Skip to main content
SpringerLink
Log in

Alimentäre Triggerfaktoren bei Migräne und Kopfschmerz vom Spannungstyp

Alimentary trigger factors that provoke migraine and tension-type headache

  • Übersichten
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Auf Basis eines Literaturüberblicks wird die Bedeutung alimentärer Triggerfaktoren bei Migräne und Kopfschmerz vom Spannungstyp (KST) kritisch diskutiert. Informationen beruhen überwiegend auf der subjektiven Einschätzung der Patienten. In kontrollierten Studien sind Alkoholkonsum und Koffeinentzug am besten als Triggerfaktoren von Kopfschmerzen belegt. Eingeschränkte Evidenz besteht für das Auslassen von Mahlzeiten. Als „neuer“, bislang kaum beachteter Triggerfaktor, verdient die Dehydrierung vermehrt Beachtung. Bei manchen Patienten wurde eine selektive Empfindlichkeit für Rotwein nachgewiesen, eine Kopfschmerztriggerung durch Schokolade darf ernsthaft bezweifelt werden, zur Bedeutung von Käse ist keine wissenschaftlich begründete Aussage möglich. Der experimentell gut belegten kopfschmerzauslösenden Wirkung von NO-Donatoren sowie parenteral verabreichtem Histamin stehen mangelnde Beweise dafür gegenüber, dass Histamin, Nitrite und Nitrate über die normale Nahrungsaufnahme Migräne oder KST auslösen. Ebenso wenig lässt sich aus den vorliegenden Daten auf eine solche Wirkung anderer biogener Amine sowie von Aspartam schließen. Natriumglutamat dürfte lediglich bei Zufuhr größerer Mengen auf nüchternem Magen zu Unverträglichkeitsreaktionen führen. Patienten mit Migräne und KST sollten über die begrenzte Bedeutung alimentärer Triggerfaktoren informiert und individuell beobachtete Unverträglichkeiten kritisch überprüft werden. Eindeutig bestätigte Trigger sollten vermieden werden. Allgemeine Diätempfehlungen lassen sich auf Basis des derzeitigen Wissensstands nicht begründen.

Abstract

Based on a review of the literature the authors discuss the role of nutrition in the precipitation of migraine and tension-type headache (TTH). The available information relies largely on the subjective assessment of the patients. Controlled trials suggest that alcohol and caffeine withdrawal are the most important nutritional precipitating factors of migraine and TTH. In addition, there is some evidence that missing meals is also an important factor. Dehydration seems to deserve more attention. A selective sensitivity to red wine has been shown in some patients, the importance of chocolate has been doubted seriously, and scientific evidence for cheese as a precipitating factor is lacking. Despite a series of experimental studies demonstrating that NO donors such as nitroglycerin and parenteral histamine cause headache the role of histamine, nitrates, and nitrites in food remains unclear. Similarly, other biogenic amines and aspartame have not been proven to precipitate headache. Sodium glutamate causes adverse reactions including headache probably at large doses ingested on an empty stomach. Therefore, patients should be advised that food plays a limited role as a precipitating factor of migraine and TTH. Subjective sensitivity to certain foods should be examined critically, and proven precipitating factors should be avoided. General dietary restrictions have not been proven to be useful.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Bánk J, Márton S (2000) Hungarian migraine epidemiology. Headache 40:164–169

    Google Scholar 

  2. Bic Z, Blix GG, Hopp HP, Leslie FM, Schell MJ (1999) The influence of a low-fat diet on incidence and severity of migraine headaches. J Womens Health Gend Based Med 8:623–630

    Google Scholar 

  3. Bigal ME, Lipton RB, Stewart WF (2004) The epidemiology and impact of migraine. Curr Neurol Neurosci Rep 4:98–104

    Google Scholar 

  4. Blau JN (1992) Migraine triggers: practice and theory. Pathol Biol 40:367–372

    Google Scholar 

  5. Blau JN (1998) The effect of national lifestyles. Cephalalgia 18 [Suppl 21]:23–25

  6. Blau JN, Kell CA, Sperling JM (2004) Water-deprivation headache: a new headache with two variants. Headache 44:79–83

    Google Scholar 

  7. Blumthal HJ, Vance DA (1997) Chewing gum headaches. Headache 37:665–666

    Google Scholar 

  8. Butchko HH, Stargel WW, Comer CP et al. (2002) Aspartame: review of safety. Regul Toxicol Pharmacol 35 (2 Pt 2):S1–93

    Google Scholar 

  9. Chabriat H, Danchot J, Michel P, Joire JE, Henry P (1999) Precipitating factors of headache. A prospective study in a national control-matched survey in migraineurs and nonmigraineurs. Headache 39:335–338

    Google Scholar 

  10. Clifford Rose F (1997) Food and headache. Headache Q 8:319–329

    Google Scholar 

  11. Cologno D, Torelh P, Manzoni CC (1999) Possible predictive factors in the prognosis of migraine with aura. Cephalalgia 19:824–830

    Google Scholar 

  12. Couturier EGM, Hering R, Steiner TJ (1992) Weekend attacks in migraine patients: caused by caffeine withdrawal? Cephalalgia 12:99–100

    Google Scholar 

  13. D’Amico D, Ferraris A, Leone M, Catania A, Carlin A, Grazzi L, Bussone G (2002) Increased plasma nitrites in migraine and cluster headache patients in interictal period: basal hyperactivity of L-arginine-NO pathway? Cephalalgia 22:33–36

    Google Scholar 

  14. D’Andrea G, Terrazzino S, Leon A, Fortin D, Perini F, Granella F, Bussone G (2004) Elevated levels of circulating trace amines in primary headaches. Neurology 62:1701–1705

    Google Scholar 

  15. Dexter JD, Roberts J, Byer JA (1978) The five hour glucose tolerance test and effect of low sucrose diet in migraine. Headache 18:91–94

    Google Scholar 

  16. Diener HC, Brune K, Pfaffenrath V, Straube A (2000) Therapie der Migräneattacke und Migräneprophylaxe. Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG). Schmerz 14:269–283

    Article  CAS  PubMed  Google Scholar 

  17. Dowson AJ, Sender J, Lipscombe S, Cady RK, Tepper SJ, Smith R, Smith TR, Taylor FR, Boudreau GP, Van Duijn NP, Poole AC, Baos V, Wöber C (2003) Establishing principles for migraine management in primary care. Int J Clin Pract 57:493–507

    Google Scholar 

  18. Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ (1993) Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey. Can J Neurol Sci 20:131–137

    Google Scholar 

  19. Empl M, Straube A (2001) Immunsystem und primäre Kopfschmerzsyndrome. Anaesthesist 50:783–791

    Google Scholar 

  20. Feinstein AR, Heinemann LA, Dalessio D, Fox JM, Goldstein J, Haag G, Ladewig D, O’Brien CP (2000) Do caffeine-containing analgesics promote dependence? A review and evaluation. Clin Pharmacol Ther 68:457–467

    Article  CAS  PubMed  Google Scholar 

  21. Fernandez E, Sheffield J (1996) Descriptive features and causal attributions of headache in an Australian community. Headache 36:246–250

    Google Scholar 

  22. Finn R (1992) Food allergy — fact or fiction: a review. J R Soc Med 85:560–564

    Google Scholar 

  23. Garriga MM, Berkebile C, Metcalfe DD (1991) A combined single-blind, double-blind, placebo-controlled study to determine the reproducibility of hypersensitivity reactions to aspartame. J Allergy Clin Immunol 87:821–827

    Google Scholar 

  24. Geha RS, Beiser A, Ren C, Patterson R, Greenberger PA, Grammer LC (2000) Review of alleged reaction to monosodium glutamate and outcome of a multicenter double-blind placebo-controlled study. J Nutr 130 [Suppl 4]:1058–1062

  25. Gibb CM, Davies PT, Glover V, Steiner TJ, Clifford Rose F, Sandler M (1991) Chocolate is a migraine-provoking agent. Cephalalgia 11:93–95

    Google Scholar 

  26. Gilbert RM, Marshman JA, Schwieder M, Berg R (1976) Caffeine content of beverages as consumed. Can Med Assoc J 114:205–208

    Google Scholar 

  27. Göbel H, Petersen-Braun M, Soyka D (1994) The epidemiology of headache in Germany: a nationwide survey of a representative sample on the basis of the headache classification of the International Headache Society. Cephalalgia 14:97–106

    Google Scholar 

  28. Göbel H (2003) Die Kopfschmerzen. Springer, Berlin Heidelberg New York, S 255–259

  29. Götz M (1996) Pseudoallergien sind Histaminintoleranzen. Wien Med Wochenschr 146:426–430

    Google Scholar 

  30. Griffiths RR, Evans SM, Heishman SJ, Preston KL, Sannerud CA, Wolf B (1990) Low-dose caffeine physical dependence in humans. J Pharmacol Exp Ther 255:1123–1132

    CAS  PubMed  Google Scholar 

  31. Griffiths RR, Woodson PP (1988) Caffeine physical dependence: a review of human and laboratory animal studies. Psychopharmacology 94:437–451

    CAS  Google Scholar 

  32. Guarnieri P, Radnitz CL, Blanchard EB (1990) Assessment of dietary risk factors in chronic headache. Biofeedback Self-Reg 15:15–25

  33. Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders, 2nd edn. Cephalalgia 24:1–151

    Article  Google Scholar 

  34. Henry P, Auray JP, Gaudin AF, Dartigues JF, Duru G, Lantéri-Minet M, Lucas C, Pradalier A, Chazot G, El Hasnaoui (2002) Prevalence and clinical characteristics of migraine in France. Neurology 59:232–237

    Google Scholar 

  35. Hering R, Couturier EGM, Steiner TJ (1992) Weekend migraine in men. Lancet 339:67

    Google Scholar 

  36. Hufnagl KN, Peroutka SJ (2002) Glucose regulation in headache: implications for dietary management. Expert Rev Neurother 2:311–317

    Google Scholar 

  37. Hughes JR, Higgins ST, Bickel WK, Hunt WK, Fenwick JW, Gulliver SB (1991) Caffeine self-administration, withdrawal, and adverse effects among coffee drinkers. Arch Gen Psychiatry 48:611–617

    CAS  PubMed  Google Scholar 

  38. Jansen SC, van Dusseldorp M, Bottema KC, Dubois AE (2003) Intolerance to dietary biogenic amines: a review. Ann Allergy Asthma Immunol 91:233–240

    Google Scholar 

  39. Jarisch R, Wantke F (1996) Wine and headache. Int Arch Allergy Immunol 110:7–12

    Google Scholar 

  40. Jarman J, Pattichis K, Peatfield R, Glover V, Sandler M (1996) Red wine-induced release of [14C]5-hydroxytryptamine from platelets of migraine patients and controls. Cephalalgia 16:41–43

    Google Scholar 

  41. Johns DR (1986) Migraine provoked by aspartame. N Engl J Med 315:456

    Google Scholar 

  42. Kasper H (1996) Ernährungsmedizin und Diätetik. Urban & Schwarzenberg, München Wien Baltimore, S 371

  43. Koehler SM, Glaros A (1988) The effect of aspartame on migraine headache. Headache 28:10–13

    Google Scholar 

  44. Lampl C, Buzath A, Yazdi K, Sandor PS (2003) One-year prevalence of migraine in Austria: a nation-wide survey. Cephalalgia 23:280–286

    Google Scholar 

  45. Leon AS, Hunninghake DB, Bell C, Rassin DK, Tephly TR (1989) Safety of long-term large doses of aspartame. Arch Intern Med 149:2318–2324

    Google Scholar 

  46. Lipton RB, Newman LC, Cohen JS, Solomon S (1989) Aspartame as a dietary trigger of headache. Headache 29:90–92

    Google Scholar 

  47. Littlewood J, Glover V, Sandler M, Petty R, Peatfiled R, Clifford Rose F (1982) Platelet phenolsulphotransferase deficiency in dietary migraine. Lancet 1:983–986

    Google Scholar 

  48. Littlewood JT, Gibb C, Glover V, Sandler M, Davies PTG, Clifford Rose F (1988) Red wine as a cause of migraine. Lancet 1:558–559

    Google Scholar 

  49. Luthy J, Schlatter C (1983) Biogene Amine in der Nahrung: Wirkung von Histamin, Tyramin und Phenylethylamin beim Menschen. Lebensm Unters Forsch 177:439–443

    Google Scholar 

  50. Mannix LK, Frame JR, Solomon GD (1997) Alcohol, smoking and caffeine use among headache patients. Headache 37:572–576

    Google Scholar 

  51. Marcus DA, Scharff L, Turk D, Gourley LM (1997) A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia 17:855–862

    Google Scholar 

  52. Martin PR, Seneviratne HM (1997) Effects of food deprivation and a stressor on head pain. Health Psychol 16:310–318

    Google Scholar 

  53. Moffett AM, Swash M, Scott DF (1974) Effect of chocolate in migraine: a double-blind study. J Neurol Neurosurg Psychiatry 37:445–448

    Google Scholar 

  54. Müller G, Weber H (1996) Mikrobiologie der Lebensmittel, Grundlagen. Behr, Hamburg, S 246–250

  55. Newman LC, Lipton RB (2001) Migraine MLT-down: an unusual presentation of migraine in patients with aspartame-triggered headaches. Headache 41:899–901

    Google Scholar 

  56. Nicolodi M, Sicuteri F (1999) Wine and migraine: compatibility or incompatibility? Drugs Exp Clin Res 25:147–153

    Google Scholar 

  57. Pattichis K, Louca LL, Jarman J, Sandler M, Glover V (1995) 5-Hydroxytryptamine release from platelets by different red wines: implications for migraine. Eur J Pharmacol 292:173–177

    Google Scholar 

  58. Peatfield RC, Glover V, Littlewood JT, Sandler M, Clifford Rose F (1984) The prevalence of diet-induced migraine. Cephalalgia 4:179–183

    Google Scholar 

  59. Peatfield RC (1995) Relationships between food, wine and beer-precipitated migrainous headaches. Headache 35:355–357

    Google Scholar 

  60. Pfaffenrath V, Brune K, Diener HC, Gerber WD, Göbel H (1998) Therapie des Kopfschmerzes vom Spannungstyp. Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft. Schmerz 12:156–168

    Google Scholar 

  61. Pradalier A, De Saint Maur P, Lamy F, Launay JM (1994) Immunocyte enumeration in duodenal biopsies of migraine without aura patients with or without food-induced migraine. Cephalagia 14:365–367

    Google Scholar 

  62. Pradalier A, Weinman S, Launay JM, Baron JF, Dry J (1983) Total IgE, specific IgE and prick-tests against foods in common migraine — a prospective study. Cephalalgia 3:231–234

    Google Scholar 

  63. Raiten DJ, Talbot JM, Fisher KD (1995) Executive summary from the report: analysis of adverse reactions to monosodium glutamate (MSG). J Nutr 125:2892–2906

    Google Scholar 

  64. Rasmussen BK (2001) Epidemiology of headache. Cephalalgia 21:774–777

    Article  Google Scholar 

  65. Rasmussen BK, Olesen J (1992) Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia 12:221–228

    Article  CAS  PubMed  Google Scholar 

  66. Rasmussen BK (1993) Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 53:65–72

    Google Scholar 

  67. Robbins L (1994) Precipitating factors in migraine: a retrospective review of 494 patients. Headache 34:214–216

    Google Scholar 

  68. Russell MB, Dremstrup Nielsen K, Rasmussen C, Schoenen J, Paiva T (2000) Multimedia education in headache: the European Neurological Network. Eur J Neurol 7:355–362

    Google Scholar 

  69. Russell MB, Rasmussen BK, Fenger K, Olesen J (1996) Migraine without aura and migraine with aura are distinct clinical entities: a study of four hundred and eighty-four male and female migraineurs from the general population. Cephalalgia 16:239–245

    CAS  PubMed  Google Scholar 

  70. Sadler MJ (1999) Encyclopedia of human nutrition. Academic Press, San Diego, pp 886–894

  71. Savi L, Rainero I, Valfre W, Gentile S, Lo Giudice R, Pinessi L (2002) Food and headache attacks. A comparison of patients with migraine and tension-type headache. Panminerva Med 44:27–31

    Google Scholar 

  72. Scharff L, Turk DC, Marcus DA (1995) Triggers of headache episodes and coping responses of headache diagnostic groups. Headache 35:397–403

    Google Scholar 

  73. Scher AI, Stewart WF, Lipton RB (2004) Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology 63:2022–2027

    Google Scholar 

  74. Schiffman SS, Buckley CE 3rd, Sampson HA, Massey EW, Baraniuk JN, Follett JV (1987) Aspartame and susceptibility to headache. N Engl J Med 317:1181–1185

    Google Scholar 

  75. Schwedt G (1999) Taschenatlas der Lebensmittelchemie. Thieme, Stuttgart, S 138ff

  76. Scopp AL (1991) MSG and hydrolyzed vegetable protein induced headache: review and case studies. Headache 31:107–110

    Google Scholar 

  77. Seltzer S (1982) Foods, and food and drug combinations, responsible for head and neck pain. Cephalalgia 2:111–124

    Google Scholar 

  78. Shirlow MJ, Mathers CD (1985) A study of caffeine consumption and symptoms; indigestion, palpitations, tremor, headache and insomnia. Int J Epidemiol 14:239–248

    Google Scholar 

  79. Silverman K, Evans SM, Strain EC, Griffiths RR (1992) Withdrawal syndrome after the double-blind cessation of caffeine consumption. N Engl J Med 327:1109–1114

    CAS  PubMed  Google Scholar 

  80. Spierings ELH, Ranke AH, Honkoop PC (2001) Precipitating and aggravating factors of migraine versus tension-type headache. Headache 41:554–558

    Google Scholar 

  81. Thomsen LL, Olesen J (2001) Nitric oxide in primary headaches. Curr Opin Neurol 14:315–321

    Article  CAS  PubMed  Google Scholar 

  82. Turner LC, Molgaard CA, Gardner CH, Rothrock JF, Stang PE (1995) Migraine trigger factors in a non-clinical Mexican-American population in San Diego county: implications for etiology. Cephalalgia 15:523–530

    Google Scholar 

  83. Ulrich V, Olesen J, Gervil M, Russell MB (2000) Possible risk factors and precipitants for migraine with aura in discordant twin-pairs: a population-based study. Cephalalgia 20:821–825

    Google Scholar 

  84. Ulrich V, Russell MB, Jensen R, Olesen J (1996) A comparison of tension-type headache in migraineurs and in non-migraineurs: a population-based study. Pain 67:501–506

    Google Scholar 

  85. Vaitl D, Propson N, Stark R, Walter B, Schienle A (2001) Headache and sferics. Headache 41:845–853

    Google Scholar 

  86. Van den Bergh V, Amery WK, Waelkens J (1987) Trigger factors in migraine: a study conducted by the Belgian Migraine Society. Headache 27:191–196

    Google Scholar 

  87. Van Den Eeden SK, Koepsell TD, Longstreth WT Jr, van Belle G, Daling JR, McKnight B (1994) Aspartame ingestion and headaches: a randomized crossover trial. Neurology 44:1787–1793

    Google Scholar 

  88. Vaughan TR (1994) The role of food in the pathogenesis of migraine headache. Clin Rev Allerg 12:167–180

    Google Scholar 

  89. Walker R (1999) The significance of excursions above the ADI. Case study: monosodium glutamate. Regul Toxicol Pharmacol 30:119–121

    Google Scholar 

  90. Walton RG, Hudak R, Green-Waite RJ (1993) Adverse reactions to aspartame: double-blind challenge in patients from a vulnerable population. Biol Psychiatry 34:13–17

    Google Scholar 

  91. Wantke F, Götz M, Jarisch R (1993) Histamine-free diet: Treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches. Clin Exp Allergy 23:982–985

    Google Scholar 

  92. Wantke F, Götz M, Jarisch R (1993) Die histaminfreie Diät. Hautarzt 44:512–516

    Google Scholar 

  93. Wantke F, Götz M, Jarisch R (1994) The red wine provocation test: intolerance to histamine a model for food intolerance. Allergy Proc 15:27–32

    Google Scholar 

  94. Wessely P, Wöber C (Hrsg) (2003) Behandlung von Kopf- und Gesichtsschmerzen. Therapieempfehlungen der Österreichischen Kopfschmerzgesellschaft. Facultas, Wien

  95. Wöber C, Zeiler K (2000) Leitsymptom Kopfschmerz. In: Wessely P (Hrsg) Praktischer Umgang mit Kopf- und Gesichtsschmerzen. Springer, Berlin Heidelberg New York, S 5–42

  96. Yang WH, Drouin MA, Herbert M, Mao Y, Karsh J (1997) The monosodium glutamate symptom complex: assessment in a double-blind, placebo-controlled, randomized study. J Allergy Clin Immunol 99:757–762

    Google Scholar 

  97. Zivadinov R, Willheim K, Sepic-Grahovac D, Jurjevic A, Bucuk M, Brnabic-Razmilic O, Relja G, Zorzon M (2003) Migraine and tension-type headache in Croatia: a population-based survey of precipitating factors. Cephalalgia 23:336–343

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Universitäts-Klinik für Neurologie, Medizinische Universität Wien

    J. Holzhammer &  C. Wöber

  2. Universitäts-Klinik für Neurologie, Medizinische Universität, Währinger Gürtel 18–20, A-1090, Wien, Österreich

    C. Wöber

Authors
  1. J. Holzhammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Wöber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Wöber.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holzhammer, J., Wöber, C. Alimentäre Triggerfaktoren bei Migräne und Kopfschmerz vom Spannungstyp. Schmerz 20, 151–159 (2006). https://doi.org/10.1007/s00482-005-0390-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-005-0390-2

Schlüsselwörter

Keywords

Search

Navigation