient.

Data condensed from a series of fact sheets produced by:-
The Migraine Trust
55-56 Russell Square
London
WC1B 4HP

For further information please write or telephone
Helpline: 020 7462 1336

Consult the Migraine Trust, they have the expertise to help and advise you. Do not limit your life unnecessarily.

Checked 4/2009