This is for our readers who treat pain patients.
Authors: Jillian Kubala MS RD and Deena Kuruvilla MD
Migraine is considered a moderate-to-severe type of headache that impacts about 16% of the U.S. adult population. Migraine is more common in women of childbearing age and in those with lower socioeconomic status.
Migraine has a strong genetic component meaning that you are more likely to experience migraine if a close relative has them.
Each individual person with migraine has different triggers which can set off a migraine attack. The sudden onset of a migraine attack can mean calling out of work, missing an important life event, or canceling plans with a loved one.
Identifying clues or patterns that may trigger a migraine attack can help to manage the disease. Common migraine triggers include:
- too little or too much sleep
- hormonal shifts
- changes in weather
- caffeine, alcohol, and water intake
Diet and food choices can also be a migraine trigger in some people.
In this article, Jillian Kubala, a registered dietitian, and Deena Kuruvilla, M.D., a neurologist, explain the link.
Older research found that up to 76% of people with migraine report certain triggers for migraine attacks. However, only some of these triggers are considered “probable” triggers, while others have not yet been proven.
Skipping meals can trigger a migraine in up to 57% of people who experience the condition.
This is because skipping meals and intentionally fasting causes fluctuations in blood sugar levels, which can trigger migraine in some people.
Research shows that fasting for long periods of time as part of religious practices such as Yom Kippur and Ramadan can trigger migraine or make migraine attacks worse.
Aspartame is an artificial sweetener considered a “possible” trigger of migraine. Large doses of aspartame between 900 to 3,000 mg per kilogram of body weight per day have been reported to trigger or worsen headaches in people who experience migraine.
This may be because aspartame consumption elevates levels of certain amino acids in the brain, which can inhibit the synthesis and release of neurotransmitters and other regulators of neurophysiological activity. Aspartame may also act as a chemical stressor, leading to the excessive production of free radicals and elevated cortisol levels.
Foods that contain aspartame include sugar-free candies, desserts, and beverages. It’s also a main ingredient in zero-calorie sweeteners like Equal.
A 2019 study that included 2,197 people with migraine found that red wine was the most common migraine trigger out of all alcoholic beverages. This may be because red wine contains compounds including flavonoid phenolic compounds, which may trigger migraine.
Other foods and drinks
Some other reported triggers include:
- coffee and other caffeinated beverages
- foods high in monosodium glutamate (MSG)
However, this does not mean these foods will cause migraine in all people affected by the condition.
For example, a 2020 review of 21 studies found that caffeine and caffeine withdrawal triggered migraine in only a small percentage of the participants, ranging from 2% to 30%. Plus, caffeine may even be helpful in treating acute migraine when used in combination with other pain relievers.
Everyone who experiences migraine is different, and what may trigger a migraine in one person may not have the same effect in another.
According to research, each person with migraine doesn’t have just one trigger that sets off an attack but the perfect storm of several triggers.
A combination of personal triggers, such as a lack of sleep, stress, and alcohol intake, can lead to a migraine attack. This combination can look different for each person and even for each individual attack.
Dietary factors likely play a role in different reactions in the brain that can produce migraine. Dietary factors affect how our brain uses glucose, can produce inflammation, and can change the release of chemicals such as serotonin.
Common food items which can trigger migraine attacks include:
- citrus fruits
- processed meats
- monosodium glutamate
A large 2020 study from Stanford University found that people with migraine did not have regular thrice-per-day mealtimes, compared to people without migraine. Skipping meals/fasting was a common trigger noted in this study. So was alcohol. The most common alcohol-related trigger was red wine.
I am also often asked about specific migraine diets. There are several books out there claiming to heal migraine disease by sticking to a specific diet, but often these recommendations are not based on solid research.
There are a few diets that have shown some benefit with managing migraine disease. These include:
- low fat diet
- ketogenic diet
- Atkins diet
- low sodium diet
However, diet is just one piece of the bigger puzzle. — Deena Kuruvilla, M.D.
Try to eat regularly. Eating every 3–4 hours or so may help reduce migraine occurrence. If you notice that going long periods without eating or skipping meals triggers migraine, try adding in snacks or small meals rich in protein and fiber in between your main meals to see if this helps decrease migraine attacks.
Add protein and fiber to meals and snacks. This can keep blood sugar levels steady while keeping you satiated between meals.
Restrict or avoid alcohol. Some people may be able to pinpoint certain alcoholic beverages that trigger or worsen migraine while others may notice that all types of alcohol are likely to trigger a migraine attack.
Identify food triggers. Foods and beverages that contain aspartame, MSG, and caffeine may trigger migraine in some people. Also, foods like chocolate, milk, cheese, and nuts have been reported as potential migraine triggers. Keeping a food and symptom journal can help you identify possible dietary migraine triggers.
Try elimination. If you notice that you constantly get migraine attacks after eating a specific food or drinking a specific beverage, consider eliminating the product from your diet for a few weeks to see if headaches improve.
Drink more water. This has been shown to be a simple, yet effective tool for reducing migraine frequency and severity.
Working with a dietitian to adjust dietary patterns
Research shows that following certain dietary patterns may be beneficial for people who have migraine.
For example, a 2020 review found that low-glycemic diets, low fat diets, the ketogenic diet, and certain elimination diets may help reduce migraine occurrence and severity in those with migraine. Gluten-free diets are appropriate for those who have celiac disease or non-celiac gluten intolerance.
However, although some diets may be helpful, certain dietary patterns may not be appropriate for everyone. Every person who experiences migraine is different and may have different triggers, dietary needs, and underlying health issues.
Rather than trying a restrictive diet or eliminating foods on your own, try working with a qualified healthcare professional like a registered dietitian to develop a diet and lifestyle plan that is specific to your health needs and symptoms.
In addition to dietary changes, people who experience migraine may consider taking certain dietary supplements.
For example, studies show that people with migraine are more likely to have low levels of vitamin B12, vitamin D and magnesium and that supplementation with these and other nutrients, like CoQ10 may help reduce migraine occurrence and severity.
If you’re interested in getting tested for nutrient deficiencies, ask your doctor to perform a blood test. Your doctor or a registered dietitian can help you decide which supplements may be the right choice for your needs. — Jillian Kubala
While it is helpful to identify specific triggers, there is no substitute for taking a whole body approach to migraine. Managing specific triggers, leading a healthy lifestyle, and discussing preventive and as-needed treatments with your doctor are all necessary to manage the disease effectively.
While specific food triggers may exist, eliminating them does not necessarily mean that migraine will be prevented.
Ultimately, migraine is a disease that results from genetic and environmental factors and will naturally fluctuate over one’s lifetime. Typically a combination of several triggers can create the stage for a migraine attack to occur. — Deena Kuruvilla, M.D.
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