Migraine and food

Take a look at what you eat… but don’t just blame the chocolate!

Alcohol, chocolate, cheese and citrus fruits are often given as examples of common migraine triggers. But is that fair? What is the relationship between migraine and diet?

“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.”

You are what you eat

It’s always tempting to point the finger at diet for illness. People often blame headache on alcoholic drinks, chocolate, cheese, citrus fruit and additives. But is that fair?

Migraine has many triggers. A change in routine affects the brain’s pattern of activity, which can in turn trigger migraine. That change may be a day off, the release after a period of stress, a lie-in or an early start.

Since these factors can all involve a change in diet, perhaps eating other foods or at different times, people can blame the food for the attack.

But is it the food that is the trigger or the change in routine? And is there a migraine diet that can be followed to reduce attacks? The relationship between food and migraine is complex and particular foods are often unfairly blamed.

Should I give up alcohol?

Probably the most common dietary migraine trigger is alcohol.

In one study, 29 per cent of people with migraine reported alcohol as a trigger for attacks, compared to 19 per cent reporting chocolate and 18 per cent reporting cheese.

Certain types of alcohol contain chemicals that can, in sufficiently large doses, cause headache in anyone, and migraine in those who are predisposed.

Some alcoholic drinks, such as vodka or champagne, contain fewer chemicals and may be better tolerated.

Matching each alcoholic drink with an equal amount of water can help avoid dehydration, which may contribute to alcohol-related headache and migraine.

What about caffeine?

Suddenly stopping regular high-dose caffeine can trigger headache.

And while there have been suggestions that caffeine may possibly have a value in treating migraine, some experts advise zero caffeine. It can be worth trying to exclude it, although most headache doctors allow moderate caffeine intake.

You could try limiting your intake to no more than three cups of coffee or four or five cups of tea each day. Cola and some other soft drinks contain caffeine and should also be consumed in moderation; energy drinks, in particular, can have high levels of caffeine.

Remember, some ‘decaffeinated’ drinks do contain a little caffeine, so always check the label.

Is migraine due to food allergy?

Allergy technically means a particular type of response by the immune system; scientific studies have not found a link with migraine. However, some use the word allergy more loosely to mean an intolerance or sensitivity.

Allergy testing is not considered helpful in migraine patients.

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, followed by lunch and an evening meal spaced relatively evenly throughout the day. Eat little and often, avoiding dehydration.

It seems sensible to eat more natural (whole) foods, although there is no scientific evidence for this advice in relation to headache.

Elimination diets have been tested by several research groups, with some limited success. This involves working with a health professional to cut out all possible triggers before introducing them one by one, noting any effects.

However, studies suggest these diets are so restrictive that patients can rarely maintain them. In one study, four out of 10 patients had dropped out within the first six weeks. And by the end of the study, only one in 10 had seen any improvement, with a similar number unchanged or actually feeling worse. Elimination 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.

Don’t look only at the hours or the day before a migraine attack, look back three days in advance. Migraine actually starts a long time before the headache. This period, well before the headache begins, can cause people to crave certain foods, such as chocolate, which may then wrongly appear to be a cause of the attack.

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 exclude that food from your diet for as long as it took to have those three (or more) attacks. 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 prevent you from being able to socialise normally.

Find out more about recording food triggers in a diary by reading our factsheet on migraine triggers.

Make time to eat and drink

The most important dietary triggers involve a lack of food and fluids, 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, as well as delivering other important health benefits. People often 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 may not have had enough to eat or drink. If your evening meal is early, a small pre-bedtime snack can help.

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. But dieting is easier if you have frequent small meals rather than infrequent large ones.

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

People with migraine should avoid unusual or trendy diets like zero carbohydrates, or restrictive combinations of a small number of foods.

In summary

• In between migraine attacks, enjoy your food and drink
• Aim for a natural diet, eating at least three times a day and starting within an hour of waking, spread relatively evenly through 24 hours
• Drink plenty of water, aiming for two litres a day
• Enjoy coffee, tea and other caffeinated drinks in moderation (up to a maximum of three cups of coffee or six cups of tea a day).
• If you drink alcohol, choose a smaller quantity of good quality drinks. Match your alcoholic drinks with glasses of water. Don’t mix different types of alcoholic drink.  Avoid intoxication. Choose drinks like white wine, weak lager or vodka over less well tolerated drinks like red wine, strong beers, rum or tequila.
• 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 so makes a measurable difference to your migraine attacks. A headache diary can help.

Book an appointment with the experts: a consultation with a leading headache specialist through the National Migraine Centre could help you understand the relationship between food and headache. Book your consultation now.