Eliminating that morning 'Cup of Joe,' consuming processed foods high in nitrites or monosodium glutamate (MSG) and enjoying too much alcohol are potential headache triggers for individuals battling migraines, says Vincent Martin, MD, professor in the Department of Internal Medicine at the University of Cincinnati (UC) College of Medicine.
There are two different approaches to preventing headaches with diet. The first approach would be an elimination diet that avoids foods and beverages known to trigger headaches. The second approach would be follow a comprehensive diet whose very composition may prevent headaches, explains Martin, co-director of the Headache and Facial Pain Center at UC Gardner Neuroscience Institute and an expert in the area of migraine. His conclusions and others for migraineurs come after performing an exhaustive literature review of more than 180 research studies on the subject of migraine and diet.
Martin's two-part review, "Diet and Headache" is available online in the scholarly publication Headache: The Journal of Head and Face Pain. It is co-authored by Dr. Brinder Vij, associate professor in the UC Department of Neurology and Rehabilitation Medicine.
"One of the most important triggers for headache is the withdrawal of caffeine," says Martin, who also sees patients at UC Health. "Let's say you regularly pound down three or four cups of coffee every morning and you decide to skip your morning routine one day, you will likely have full-fledged caffeine withdrawal headache that day."
That said, too much coffee may also present a risk, no more than 400 milligrams daily - one cup is 125 milligrams - is probably the maximum for migraine patients, says Martin. "Large amounts of caffeine can bring on anxiety and depressive symptoms as well as headaches," he explains.
Another trigger for migraine is MSG, which is a flavor enhancer used in a variety of processed foods, including frozen or canned foods, soups, international foods, snack foods, salad dressing, seasoning salts, ketchup, barbecue sauce, and heavily in Chinese cooking, says Martin.
"You eliminate it by eating fewer processed foods," explains Martin. "You eat more natural things such as fresh vegetables, fresh fruits and fresh meats. MSG is most provocative when consumed in liquids such as soups."
Nitrites are preservatives food in processed meats such as bacon, sausage, ham and lunch meat to preserve color and flavor. Martin says a diary study found that five percent of individuals with migraine were statistically more likely to have an attack on days when they consume nitrites. Use of nitrites in foods has declined with stronger government regulation though checking labels remains a good idea, he explains.
Alcohol is one of the most commonly reported dietary trigger factors for migraine and studies suggest vodka and red wines, especially those with highest histamine content are problematic, says Martin. There is a lot of interest in gluten-free diets, but they are only helpful in lessening headaches if the individuals suffer from celiac disease, which can be established by a positive blood test or intestinal biopsy, he adds.
There have been three comprehensive diets whose very composition may prevent headaches such as low fat and low carbohydrate diets as well as those that increase the amount of omega-3 fatty acids and decrease the amount of omega-6 fatty acids, according to Martin.
Vij says low fat diets restrict the amount of fat in the diet to less than 20 percent of your daily energy requirements. "The beauty of these diets is that they not only reduce headaches, but may produce weight loss and prevent heart disease", says Vij.
Low carbohydrate diets such as ketogenic diets can reduce headache frequency, but it's not something to consider without strict physician supervision. The diet limits carbohydrates more than the well-known Atkins diet, Vij explains.
One of the most promising diets for those with more frequent attacks of migraine is one that boosts your omega-3 fats while lessoning your omega-6 levels and that means tossing out polyunsaturated vegetable oils (corn, sunflower, safflower, canola and soy) in favor of flaxseed oil, says Martin. Foods to consume would include flaxseed, salmon, halibut, cod and scallops while those to avoid would be peanuts and cashews.
"Persons with headache and migraine have more dietary options than ever. Ultimately a healthy headache diet excludes processed foods, minimizes caffeine and includes a lot of fruits, vegetables, fish and lean meats", Martin says. He adds, "After all, you are what you eat."
Articles: Diet and Headache: Part 1 Authors, Vincent T. Martin MD, Brinder Vij MD, Headache: The Journal of Head and Face Pain, doi: 10.1111/head.12953, published 4 October 2016.
Diet and Headache: Part 2, Vincent T. Martin MD, Brinder Vij MD, Headache: The Journal of Head and Face Pain, doi: 10.1111/head.12952, published 4 October 2016.