NUTRITIONAL ISSUES IN MIGRAINE
An awareness of nutritional issues that may affect migraines can be very helpful in decreasing the occurrence of headaches. People who suffer from migraines should know which foods can potentially trigger headaches, and what types of eating patterns are best for avoiding headaches. Some people know exactly what foods consistently trigger their headaches, but others may not be able to accurately pinpoint their food triggers. Often a food diary is helpful in determining which foods are linked to your migraines.
Eating To Prevent Headaches
The importance of eating regularly cannot be overstated, since skipping meals can trigger headaches. Skipped meals and fasting were reported migraine triggers in more than half of patients surveyed in several studies. Low blood sugar can trigger headaches so it is important to eat breakfast, lunch and dinner everyday. Many people skip breakfast, which puts them at risk for having headaches in the morning. Snacks in the mid-morning and mid-afternoon might also be helpful for people who find that their headaches are often triggered by hunger.
Also, spikes and falls in your blood sugar can trigger headaches. Eating protein and fiber with each meal can help to stabilize the way the food is broken down by your body, thus preventing large fluctuations in blood sugar. For example, having cereal with milk (which has protein) is a better breakfast choice than a big muffin, which is generally high in sugar and low in protein. Protein-rich foods include: meat, fish, poultry, eggs, dairy, beans, and nuts. High-fiber foods include wholegrain breads, whole wheat pastas, bran, fruit (especially dried fruit), green leafy vegetables, and nuts and seeds.
Staying well-hydrated throughout the day is also important, since dehydration can trigger headaches. We recommend drinking 8-10 glasses of water daily to prevent headaches. Caffeinated drinks (coffee, tea, soda) can actually have a dehydrating effect by causing increased urination so these should be limited as much as possible. This is especially important since caffeine also has a role in increasing headaches (see Caffeine section under Identifying Your Triggers).
Identifying Your Triggers
Many migraineurs appear to be very sensitive to certain foods, although the scientific basis for food triggers is controversial. Though the foods and substances discussed below are often identified by patients as headache triggers, not all of the foods will trigger a migraine in any one person. Headaches are generally triggered by a combination of substances, during a time of particular vulnerability (such as menses). Food diaries are helpful in sorting out which ones are problematic for each patient.
Alcohol, especially red wine, is commonly identified as a headache trigger by migraine sufferers. It can either trigger a headache shortly after drinking, or it can cause a hangover headache the next morning. Headaches that occur within several hours after drinking alcohol are probably the result of blood vessel dilation and constriction. Wine also contains substances such as tyramine, histamine, and sulfites, all of which can trigger headaches.
On the other hand, hangover headaches are due to impurities called congeners that are formed as the alcohol is metabolized by the body. Darker colored beverages such as red wine, whiskey, and bourbon have higher levels of congeners than clear drinks such as gin or vodka, and are therefore more likely to cause a hangover headache. Though the severity of the hangover headache generally increases with larger amounts of alcohol consumed, hangover headaches actually occur more often in light or moderate drinkers than in regular heavy drinkers. Drinking in moderation and eating greasy foods prior to drinking may help to decrease the severity of the hangover.
Caffeine is a substance found in coffee, tea, soda, and chocolate. The relationship between caffeine and headaches is a tricky one. When used infrequently in small amounts, caffeine can be very helpful in treating headaches. This is because caffeine has some pain-killing properties, gets to the brain quickly, and helps in the absorption of other medications. That’s why it’s included in over-the-counter headache medications such as Excedrin, and prescription drugs such as Fioricet. However, too much caffeine (usually 2-3 cups of coffee per day) on a regular basis can actually give you more headaches. Even 1 cup of coffee on a daily basis can worsen headaches in some people. If you have a “withdrawal headache” after skipping your usual amount of coffee, then you’re probably drinking too much every day, whether it’s 1 cup or 3 cups.
Food additives that are commonly identified as headache triggers include nitrites and monosodium glutamate (MSG). Nitrates and nitrites are preservatives that are used for food coloring, prevention of food poisoning, and to add a cured or smoked flavor. After eating foods with nitrites, such as sausages or other cured meats and fish including hot dogs, bacon, ham, salami, pepperoni, corned beef, pastrami and lox, some people develop headaches within minutes to hours. Nitrates and nitrites probably trigger headaches by dilating blood vessels. People who are sensitive to these substances should read food labels and avoid foods with sodium nitrite, sodium nitrate, potassium nitrite, or potassium nitrate.
MSG is a flavor enhancer that is most commonly associated with Chinese food. It is also used in meat tenderizer (Accent) and many canned, prepared and packaged foods. MSG is often disguised on food labels as “hydrolyzed vegetable protein (HVP),” “autolyzed yeast,” “sodium caseinate,” “yeast extract,” “hydrolyzed oat flour,” “texturized protein,” or “calcium casinate.” In sensitive patients, MSG can trigger a headache within 30 minutes. Other symptoms may include a hot flush in the chest, neck, and shoulders, dizziness, and abdominal discomfort.
Aspartame is an artificial sweetener (NutraSweet ®) that is 180 to 200 times sweeter than regular sugar. Since it became available in 1981, there have been many reports of headaches in connection with its use. The scientific evidence suggests that aspartame may be a headache trigger in people who ingest moderate to high doses (900-3000 mg per day). As a frame of reference, one packet of NutraSweet contains about 36 mg of aspartame. Sucralose is the active component of another common artificial sweetener (Splenda ®). Some case reports have suggested that it may also be a headache trigger. Though many people add artificial sweeteners directly to their coffee or tea, they are actually included in many different foods, such as cereals, breath mints, and even yogurt. People who think they are sensitive to aspartame or sucralose should check food labels for these substances.
The role of chocolate as a headache trigger is a controversial issue. Chocolate and cacao contain phenylethylamine, a substance which may trigger headaches in some migraineurs by altering the size of blood vessels. Chocolate also contains some caffeine, which may trigger headaches. However, some people have cravings for certain foods such as chocolate during a very early stage of migraine called the “prodrome,” which may start up to 48 hours before headache pain begins. In these people, eating chocolate does not trigger the headache- the migraine mechanism has already begun.
Tyramine is a substance that is found in aged cheese, cured meats, smoked fish, beer, fermented food and yeast extract (including freshly baked bread or cake), among other foods. It probably triggers headaches by constricting blood vessels or by activating some biochemicals in the body that can then set a migraine in motion.
Gluten and migraines
See this blog post about gluten.