Diet and migraines: When what we’re eating is giving us a headache

A migraine is not simply a “bad headache”. It is really a neurological storm which can last for hours, or even days [1-2]. There are a whole range of accompanying symptoms: intense throbbing pain and nausea plus heightened sensitivity to light and noise. When it hits, we only want one thing: to curl up in a blanket, shut ourselves away in the dark and wait for it to pass.

Science is still exploring this question, but we do know that migraines are based on the interaction of many genetic, neurological, hormonal and environmental factors [1-3]. The brains of migraine sufferers seem to be particularly sensitive to different stimuli, and specific factors—such as stress, lack of sleep, hormone fluctuations or some dietary aspects—may trigger or worsen episodes.

We need to approach the topic of diet-related causes with care and understanding. We often point to certain foods, such as caffeine, alcohol, monosodium glutamate (present in many processed foods), aged cheeses, citrus fruits, cold cuts (which contain sulfites and sulfates) and aspartame (an artificial sweetener) [5]. Yet foods are not the only things which can trigger a migraine — fatigue can play a role too.

It is important to understand that, first and foremost, migraines are a complex neurological condition (the cause), and that migraine attacks can be simply triggered by a combination of daily factors, such as stress or diet [2]. Looking at the situation sympathetically can defuse things and allow us not to feel guilty that our diet isn’t “perfect” when an episode comes on.

And that goes a long way toward managing migraines better.

Before we even start thinking about foods to avoid, it is crucial to establish a healthy dietary routine. Think about it as establishing a solid foundation [5-6]. This includes how much we gain by choosing complete, varied meals consisting of fruits, vegetables, whole grains, lean protein and good sources of fat, such as nuts, seeds and fatty fish. Not only do these habits promote overall health but they may also play a protective role against migraine attacks.

Not only is what we eat important, but also when we eat. Studies have shown that not eating for long periods and/or skipping meals are common migraine triggers. Maintaining stable energy intake all day long can help prevent headaches. For many, planning a small snack every 3-4 hours can really make a difference. It is worth noting that people prone to migraines should avoid popular eating trends, such as intermittent fasting, which may worsen the frequency or intensity of episodes.

Dehydration is a well-established migraine trigger. And yet, we often forget that we start feeling thirsty after the body has started running short of water. Drinking regularly, even when we’re not thirsty, really can decrease the frequency and intensity of migraine attacks. This is particularly important in a cold climate, where we naturally tend not to drink as much. The goal: aim to drink about 1.5–2 litres of fluids a day, distributed over the whole day.

There have been many studies of the interaction between caffein and migraines [7]. As a result, we can make credible recommendations. For some, a small amount of caffeine—an espresso, black tea or cola drink—may help relieve a budding migraine, and caffeine is even an ingredient in many headache medications. But for others, the opposite is true: excessive or irregular coffee consumption may promote the onset of migraines and even lead to so-called rebound headaches.

If migraines are occasional: the recommendation is not to have more than one or two caffeinated drinks a day.

If headaches are frequent or daily: ideally, limit caffeine or even avoid it completely.

For medications which contain caffeine: the best thing is to use them sparingly, not more than two days a week, to avoid any rebound, and talk to your pharmacist.

If you want to decrease your consumption: go slowly! Gradually cutting back will reduce withdrawal symptoms (fatigue, irritability) and a few more headaches!

When a connection between diet and migraines is suspected, there are several approaches which can help understand what is impacting the attacks and how our diet may be contributing.

This is often the starting point for nutritional management and is the method recommended in the guidelines [1-4]. For a few weeks, record everything you eat and drink, as well as migraine symptoms and other factors, such as stress, sleep, menstrual cycle or physical activity.

The goal is not so much to eliminate certain foods, but rather to identify connections between lifestyle habits and migraine episodes. This method is valuable for understanding your own reality… without jumping to conclusions too quickly.

For many migraine sufferers, the food itself is not always the problem, but rather the time when it is eaten or the conditions surrounding its consumption. For example, a piece of chocolate may be tolerated very well after a good night’s sleep and a balanced meal… but it may trigger a migraine if eaten in the middle of a stressful day, on an empty stomach or after skipping a meal.

The goal of this approach is to better understand your own triggers, instead of eliminating foods unnecessarily. Ideally, you should do this with support from a dietician-nutritionists, who can help separate real signals from false alarms – while keeping your meals varied and enjoyable.

Global food approaches to prioritize:

• Mediterranean diet: this approach has been the best documented one so far, for many medical conditions, including migraines. Packed with veggies, fruits, whole grains, legumes, fish, nuts and olive oil, it offers a combination of foods which provide nutritional balance and protect our health. A number of studies seem to indicate that it may help reduce the frequency/intensity of migraines, as well as improving cardiovascular and metabolic health. Accessible, balanced and sustainable, it is a solid base for anyone who wants to eat better without depriving themselves unnecessarily.

Watch for these dietary approaches, which are still exploratory

Some dietary approaches are attracting interest because they potentially affect migraines, but the scientific data are still limited or inconclusive. In some cases, they may be considered, but always cautiously and with professional support [1-2,6]:

• Low-histamine diets: histamine is a molecule which is naturally present in some foods, such as red wine, aged cheeses, cold cuts, canned or smoked fish, commercial broth, chocolate, tomatoes, spinach and avocado. Since sensitivity can vary from one person to the next, science cannot yet draw any clear conclusions. As a result, a low-histamine diet is sometimes tested in specific cases, but it should never be adopted without supervision, because of how many restrictions it has and how difficult it is to follow.
• Keto (ketogenic) diet: often presented as a miracle solution, the keto diet is also one of the most restrictive ones [9]. A few small studies have seen positive short-term effects on the frequency of migraines, but the results are still preliminary. This approach may lead to side effects or deficiencies and requires strict medical monitoring. Despite its popularity, a keto diet is not the first approach to try, nor is it a sustainable solution for most of us.
• Low- tyramine or low-monosodium-glutamate (MSG) diets: some patients show individual sensitivity to compounds such as tyramine (aged cheeses, cold cuts, red wine) or monosodium glutamate (present in some prepared dishes or Asian cuisine) [6,10]. Research has not established any clear connection between these compounds and migraines in the general population. Even though their effectiveness has yet to be demonstrated, these diets may sometimes be explored on a case-by-case basis.

When you live with migraines, you’re often ready to try anything, but eliminating food “just in case” is not always the best solution [6].

An elimination diet consists of temporarily removing certain foods suspected of triggering migraines, then reintroducing them one at a time. Although this approach may sometimes help to identify trends or personal triggers, it still has its limitations.

Even though this method has been recommended for a long time, we now know that studies have not been conclusive, particularly in adults. When poorly managed, this approach may lead to deficiencies or an unhealthy relationship with food. For these reasons, it is only suggested in very specific cases, and always with professional support.

Certain nutrients (such as magnesium, riboflavin [B2], coenzyme Q10 or alpha-lipoic acid) are being studied for preventing migraines [11-12]. These supplements may sometimes be helpful, but they are not right for everyone.

Just because a product is “natural” does not mean that there is no risk. Any supplementation needs to be done under medical supervision and with advice from a nutritionist, to avoid interactions, adjust doses and make sure it really is relevant.

Eating better may not make migraines go away right away but understanding when and what to eat can go a long way toward controlling them.