Dietary triggers are commonly reported by patients with a variety of headaches, particularly those with migraines. The presence of any specific dietary trigger in migraine patients varies from 10 to 64 % depending on study population and methodology. Some foods trigger headache within an hour while others develop within 12 h post ingestion. Alcohol (especially red wine and beer), chocolate, caffeine, dairy products such as aged cheese, food preservatives with nitrates and nitrites, monosodium glutamate (MSG), and artificial sweeteners such as aspartame have all been studied as migraine triggers in the past. This review focuses the evidence linking these compounds to headache and examines the prevalence of these triggers from prior population-based studies. Recent literature surrounding headache related to fasting and weight loss as well as elimination diets based on serum food antibody testing will also be summarized to help physicians recommend low-risk, non-pharmacological adjunctive therapies for patients with debilitating headaches.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population—a prevalence study. J Clin Epidemiol. 1991;44:1147–57.
Martelletti P, Birbeck G, Katsarava Z, et al. The Global Burden of Disease survey 2010, lifting the burden and thinking outside-the-box on headache disorders. J Headache Pain. 2013;14(1):13.
Hawkins K, Wang S, Rupnow M. Direct cost burden among insured US employees with migraine. Headache. 2008;48:553–63.
Taylor F. Nutraceuticals and headache: the biological basis. Headache. 2011;51:484–501.
Orr SL. Diet and nutraceutical interventions for headache management: a review of the evidence. Cephalalgia. 2015. Literature review demonstrated generally poor quality of evidence on the efficacy of diet and nutraceutical management of migraines or other headache disorders.
Martin PR. Behavioral management of migraine headache triggers: learning to cope with triggers. Curr Pain Headache Rep. 2010;14:221–7.
Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993;53:65–72.
Rasmussen BK, Olesen J. Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia. 1992;12:221–8.
Kelman L. Migraine changes with age: IMPACT on migraine classification. Headache. 2006;46:1161–71.
Zivadinov R, Willheim K, Sepic-Grahovac D, et al. Migraine and tension-type headache in Croatia: a population-based survey of precipitating factors. Cephalalgia. 2003;23:336–43.
Cologno D, Torelli P, Manzoni GC. Possible predictive factors in the prognosis of migraine with aura. Cephalalgia. 1999;19:824–30.
Andress-Rothrock D, King W, Rothrock J. An analysis of migraine triggers in a clinic-based population. Headache. 2010;50:1366–70.
Turner LC, Molgaard CA, Gardner CH, et al. Migraine trigger factor in a non-clinical Mexican-American population in San Diego County: implications for etiology. Cephalalgia. 1995;15:523–30.
Robbins L. Precipitating factors in migraine: a retrospective review of 494 patients. Headache. 1994;34:214–6.
Deniz O, Aygul R, Kocak N, et al. Precipitating factors of migraine attacks in patients with migraine with and without aura. Pain Clin. 2004;16:451–6.
Constantinides V, Anagnostou E, Bougea A, et al. Migraine and tension-type headache triggers in a Greek population. Arq Neuropsiquiatr. 2015;73:665–9.
Karli N, Zarifoglu M, Calisir N, et al. Comparison of pre-headache phases and trigger factors of migraine and episodic tension-type headache: do they share similar clinical pathophysiology? Cephalalgia. 2005;25:444–51.
Chabriat H, Danchot J, Michel I, et al. Precipitating factors of headache. a prospective study in a national control-matched survey in migraineurs and nonmigraineurs. Headache. 1999;39:335–8.
Mollaoğlu M. Trigger factors in migraine patients. J Health Psychol. 2013;18:984–94.
Ierusalimschy R, Moreira Filho PF. Precipitating factors of migraine attacks in patients with migraine without aura. Arq Neuropsiquiatr. 2002;60:609–13.
Spierings ELH, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001;41:554–8.
Chakravarty A, Mukherjee A, Roy D. Trigger factors in childhood migraine: a clinic-based study from eastern India. J Headache Pain. 2009;10:375–80.
Yadav RK, Kalita J, Misra UK. A study of triggers of migraine in India. Pain Med. 2010;11:44–7.
Bes A, Kunkel R, Lance J, et al. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.
Gibb C, Davies P, Glover V, Steiner T, Rose FC, Sandler M. Chocolate is a migraine-provoking agent. Cephalalgia. 1991;11:93–5.
Bánk J, Márton S. Hungarian migraine epidemiology. Headache. 2000;40:164–9.
Van den Bergh V, Amery WK, Waelkens J. Trigger factors in migraine: a study conducted by the Belgian Migraine Society. Headache. 1987;27:191–6.
Ulrich V, Olesen J, Gervil M, et al. Possible risk factors and precipitants for migraine with aura in discordant twin-pairs: a population-based study. Cephalalgia. 2000;20:821–5.
Henry P, Auray JP, Gaudin AF, et al. Prevalence and clinical characteristics of migraine in France. Neurology. 2002;59:232–7.
Peatfield RC, Glover V, Littlewood JT, et al. The prevalence of diet-induced migraine. Cephalalgia. 1984;4:179–83.
Russell MB, Rasmussen BK, Fenger K, et al. 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. 1996;16:239–45.
Takeshima T, Ishizaki K, Fukuhara Y, et al. Population-based door-to-door survey of migraine in Japan: the Daisen study. Headache. 2004;44(1):8–19.
Marcus DA, Scharff L, Turk D, Gourley LM. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia. 1997;17:855–62.
Moffett AM, Swash M, Scott DF. Effect of chocolate in migraine: a double-blind study. J Neurol Neurosurg Psychiatry. 1974;37:445–8.
Frary CD, Johnson RK, Wang MQ. Food sources and intakes of caffeine in the diets of persons in the United States. J Am Diet Assoc. 2005;105:110–3.
Fredholm B, Battig K, Holmen J, Nehlig A, Zvartau E. Actions of caffeine in the brain with special reference to factors that contribute to its widespread use. Pharmacol Rev. 1999;51:83–133.
Guieu R, Devaux C, Henry H, et al. Adenosine and migraine. Can J Neurol Sci. 1998;25:55–8.
Brown S, Waterer G. Migraine precipitated by adenosine. Med J Aust. 1995;162:389–91.
Shapiro RE. Caffeine and headaches. Curr Pain Headache Rep. 2008;12(4):311–5.
Derry C, Derry S, Moore R. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev. 2014: CD009281.
Ona X, Osorio D, Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015;7:CD007887.
Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. a double-blind, placebo-controlled trial. Anesth Analg. 1990;70(2):181–4.
Sechzer PH. Post-spinal anesthesia headache treated with caffeine. part II: intracranial vascular distention, a key factor. Curr Therapeut Res Clin Experiment. 1979;26(4):440–8.
Zeger W, Younggren B, Smith L. Comparison of cosyntropin versus caffeine for post-dural puncture headaches: a randomized double-blind trial. World J Emergency Med. 2012;3(3):182–5.
Erol DD. The analgesic and antiemetic efficacy of gabapentin or ergotamine/caffeine for the treatment of postdural puncture headache. Adv Med Sci. 2011;56(1):25–9.
Sen J, Sen B. Non-invasive management of post dural puncture headache—a comparison. Bangladesh J Med Sci. 2014;13(02):114–8.
Yücel EC, Yücel A, Özyalçin S, Talu GK, Erdine S. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med. 1999;24:51–4.
Strelec S, Prylinski J, Sakert T, Royal M. The efficacy of multi-dose oral caffeine in prevention of post-dural puncture headache. Reg Anesth. 1994;19(2S):79.
Esmaoglu A, Akpinar H, Uqur F. Oral multidose caffeineparacetamol combination is not effective for the prophylaxis of postdural puncture headache. J Clin Anesth. 2005;17:58–61.
Liang J, Wang S. Hypnic headache: a review of clinical features, therapeutic options and outcomes. Cephalalgia. 2014;34:795–805.
Holle D, Naegel S, Krebs S, et al. Clinical characteristics and therapeutic options in hypnic headache. Cephalalgia. 2010;30:1435–42.
Donnet A, Lanteri-Minet M. A consecutive series of 22 cases of hypnic headache in France. Cephalalgia. 2009;29:928–34.
Dodick D, Mosek A, Campbell J. The hypnic (“alarm clock”) headache syndrome. Cephalalgia. 1998;18:152–6.
Pinto CA, Fragoso YD, Souza Carvalho D, et al. Hypnic headache syndrome: clinical aspects of eight patients in Brazil. Cephalalgia. 2002;22:824–7.
Johansson B, Georgiev V, Lindström K, Fredholm BB. A1 and A2A adenosine receptors and A1 mRNA in mouse brain: effect of long-term caffeine treatment. Brain Res. 1997;762:153–64.
Varani K, Portaluppi F, Merighi S, Ongini E, Belardinelli L, Borea PA. Caffeine alters A2A adenosine receptors and their function in human platelets. Circulation. 1999;99:2499–502.
Courturier EGM, Hering R, Steiner TJ. Weekend attacks in migraine patients: caused by caffeine withdrawal?. Cephalalgia. 1992; 12: 99– 100 22b.
Sjaastad O, Bakketeig LS. Caffeine-withdrawal headache. the Vaga study of headache epidemiology. Cephalalgia. 2004;24:241–9.
Juliano LM, Griffiths RR. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology. 2004;176:1–29.
Fukui PT, Gonçalves TRT, Strabelli CG, et al. Trigger factors in migraine patients. Arq Neuropsiquiatr. 2008;66:494–9.
Hage K, Thoresen K, Stovne LJ, Zwart J. High dietary caffeine consumption is associated with a modest increase in headache prevalence: results from the Head-HUNT Study. J Headache Pain. 2009;10:153–9.
Bigal M, Sheftell FD, Rapoport AM, et al. Chronic daily headache: identification of factors associated with induction and transformation. Headache. 2002;42:575–81.
Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache. Neurology. 2004;63:2022–7.
Patrick CH. Alcohol, culture, and society. New York: AMS Press; 1970. p. 26–7.
Low tyramine diet. Queensland government: dietitian/ nutritionists from the Nutrition Education Materials Online, “NEMO”, team. https://www.health.qld.gov.au/nutrition/resources/oncol_maoi.pdf. Published Nov. 2015. Updated Nov. 2015. Accessed June 20, 2016.
Rose F. Food and headache. Headache Quart-Curr Treatment Res. 1997;8:319–29.
Aamodt AH, Stovner LJ, Hagen K, et al. Headache prevalence related to smoking and alcohol use. Head-HUNT Stud Eur J Neurol. 2006;13:1233–8.
Schürks M, Kurth T, Knorn P, Pageler L, Diener HC. Predictors of hazardous alcohol consumption among patients with cluster headache. Cephalalgia. 2006;26(5):623–7.
Littlewood JT, Glover V, Davies PTG, et al. Red wine as a cause of migraine. Lancet. 1988;1:558–9.
Panconesi A. Alcohol and migraine: trigger factor, consumption, mechanisms. A review. J Headache Pain. 2008;9:71–6.
Rist P, Buring J, Kurth T. Dietary patterns according to headache and migraine status: a cross-sectional study. Cephalalgia. 2015;35:767–75. Cross sectional study within the Women’s Health Study evaluating avoidance of certain diets/foods in migraine and non-migraine headache patients.
Smith I, Kellow AH, Mullen PE, Hanington E. Dietary migraine and tyramine metabolism. Nature (London). 1971;230:246–8.
Hanington E. Preliminary report on tyramine headache. BMJ. 1967;2:550–1.
Peatfield RC. Relationships between food, wine, and beer-precipitated migrainous headaches. Headache. 1995;35:355–7.
Jansen SC, van Dusseldorp M, Bottema KC, Dubois AEJ. Intolerance to dietary biogenic amines: a review. Ann Allergy Asthma Immunol. 2003;91:233–41.
Jarisch R, Wantke F. Wine and headache. Int Arch Allergy Immunol. 1996;110(1):7–12.
Lassen LH, Christiansen I, Iversen HK, Jansen-Olesen I, Olesen J. The effect of nitric oxide synthase inhibition on histamine induced headache and arterial dilatation in migraineurs. Cephalalgia. 2003;23:877–86.
Sandler M, Youdim MB, Hanington E. A phenylethylamine oxidising defect in migraine. Nature. 1974;250:335–7.
Marcus DA, Scharff L, Turk D, Gourley LM. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia. 1997;17:855–86.
Roberts HJ. Reactions attributed to aspartame containing products: 551 cases. J Appl Nutr. 1988;40:85–94.
Schiffman SS, Buckley CE, Sampson HA. Aspartame and susceptibility to headache. N Engl J Med. 1987;317:1181.
Sathyapalan T, Thatcher NJ, Hammersley R, et al. Aspartame sensitivity? A double blind randomised crossover study: e0116212. PLoS One. 2015; 10.
Leon AS, Hunninghake DB, Bell C, et al. Safety of long-term doses of aspartame. Arch Intern Med. 1989;1989:2318–24.
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.
Koehler SM, Glaros A. The effect of aspartame on migraine headache. Headache. 1988;28:10–4.
Newman LC, Lipton RB. Migraine MLT-down: an unusual presentation of migraine in patients with aspartame-triggered headaches. Case report. Headache. 2001;41:899–901.
Blumenthal HJ, Vance DA. Chewing gum headaches. Headache. 1997;37:665–6.
Scharff L, Turk DC, Marcus DA. Triggers of headache episodes and coping responses of headache diagnostic groups. Headache. 1995;35:397–403.
Henderson W, Raskin N. Hot-dog headache: individual susceptibility to nitrite. Lancet. 1972;300:1162–3.
Bryan N, Calvert J, Gundewar S, Lefer D. Dietary nitrite restores NO homeostasis and is card ioprotective in endothelial nitric oxide synthase-deficient mice. Free Radic Biol Med. 2008;45:468–74.
Machha A, Schechter AN. Dietary nitrite and nitrate: a review of potential mechanisms of cardiovascular benefits. Eur J Nutr. 2011;50:293–303.
Olesen J. The role of nitric oxide (NO) in migraine, tension-type headache and cluster headache. Pharmacol Ther. 2008;120:157–71.
Neyal M, Geyik S, Çekmen M, Balat A, Neyal A. Elevated plasma total nitrite levels may be related to migraine attacks. Gaziantep Med J. 2014;20(4):299–30.
Barbanti P, Egeo G, Aurilia C, Fofi L, Della-Morte D. Drugs targeting nitric oxide synthase for migraine treatment. Expert Opin Investig Drugs. 2014;23(8):1141–8.
Kurihara K. Glutamate: from discovery as a food flavor to role as a basic taste (umami). Am J Clin Nutr. 2009;90:719S–22.
Obayashi Y, Nagamura Y. Does monosodium glutamate really cause headache?: a systematic review of human studies. J Headache Pain. 2016;17:54.
Tarasoff L, Kelly MF. Monosodium L-glutamate: a double-blind study and review. Food Chem Toxicol. 1993;31(12):1019–35.
Prawirohardjono W, Dwiprahasto I, Astuti I, Hadiwandowo S, Kristin E, Muhammad M, et al. The administration to Indonesians of monosodium L-glutamate in Indonesian foods: an assessment of adverse reactions in a randomized double-blind, crossover, placebo-controlled study. J Nutr. 2000;130(4S Suppl):1074S–6.
Tanphaichitr V, Srianujata S, Pothisiri P, Sammasut R, Kulapongse S. Post prandial responses to Thai foods with and without added monosodium L-glutamate. Nutr Rep Int. 1983;28:783–92.
Merrett J, Peatfield RC, Rose FC, Merret TG. Food related antibodies in headache patients. J Neurol Neurosurg Psychiatry. 1983;46:738–42.
Moghadam MH, Ardalani H, Alehashemi A, Dehkordi MA, Meshkat M. Correlation between severity of migraine attacks and IgE level in peripheral blood. Lab Med. 2016;40:215–9.
Rosario D, Pinto G. Role of gender and serum immunoglobulin E (IGE) levels on severity of migraine. J Clin Diagn Res. 2014;8:57.
Cakici M, Bilen S, Motor S, Ak F. Migraine and immunoglobulin E-mediated hypersensitivity. Noropsikiyatri Arsivi-Arch Neuropsychiatr. 2012;49:129–32.
Pradalier A, Weinman S, Launay JM, Baron JF, Dry J. Total IgE, specific IgE and prick-tests against foods in common migraine—a prospective study. Cephalalgia. 1983;3:231–4.
Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004;53(10):1459.
Arroyave Hernandez CM, Echevarria Pinto M, Hernandez Montiel HL. Food allergy mediated by IgG antibodies associated with migraine in adults. Rev Alerg Mex. 2007;54:162–8.
Alpay K, Ertaş M, Orhan EK, Üstay 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.
Aydinlar EI, Dikmen PY, Tiftikci A, et al. IgG‐based elimination diet in migraine plus irritable bowel syndrome. Headache: J Head Face Pain. 2013;53:514–25.
Mitchell N, Hewitt C, Jayakody S, 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.
Pascual J, Oterino A. IgG-mediated allergy: a new mechanism for migraine attacks? Cephalalgia. 2010;30:777–9.
Chai NC, Scher AI, Moghekar A, et al. Obesity and headache: part I—a systematic review of the epidemiology of obesity and headache. Headache. 2014;54:219–34.
Vo M, Ainalem A, Qiu C, Peterlin BL, Aurora SK, Williams MA. Body mass index and adult weight gain among reproductive age women with migraine. Headache. 2011;51:559–69.
Peterlin BL, Rosso AL, Rapoport AM, Scher AI. Obesity and migraine: the effect of age, gender and adipose tissue distribution. Headache. 2010;50:52–62.
Novack V, Fuchs L, Lantsberg L, et al. Changes in headache frequency in premenopausal obese women with migraine after bariatric surgery: a case series. Cephalalgia. 2011;31:1336–42.
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.
Mosek A, Korczyn AD. Yom Kippur headache. Neurology. 1995;45:1953–5.
Awada A, al Jumah M. The first-of-Ramadan headache. Headache. 1999;39:490–3.
Abu-Salameh I, Plakht Y, Ifergane G. Migraine exacerbation during Ramadan fasting. J Headache Pain. 2010;11:513–7.
Blau JN. Water deprivation: a new migraine precipitant. Headache. 2005;45:757–9.
Spigt MG, Kuijper EC, Schayck CP, et al. Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial. Eur J Neurol. 2005;12:715–8.
Amer M, Woodward M, Appel LJ. Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial. BMJ Open. 2014;4:1–7.
Ferrara L, 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(4):370–5.
Bic Z, Blix GG, Hopp HP, et al. The influence of a low-fat diet on incidence and severity of migraine headache. J Womens Health Gend Based Med. 1999;8:623–9.
Schnabel TG. An experience with a ketogenic dietary in migraine. Ann Intern Med. 1928;2:341–7.
Maggioni F, Margoni M, Zanchin G. Ketogenic diet in migraine treatment: a brief but ancient history. Cephalalgia. 2011;31:1150–1.
Di Lorenzo C, Coppola G, Sirianni G, et al. Migraine improvement during short lasting ketogenesis: a proof‐of‐concept study. Eur J Neurol. 2015;22:170–7.
Kelman L. The triggers or precipitants of the acute migraine attack. Cephalagia. 2007;27:394–402.
Conflict of Interest
Zoya Zaeem, Lily Zhou, and Esma Dilli declare that they have no conflict of interest.
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.
This article is part of the Topical Collection on Headache
About this article
Cite this article
Zaeem, Z., Zhou, L. & Dilli, E. Headaches: a Review of the Role of Dietary Factors. Curr Neurol Neurosci Rep 16, 101 (2016). https://doi.org/10.1007/s11910-016-0702-1
- Dietary triggers
- Elimination diets
- Biogenic amines