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A Clinical Approach to Addressing Diet with Migraine Patients

  • Headache (RB Halker, Section Editor)
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Abstract

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.

Summary

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.

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References

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

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  4. Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015;35:6619–29. A great review of migraine pathophysiology.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394–402.

    Article  CAS  PubMed  Google Scholar 

  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: http://link.springer.com/10.1007/s11916-013-0373-4 This paper is a good review of diet in migraine patients

  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.

    Article  PubMed  Google Scholar 

  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.

  9. Lance JW, Goadsby PJ. Mechanism and management of headache. 6th ed. London: Butterworth-Heinemann; 1998.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  12. Gibb CM, Davies PTG, Glover V, Steiner TJ, Rose FC, Sandler M. Chocolate is a migraine-provoking agent. Cephalalgia. 1991;11:93–5.

    Article  CAS  PubMed  Google Scholar 

  13. Sandler M, Youdin MBH, Hanington E. A phenylethylamine oxidising defect in migraine. Nature. 1974;250.

  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.

    Article  CAS  Google Scholar 

  15. Koehler SM, Glaros A. The effect of aspartame on migraine headache. Headache. 1988;28:10–4.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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. 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: http://www.thejournalofheadacheandpain.com/content/16/1/27. 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. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  29. Peroutka SJ. What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep. 2014;18. Available from: http://link.springer.com/10.1007/s11916-014-0454-z.

  30. Byer JA, Dexter JD. Hypoglycemic migraine. Mo Med. 1975;72:194–7.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  32. Wilkinson CF. Recurrent migrainoid headaches associated with spontaneous hypoglycemia. Am J Med Sci. 1949;218:209–12.

    Article  PubMed  Google Scholar 

  33. Schnabel TG. An experience with a ketogenic dietary in migraine. Ann Intern Med. 1928;2:341–7.

    Article  Google Scholar 

  34. Barborka CJ. Migraine: results of treatment by ketogenic diet in fifty cases. J Am Med Assoc. 1930;95:1825–8.

    Article  Google Scholar 

  35. Gainsborough H. The therapeutic use of the ketogenic diet. The Practitioner. 1934;132:45–53.

    Google Scholar 

  36. Strahlman RS. Can ketosis help migraine sufferers? A case report. Headache. 2006;179–82.

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  43. Mormile R. Celiac disease and migraine: is there a common backstage? Int J Colorectal Dis. 2014;29:1571–1.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  47. Zelnik N, Pacht A, Obeid R, Lerner A. Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004;113:1672–6.

    Article  PubMed  Google Scholar 

  48. Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F. Systematic review: noncoeliac gluten sensitivity. Aliment Pharmacol Ther. 2015;41:807–20.

    Article  CAS  PubMed  Google Scholar 

  49. Panconesi A. Alcohol and migraine: trigger factor, consumption, mechanisms. a review. J Headache Pain. 2008;9:19–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed Central  Google Scholar 

  52. Krymchantowski AV, da Cunha Jevoux C. Wine and headache. Headache J Head Face Pain. 2014;54:967–75.

    Article  Google Scholar 

  53. Imam I. Alcohol and the central nervous system. Br J Hosp Med. 2010;71:635–9.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  55. Panconesi A, Franchini M, Bartolozzi ML, Mugnai S, Guidi L. Alcoholic drinks as triggers in primary headaches. Pain Med. 2013;14:1254–9.

    Article  PubMed  Google Scholar 

  56. Littlewood JT, Glover V, Davies PT, Gibb C, Sandler M, Cifford RF. Red wine as a cause of migraine. Lancet. 1988;558–9.

  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.

    Article  CAS  PubMed  Google Scholar 

  58. Panconesi A, Bartolozzi ML, Guidi L. Alcohol and migraine: what should we tell patients? Curr Pain Headache Rep. 2011;15:177–84.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed Central  Google Scholar 

  62. Sjaastad O, Bakketeig LS. Hangover headache: accompanying symptoms. Vågå study of headache epidemiology. J. Headache Pain. 2004;5:224–9.

    Article  Google Scholar 

  63. Wiese JG, Shlipak MG, Browner WS. The alcohol hangover. Ann Intern Med. 2000;132:897–902.

    Article  CAS  PubMed  Google Scholar 

  64. Evans RW, Sun C, Lay C. Alcohol hangover headache. Headache J Head Face Pain. 2007;47:277–9.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Shapiro RE. Caffeine and headaches. Neurol Sci. 2007;28:S179–83.

    Article  PubMed  Google Scholar 

  67. Sawynok J. Caffeine and pain. Pain. 2011;152:726–9.

    Article  PubMed  Google Scholar 

  68. Spencer B. Caffeine withdrawal: a model for migraine? Headache J Head Face Pain. 2002;42:561–2.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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: http://www.biomedcentral.com/content/pdf/1745-6215-12-97.pdf

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

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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.

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

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This article is part of the Topical Collection on Headache

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Slavin, M., Ailani, J. A Clinical Approach to Addressing Diet with Migraine Patients. Curr Neurol Neurosci Rep 17, 17 (2017). https://doi.org/10.1007/s11910-017-0721-6

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