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.
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 importance
Scher AI, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache. 1998;38(7):497–506.
Ashina S, Serrano D, Lipton RB, Maizels M, Manack AN, Turkel CC, et al. 3 Depression and risk of transformation of episodic to chronic migraine. J Headache Pain. 2012;13(8):615–24.
Buse D, Manack A, Serrano D, Reed M, Varon S, Turkel C, et al. Headache impact of chronic and episodic migraine: results from the American Migraine Prevalence and Prevention study. Headache. 2012;52(1):3–17.
Bigal ME, Lipton RB. What predicts the change from episodic to chronic migraine? Curr Opin Neurol. 2009;22(3):269–76.
Bigal ME, Tsang A, Loder E, Serrano D, Reed ML, Lipton RB. Body mass index and episodic headaches: a population-based study. Arch Intern Med. 2007;167(18):1964–70.
Bigal ME, Lipton RB. Modifiable risk factors for migraine progression (or for chronic daily headaches)–clinical lessons. Headache. 2006;46 Suppl 3:S144–6.
Bigal ME, Lipton RB. Obesity is a risk factor for transformed migraine but not chronic tension-type headache. Neurology. 2006;67(2):252–7.
Bigal ME, Gironda M, Tepper SJ, Feleppa M, Rapoport AM, Sheftell FD, et al. Headache prevention outcome and body mass index. Cephalalgia. 2006;26(4):445–50.
Bigal ME, Liberman JN, Lipton RB. Obesity and migraine: a population study. Neurology. 2006;66(4):545–50.
Dimitrova AK, Ungaro RC, Lebwohl B, Lewis SK, Tennyson CA, Green MW, et al. Prevalence of migraine in patients with celiac disease and inflammatory bowel disease. Headache. 2013;53(2):344–55.
Rai MF, Sandell LJ. Inflammatory mediators: tracing links between obesity and osteoarthritis. Crit Rev Eukaryot Gene Expr. 2011;21(2):131–42.
• 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.
Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30(9):1065–72.
Diamond M. The impact of migraine on the health and well-being of women. J Womens Health (Larchmt). 2007;16(9):1269–80.
Judit A, Sándor PS, Schoenen J. Habituation of visual and intensity dependence of auditory evoked cortical potentials tends to normalize just before and during the migraine attack. Cephalalgia. 2000;20(8):714–9.
Sener HO, Haktanir I, Demirci S. Pattern-reversal visual evoked potentials in migraineurs with or without visual aura. Headache. 1997;37(7):449–51.
Woestenburg JC, Kramer CJ, Orlebeke JF, Passchier J. Brain potential differences related to spatial attention in migraineurs with and without aura symptoms support supposed differences in activation. Headache. 1993;33(8):413–6.
Calhoun A, Ford S. Elimination of menstrual-related migraine beneficially impacts chronicifcation and medication overuse. Headache. 2008;48(8):1186–93.
Johnson KG, Ziemba AM, Garb JL. Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis. Headache. 2013;53(2):333–43.
Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Appl Psychophysiol Biofeedback. 2002;27(2):163–81.
Calhoun AH, Ford S. Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache. 2007;47(8):1178–83.
Nappi G, Jensen R, Nappi RE, Sances G, Torelli P, Olesen J. Diaries and calendars for migraine. A review. Cephalalgia. 2006;26(8):905–16.
Winner P. Migraine-related symptoms in childhood. Curr Pain Headache Rep. 2013;17(9):339.
Guidetti V, Galli F, Cerutti R, Fortugno S. “From 0 to 18”: what happens tithe child and his headache? Funct Neurol. 2000;15 Suppl 3:122–9.
Chai NC, Shapiro RE, Rapoport AM. Why does vomiting stop a migraine attack? Curr Pain Headache Rep. 2013;17(9):362.
Becker WL. Migraine-associated symptoms: clinical significance and management. Can J Clin Pharmacol. 1999;6(Suppl A):15A–9A.
Aurora SK, Papapetropoulos S, Kori SH, Kedar A, Abell TL. Gastric stasis in migraineurs: etiology, characteristics, and clinical and therapeutic implications. Cephalalgia. 2013;33(6):408–15.
Charles A. The evolution of a migraine attack - a review of recent evidence. Headache. 2013;53(2):413–9.
• 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.
Yaman M, Ucok K, Demirbas H, Genc A, Oruc S, Karabacak H, et al. Effects of topiramate use on body composition and resting metabolic rate in migraine patients. Neurol Sci. 2013;34(2):225–9.
Lakhanpal D, Kataria H, Kaur G. Neuroendocrine plasticity in GnRH release is disrupted by valproic acid treatment of cycling rats. Acta Neurol Belg. 2011;111(2):121–9.
Ray ST, Kumar R. Migraine and obesity: cause or effect? Headache. 2010;50(2):326–8.
• 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.
Sensenig J, Johnson M, Staverosky T. Treatment of migraine with targeted nutrition focused on improved assimilation and elimination. Altern Med Rev. 2001;6(5):488–94.
Monro J, Carini C, Brostoff J. Migraine is a food-allergic disease. Lancet. 1984;2(8405):719–21.
Monro J, Brostoff J, Carini C, Zilkha K. Food allergy in migraine. Study of dietary exclusion and RAST. Lancet. 1980;2(8184):1–4.
Giacovazzo M, Martelletti P. Migraine: a food-related immune reaction? Ann Allergy. 1989;63(3):255.
Bruno PP, Carpino F, Carpino G, Zicari A. An overview on immune system and migraine. Eur Rev Med Pharmacol Sci. 2007;11(4):245–8.
Marcus DA, Scharff L, Turk D, Gourley LM. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia. 1997;17(8):855–62.
Panconesi A. Alcohol and migraine: trigger factor, consumption, mechanisms. A review. J Headache Pain. 2008;9(1):19–27.
Hauge AW, Kirchmann M, Olesen J. Characterization of consistent triggers of migraine with aura. Cephalalgia. 2011;31(4):416–38.
Abu-Salameh I, Plakht Y, Ifergane G. Migraine exacerbation during Ramadan fasting. J Headache Pain. 2010;11(6):513–7.
Drescher MJ, Elstein Y. Prophylactic COX 2 inhibitor: an end to the Yom Kippur headache. Headache. 2006;46(10):1487–91.
• 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.
Drescher MJ, Wimpfheimer Z, Abu Khalef S, et al. Prophylactic etoricoxib is effective in preventing “first of Ramadan” headache: a placebo-controlled double-blind and randomized trial of prophylactic etoricoxib for ritual fasting headache. Headache. 2012;52:573–81.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495–505.
Harel Z, Gascon G, Riggs S, Vaz R, Brown W, Exil G. Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents. J Adolesc Health. 2002;31(2):154–61.
• 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.
Eccles JC. Developing concepts of the synapses. J Neurosci. 1990;10(12):3769–81.
Spigt M, Weerkamp N, Troost J, van Schayck CP, Knottnerus JA. A randomized trial on the effects of regular water intake in patients with recurrent headaches. Fam Pract. 2012;29:370–5.
Amandusson A, Blomqvist A. Estrogenic influences in pain processing. Front Neuroendocrinol. 2013. doi:10.1016/j.yfrne.2013.06.001.
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.
Messina G, Viggiano A, De Luca V, Messina A, Chieffi S, Monda M. Hormonal changes in menopause and orexin-a action. Obstet Gynecol Int. 2013;2013:209812.
Quirk SE, Williams LJ, O'Neil A, Pasco JA, Jacka FN, Housden S, et al. The association between diet quality, dietary patterns and depression in adults: a systematic review. BMC Psychiatry. 2013;13(1):175.
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.
Young WB. Preventive treatment of migraine: effect on weight. Curr Pain Headache Rep. 2008;12(3):201–6.
Taylor FR. Weight change associated with the use of migraine-preventive medications. Clin Ther. 2008;30(6):1069–80.
Berge LI, Riise T, Fasmer OB, et al. Does diabetes have a protective effect on migraine? Epidemiology. 2013;53:514–25.
Ford S, Finkel AG, Isaacs KL. Migraine in patients with inflammatory bowel disorders. J Clin Gastroenterol. 2009;43(5):499.
Maizels M et al. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache. 2004;44:885–90.
O’Brien, HL and Hershey AD. Vitamins and paediatric migraine: riboflavin as a preventative medication. Cephalalgia. 2010;30: 1417–18.
Schoenen J et al. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1999;50:466–70.
Tarighat Esfanjani A, Mahdavi R, Ebrahimi Mameghani M, Talebi M, Nikniaz Z, Safaiyan A. The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis. Biol Trace Elem Res. 2012;150:42–8.
Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009;25:446–52.
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.
Chang FY, Lu CL. Irritable bowel syndrome and migraine: bystanders or partners? J Neurogastroenterol Motil. 2013;19(3):301–11.
• 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.
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.
Matricon J, Meleine M, Gelot A, Piche T, Dapoigny M, Muller E, et al. Review article: associations between immune activation, intestinal permeability and the irritable bowel syndrome. Aliment Pharmacol Ther. 2012;36(11–12):1009–31.
Akerman S, Holland PR, Goadsby PJ. Diencephalic and brainstem mechanisms in migraine. Nat Rev Neurosci. 2011;12(10):570–84.
Welch KM, Nagesh V, Aurora SK, Gelman N. Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness? Headache. 2001;41(7):629–37.
Blasbalg TL, Hibbeln JR, Ramsden CE, et al. Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century. Am J Clin Nutr. 2011;93:950–62.
Pradlier A, Bakouche P, Baudesson G, et al. Failure of omega-3polyunsaturated fatty acids in prevention of migraine: a double blind study versus placebo. Cephalalgia. 2001;21:818–22.
Ramsden CE, Mann JD, Faurot KR, 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. Trials. 2011;12:97.
Ramsden CE, Ringel A, Feldstein AE, et al. Lowering dietary linoleic acid reduces bioactive oxidized linoleic acid metabolites in humans. Prostaglandins Leukot Essent Fatty Acids. 2012;87:135–41.
Perez-Leighton CE, Billington CJ, Kotz CM. Orexin modulation of adipose tissue. Biochim Biophys Acta. 2013. doi:10.1016/j.bbadis.2013.06.007.
Bigal ME, Lipton RB. Putative mechanisms of the relationship between obesity and migraine progression. Curr Pain Headache Rep. 2008;12(3):207–12.
• 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.
Holland P, Goadsby PJ. The hypothalamic orexinergic system: pain and primary headaches. Headache. 2007;47(6):951–62.
Lutter M, Krishnan V, Russo SJ, Jung S, McClung CA, Nestler EJ. Orexin signaling mediates the antidepressant-like effect of calorie restriction. J Neurosci. 2008;28(12):3071–5.
Sarchielli P, Rainero I, Coppola F, Rossi C, Mancini M, Pinessi L, et al. Involvement of corticotrophin-releasing factor and orexin-A in chronic migraine and medication-overuse headache: findings from cerebrospinal fluid. Cephalalgia. 2008;28(7):714–22.
Hoever P, Hay J, Rad M, Cavallaro M, van Gerven JM, Dingemanse J. Tolerability, pharmacokinetics, and pharmacodynamics of single-dose almorexant, an orexin receptor antagonist, in healthy elderly subjects. J Clin Psychopharmacol. 2013;33(3):363–70.
Loder E. What is the evolutionary advantage of migraine? Cephalalgia. 2002;22(8):624–32.
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.
This article is part of the Topical Collection on Migraine
About this article
Cite this article
Finkel, A.G., Yerry, J.A. & Mann, J.D. Dietary Considerations in Migraine Management: Does a Consistent Diet Improve Migraine?. Curr Pain Headache Rep 17, 373 (2013). https://doi.org/10.1007/s11916-013-0373-4
- Inflammatory Bowel Disease