Dietary Considerations in Migraine Management: Does a Consistent Diet Improve Migraine?
- 2k Downloads
The clinical expression of migraine is significantly impacted by dietary and gastrointestinal issues. This includes gut dysfunction during and between attacks, food triggers, increase in migraine with obesity, comorbid GI and systemic inflammation influenced by diet, and specific food allergies such as dairy and gluten. Practitioners often encourage migraineurs to seek consistency in their lifestyle behaviors, and environmental exposures, as a way of avoiding sudden changes that may precipitate attacks. However, rigorous evidence linking consistency of diet with improvement in migraine is very limited and is, at best, indirect, being based mainly on the consistency of avoiding suspected food triggers. A review of current data surrounding the issue of dietary consistency is presented from the perspective of migraine as an illness (vulnerable state), as a disease (symptom expression traits), and with a view toward the role of local and systemic inflammation in its genesis. Firm recommendations await further investigation.
KeywordsMigraine Diet Inflammation Lifestyle Orexin Inflammatory Bowel Disease Obesity Triggers Umami
Compliance with Ethics Guidelines
Conflict of Interest
Dr. Alan G. Finkel, Juanita A. Yerry PA-C, and Dr. J. Douglas Mann reported no potential conflicts of interest relevant to this article.
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
- 12.• Bond DS, O’Leary KC, Thomas JG, Lipton RB, Papandonatos GD, Roth J, et al. Can weight loss improve migraine headaches in obese women? Rationale and design of the Women's Health and Migraine (WHAM) randomized controlled trial. Contemp Clin Trials. 2013;35(1):133–44. In a well written paper explaining the rationale and methodology for studying the link between obesisty and migraine and chronic migraine, the authors provide details including statistical approaches. By describing the process of study, additional investigators may bypass pitfalls in studying these two concurrent disorders.Google Scholar
- 29.• Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain. Pain. 2013. doi: 10.1016/j.pain.2013.07.021. A review of contemporary ideas in translating the biology and anatomy of the nervous system into and understanding of migraine, this paper offers the reader a one-stop description. The relevance to the understanding of all of headache medicine is worth the read.
- 33.• Finocchi C, Sivori G. Food as trigger and aggravating factor of migraine. Neurol Sci. 2012;33 Suppl 1:S77–80. Reviewing the knowledge to date, this paper details the knowns and unknowns of food triggers. It helps the reader understand the ephemeral nature of this target for treatment.Google Scholar
- 44.• Camboim Rockett F, Castro K, de Oliveira Rossoni V, da Silveira Perla A, Fagundes Chaves ML, Schweigert Perry ID. Perceived migraine triggers: do dietary factors play a role? Nutr Hosp. 2012;27(2):483–9. Using survey data, the authors use both specific and non-specific behaviors and items, including food or food groups, to assess self reported triggers. Acknowledging the biases and difficulties with self-report, this study confirms previous large epidemiologic sampling with the addition of the importance of hunger as the second most cited trigger.Google Scholar
- 48.• 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. doi: 10.1016/j.pain.2013.07.028. As a part of a series of papers resulting from a NIH/NICAM grant, the authors describe the trials and outcomes. With citations 77 & 78, the reader will be brought up to date on this interesting area of research, translating biological and clinical data into a series of real world recommendations.
- 51.Amandusson A, Blomqvist A. Estrogenic influences in pain processing. Front Neuroendocrinol. 2013. doi: 10.1016/j.yfrne.2013.06.001.
- 52.Smith AW, Bosch MA, Wagner EJ, Rønnekleiv OK, Kelly MJ. The membrane estrogen receptor ligand STX rapidly enhances GABAergic signaling in NPY/AgRP neurons: role in mediating the anorexigenic effects of 17β-estradiol. Am J Physiol Endocrinol Metab. 2013. doi: 10.1152/ajpendo.00281.2013.
- 55.Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M et al. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ. 2010. doi: 10.1136/bmj.c5222.
- 58.Berge LI, Riise T, Fasmer OB, et al. Does diabetes have a protective effect on migraine? Epidemiology. 2013;53:514–25.Google Scholar
- 61.O’Brien, HL and Hershey AD. Vitamins and paediatric migraine: riboflavin as a preventative medication. Cephalalgia. 2010;30: 1417–18.Google Scholar
- 67.• 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. 2013;53(3):514–25. This paper details the course of patients with IBS, identified IgG elevations to certain foods and a dietary intervention to reduce provocation. Through validated instruments and clinical assessment, patients were found to have concurrent improvement in IBS, migraine and quality of life.Google Scholar
- 68.Vivinus-Nébot M, Frin-Mathy G, Bzioueche H, Dainese R, Bernard G, Anty R et al. Functional bowel symptoms in quiescent inflammatory bowel diseases: role of epithelial barrier disruption and low-grade inflammation. Gut. 2013. doi: 10.1136/gutjnl-2012-304066.
- 76.Perez-Leighton CE, Billington CJ, Kotz CM. Orexin modulation of adipose tissue. Biochim Biophys Acta. 2013. doi: 10.1016/j.bbadis.2013.06.007.
- 78.• Peterlin BL, Rapoport AM, Kurth T. Migraine and obesity: epidemiology, mechanisms, and implications. Headache. 2010;50(4):631–48. Though a somewhat older paper, this still remains the clearest dissertation on the subject and questions necessary to answer going forward.Google Scholar