A Clinical Approach to Addressing Diet with Migraine Patients

  • Margaret Slavin
  • Jessica Ailani
Headache (RB Halker, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Headache


Purpose of Review

Migraine is a common disorder causing attacks of neurological dysfunction and pain. Treatment ranges from pharmacological to lifestyle changes to improve both frequency and severity of attacks. Focus on lifestyle changes, especially diet, is often discussed during clinical visits in the care of migraine patients.

Recent Findings

Diet may play a role in triggering migraine, but available evidence on migraine and diet is limited. When advising patients on dietary changes to improve migraine, it is important to acknowledge the limits in evidence and the larger role that diet may play in lifestyle changes.


This review will focus on current evidence on the effect of diet and migraine and use a case to illustrate how to approach diet changes in a patient with migraine.


Migraine Headache Diet Food 


Compliance with Ethical Standards

Conflict of Interest

Margaret Slavin reports grants from McCormick Science Institute and a research contract (co-investigator) from PepsiCo.

Jessica Ailani has received honoraria payments from Teva, Avanir, and Allergan.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •Of importance •• Of major importance

  1. 1.
    Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache J Head Face Pain. 2013;53:427–36.CrossRefGoogle Scholar
  2. 2.
    Ferrari MD, Klever RR, Terwindt GM, Ayata C, van den Maagdenberg AMJM. Migraine pathophysiology: lessons from mouse models and human genetics. Lancet Neurol. 2015;14:65–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.CrossRefGoogle Scholar
  4. 4.•
    Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015;35:6619–29. A great review of migraine pathophysiology.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394–402.CrossRefPubMedGoogle Scholar
  6. 6.•
    Finkel AG, Yerry JA, Mann JD. Dietary considerations in migraine management: does a consistent diet improve migraine? Curr. Pain Headache Rep. 2013;17. Available from: 10.1007/s11916-013-0373-4 This paper is a good review of diet in migraine patients
  7. 7.
    Wöber C, Brannath W, Schmidt K, Kapitan M, Rudel E, Wessely P, et al. Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia. 2007;27:304–14.CrossRefPubMedGoogle Scholar
  8. 8.•
    Peris F, Donoghue S, Torres F, Mian A, Wöber C. Towards improved migraine management: determining potential trigger factors in individual patients. Cephalalgia Int. J. Headache. 2016; This paper provides an example of the direction of migraine trigger research toward determining individualized triggers. Google Scholar
  9. 9.
    Lance JW, Goadsby PJ. Mechanism and management of headache. 6th ed. London: Butterworth-Heinemann; 1998.Google Scholar
  10. 10.•
    Houle TT, Turner DP. Natural experimentation is a challenging method for identifying headache triggers. Headache J Head Face Pain. 2013;53:636–43. See next.CrossRefGoogle Scholar
  11. 11.•
    Turner DP, Smitherman TA, Martin VT, Penzien DB, Houle TT. Causality and headache triggers. Headache J Head Face Pain. 2013;53:628–35. This paper provides an analysis of the logic behind using natural experimentation to identify migraine triggers and, along with their statistical analysis in Houle and Turner (2013), determines the process is unlikely to work and demonstrates the need for better methods of trigger identification. CrossRefGoogle Scholar
  12. 12.
    Gibb CM, Davies PTG, Glover V, Steiner TJ, Rose FC, Sandler M. Chocolate is a migraine-provoking agent. Cephalalgia. 1991;11:93–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Sandler M, Youdin MBH, Hanington E. A phenylethylamine oxidising defect in migraine. Nature. 1974;250.Google Scholar
  14. 14.
    Marcus DA, Scharff L, Turk D, Gourley LM. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia Int J Headache. 1997;17:855–62. discussion 800.CrossRefGoogle Scholar
  15. 15.
    Koehler SM, Glaros A. The effect of aspartame on migraine headache. Headache. 1988;28:10–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Schiffman SS, Buckley CE, Sampson HA, Massey EW, Baraniuk JN, Follett JV, et al. Aspartame and susceptibility to headache. N Engl J Med. 1987;317:1181–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Van Den Eeden SK, Koepsell TD, Longstreth WT, van Belle G, Daling JR, McKnight B. Aspartame ingestion and headaches: a randomized crossover trial. Neurology. 1994;44:1787–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Kemper RHA, Meijler WJ, Korf J, Ter Horst GJ. Migraine and function of the immune system: a meta-analysis of clinical literature published between 1966 and 1999. Cephalalgia. 2001;21:549–57.CrossRefPubMedGoogle Scholar
  19. 19.
    Mullin GE, Swift KM, Lipski L, Turnbull LK, Rampertab SD. Testing for food reactions: the good, the bad, and the ugly. Nutr Clin Pract. 2010;25:192–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Mylek D. ALCAT test results in the treatment of respiratory and gastrointestinal symptoms, arthritis, skin and central nervous system. Rocz Akad Med Bialymst. 1995;40:625–9.PubMedGoogle Scholar
  21. 21.
    Solomon BA. The ALCAT test—a guide and barometer in the therapy of environmental and food sensitivities. Environ Med. 1992;9:2–6.Google Scholar
  22. 22.••
    Ornello R, Ripa P, Pistoia F, Degan D, Tiseo C, Carolei A, et al. Migraine and body mass index categories: a systematic review and meta-analysis of observational studies. J. Headache Pain. 2015;16. Available from: This meta-analysis of observational studies lends support to the connection between obesity and migraine. Prior research had connected overweight and obesity with risk of worsening migraine severity, but not prevalence.
  23. 23.
    Bond DS, Vithiananthan S, Nash JM, Thomas JG, Wing RR. Improvement of migraine headaches in severely obese patients after bariatric surgery. Neurology. 2011;76:1135–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Novack V, Fuchs L, Lantsberg L, Kama S, Lahoud U, Horev A, et al. Changes in headache frequency in premenopausal obese women with migraine after bariatric surgery: a case series. Cephalalgia. 2011;31:1336–42.CrossRefPubMedGoogle Scholar
  25. 25.
    Jahromi SR, Abolhasani M, Togha M, Meysamie A, Talebpour M, Sadre-Jahani S. A cross-sectional study of migraine improvement after diet/exercise-induced weight loss or bariatric surgery. Eur J Neurol. 2014;21:163.Google Scholar
  26. 26.
    Gunay Y, Jamal M, Capper A, Eid A, Heitshusen D, Samuel I. Roux-en-Y gastric bypass achieves substantial resolution of migraine headache in the severely obese: 9-year experience in 81 patients. Surg Obes Relat Dis. 2013;9:55–62.CrossRefPubMedGoogle Scholar
  27. 27.
    Verrotti A, Agostinelli S, D’Egidio C, Di Fonzo A, Carotenuto M, Parisi P, et al. Impact of a weight loss program on migraine in obese adolescents. Eur J Neurol. 2013;20:394–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Verrotti A, Carotenuto M, Altieri L, Parisi P, Tozzi E, Belcastro V, et al. Migraine and obesity: metabolic parameters and response to a weight loss programme: migraine outcome after weight loss strategy. Pediatr Obes. 2015;10:220–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Peroutka SJ. What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep. 2014;18. Available from: 10.1007/s11916-014-0454-z.
  30. 30.
    Byer JA, Dexter JD. Hypoglycemic migraine. Mo Med. 1975;72:194–7.PubMedGoogle Scholar
  31. 31.
    Dexter JD, Roberts J, Byer JA. The five hour glucose tolerance test and effect of low sucrose diet in migraine. Headache J Head Face Pain. 1978;18:91–4.CrossRefGoogle Scholar
  32. 32.
    Wilkinson CF. Recurrent migrainoid headaches associated with spontaneous hypoglycemia. Am J Med Sci. 1949;218:209–12.CrossRefPubMedGoogle Scholar
  33. 33.
    Schnabel TG. An experience with a ketogenic dietary in migraine. Ann Intern Med. 1928;2:341–7.CrossRefGoogle Scholar
  34. 34.
    Barborka CJ. Migraine: results of treatment by ketogenic diet in fifty cases. J Am Med Assoc. 1930;95:1825–8.CrossRefGoogle Scholar
  35. 35.
    Gainsborough H. The therapeutic use of the ketogenic diet. The Practitioner. 1934;132:45–53.Google Scholar
  36. 36.
    Strahlman RS. Can ketosis help migraine sufferers? A case report. Headache. 2006;179–82.Google Scholar
  37. 37.
    Di Lorenzo C, Currà A, Sirianni G, Coppola G, Bracaglia M, Cardillo A, et al. Diet transiently improves migraine in two twin sisters: possible role of ketogenesis? Funct Neurol. 2013;28:305.PubMedGoogle Scholar
  38. 38.
    Di Lorenzo C, Coppola G, Sirianni G, Di Lorenzo G, Bracaglia M, Di Lenola D, et al. Migraine improvement during short lasting ketogenesis: a proof-of-concept study. Eur J Neurol. 2015;22:170–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Cicarelli G, Della Rocca G, Amboni M, Ciacci C, Mazzacca G, Filla A, et al. Clinical and neurological abnormalities in adult celiac disease. Neurol Sci. 2003;24:311–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Dimitrova AK, Ungaro RC, Lebwohl B, Green MW, Babyatsky MW, Green PH. Increased prevalence of migraine in patients with celiac disease compared to patients with inflammatory bowel disease and controls: a multicenter prospective study. Gastroenterology. 2011;140:442.CrossRefGoogle Scholar
  41. 41.
    Gabrielli M. Association between migraine and celiac disease: results from a preliminary case-control and therapeutic study. Am J Gastroenterol. 2003;98:625–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Cady RK, Farmer K, Dexter JK, Hall J. The bowel and migraine: update on celiac disease and irritable bowel syndrome. Curr Pain Headache Rep. 2012;16:278–86.CrossRefPubMedGoogle Scholar
  43. 43.
    Mormile R. Celiac disease and migraine: is there a common backstage? Int J Colorectal Dis. 2014;29:1571–1.Google Scholar
  44. 44.
    Hadjivassiliou M, Grunewalk RA, Lawden M, Davies-Jones GAB, Powell T, Smith CML. Headache and CNS white matter abnormalities associated with gluten sensitivity. Neurology. 2001;56:385–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Serratrice J, Disdier P, de Roux C, Christides C, Weiller PJ. Migraine and coeliac disease. Headache J Head Face Pain. 1998;38:627–8.CrossRefGoogle Scholar
  46. 46.
    Sharp K, Walker H, Coppell KJ. Coeliac disease and the gluten-free diet in New Zealand: The New Zealand coeliac health survey. Nutr Diet. 2014;71:223–8.CrossRefGoogle Scholar
  47. 47.
    Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004;113:1672–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F. Systematic review: noncoeliac gluten sensitivity. Aliment Pharmacol Ther. 2015;41:807–20.CrossRefPubMedGoogle Scholar
  49. 49.
    Panconesi A. Alcohol and migraine: trigger factor, consumption, mechanisms. a review. J Headache Pain. 2008;9:19–27.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Panconesi A, Bartolozzi ML, Mugnai S, Guidi L. Alcohol as a dietary trigger of primary headaches: what triggering site could be compatible? Neurol Sci. 2012;33:203–5.CrossRefGoogle Scholar
  51. 51.
    Peatfield RC, Fletcher G, Rhodes K, Gardiner IM, De Belleroche J. Pharmacological analysis of red-wine-induced migrainous headaches. J Headache Pain. 2003;4:18–23.CrossRefPubMedCentralGoogle Scholar
  52. 52.
    Krymchantowski AV, da Cunha Jevoux C. Wine and headache. Headache J Head Face Pain. 2014;54:967–75.CrossRefGoogle Scholar
  53. 53.
    Imam I. Alcohol and the central nervous system. Br J Hosp Med. 2010;71:635–9.CrossRefGoogle Scholar
  54. 54.
    Kuster GW, Da Silva ALP, Aquino CH, Ziviani LF, Domingues RB. Frequency and features of delayed alcohol-induced headache among university students. Headache J Head Face Pain. 2006;46:688–91.CrossRefGoogle Scholar
  55. 55.
    Panconesi A, Franchini M, Bartolozzi ML, Mugnai S, Guidi L. Alcoholic drinks as triggers in primary headaches. Pain Med. 2013;14:1254–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Littlewood JT, Glover V, Davies PT, Gibb C, Sandler M, Cifford RF. Red wine as a cause of migraine. Lancet. 1988;558–9.Google Scholar
  57. 57.
    Rasmussen BK. Migraine and tension-type headache in general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993;53:65–72.CrossRefPubMedGoogle Scholar
  58. 58.
    Panconesi A, Bartolozzi ML, Guidi L. Alcohol and migraine: what should we tell patients? Curr Pain Headache Rep. 2011;15:177–84.CrossRefPubMedGoogle Scholar
  59. 59.
    Winter AC, Hoffmann W, Meisinger C, Evers S, Vennemann M, Pfaffenrath V, et al. Association between lifestyle factors and headache. J Headache Pain. 2011;12:147–55.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Costanigro M, Appleby C, Menke SD. The wine headache: consumer perceptions of sulfites and willingness to pay for non-sulfited wines. Food Qual Prefer. 2014;31:81–9.CrossRefGoogle Scholar
  61. 61.
    Diaz-Insa S, Rodrigo A, Pamblanco Y, Lacruz L, Soler A, Guillen C. Headache and wine. Are all wines the same? J Headache Pain. 2013;14:P32.CrossRefPubMedCentralGoogle Scholar
  62. 62.
    Sjaastad O, Bakketeig LS. Hangover headache: accompanying symptoms. Vågå study of headache epidemiology. J. Headache Pain. 2004;5:224–9.CrossRefGoogle Scholar
  63. 63.
    Wiese JG, Shlipak MG, Browner WS. The alcohol hangover. Ann Intern Med. 2000;132:897–902.CrossRefPubMedGoogle Scholar
  64. 64.
    Evans RW, Sun C, Lay C. Alcohol hangover headache. Headache J Head Face Pain. 2007;47:277–9.CrossRefGoogle Scholar
  65. 65.
    Yokoyama M, Yokoyama T, Funazu K, Yamashita T, Kondo S, Hosoai H, et al. Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population. J Headache Pain. 2009;10:177–85.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Shapiro RE. Caffeine and headaches. Neurol Sci. 2007;28:S179–83.CrossRefPubMedGoogle Scholar
  67. 67.
    Sawynok J. Caffeine and pain. Pain. 2011;152:726–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Spencer B. Caffeine withdrawal: a model for migraine? Headache J Head Face Pain. 2002;42:561–2.CrossRefGoogle Scholar
  69. 69.••
    Ramsden CE, Faurot KR, Zamora D, Suchindran CM, MacIntosh BA, Gaylord S, et al. Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain. 2013;154:2441–51. This study used a particularly robust research design for the dietary intervention as part of a randomized, single-blind, parallel-group trial. An altered diet was implemented as the control conditions, which allowed the isolation of omega-3 fatty acids as the primary difference in nutrient intake between groups and for the participants to remain blinded. Also, dietary coaching was extensive and actual nutrient consumption was verified with periodic, unannounced diet recall interviews by phone. CrossRefPubMedGoogle Scholar
  70. 70.
    Ferrara LA, Pacioni D, Di Fronzo V, Russo BF, Speranza E, Carlino V, et al. Low-lipid diet reduces frequency and severity of acute migraine attacks. Nutr Metab Cardiovasc Dis. 2015;25:370–5.CrossRefPubMedGoogle Scholar
  71. 71.
    Ramsden CE, Mann JD, Faurot KR, Lynch C, Imam ST, MacIntosh BA, et al. Low omega-6 vs. low omega-6 plus high omega-3 dietary intervention for chronic daily headache: protocol for a randomized clinical trial. Headache. 2010; Available from:
  72. 72.
    Alpay K, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010;30:829–37.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Aydinlar EI, Dikmen PY, Tiftikci A, Saruc M, Aksu M, Gunsoy HG, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache J Head Face Pain. 2013;53:514–25.CrossRefGoogle Scholar
  74. 74.
    Mitchell N, Hewitt CE, Jayakody S, Islam M, Adamson J, Watt I, et al. Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutr J. 2011;10:85.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Margaret Slavin
    • 1
  • Jessica Ailani
    • 2
  1. 1.Nutrition and Food StudiesGeorge Mason UniversityFairfaxUSA
  2. 2.Georgetown Headache CenterMedstar Georgetown University HospitalWashingtonUSA

Personalised recommendations