Is it something I ate? Separating migraine fact from fiction

Is it something I ate? Separating migraine fact from fiction

The diet-headache connection is one of the hottest of topics for patients and experts alike. Migraine sufferers often see a direct link between how and what they eat and a migraine attack. This article takes a hard look at some core assumptions about the relationship between diet and migraine, shows what the evidence says – and busts a myth or two along the way.

Can a special diet cure migraines? Sadly, it’s not that simple. Here’s why:

Research into the diet-migraine relationship is as vigorous as ever. With all the anecdotal reports from the migraine community about culprit foods and chatter about migraine-curing diets, there’s a lot of confusion out there that needs to be clarified. However, identifying evidence-led solutions is hard when there is so much conflicting advice about the best diet for us. The Mediterranean diet, keto, intermittent fasting – proponents from all sides claim universal validity for their favorite theories, but they can’t all be right.

Life is complex: nutrition isn’t everything

The main challenge is that it is virtually impossible to isolate nutrition as the key to health and well-being to the exclusion of all other potential causes. Is the fact that people in Sardinia live much longer than the average European really down to the 'Mediterranean diet' only – or might other factors be just as important (plenty of sleep, living in harmony with nature, social cohesion, the weather, their genes)? And how do you square the theories about the healthy Mediterranean diet with more recent claims that intermittent fasting is the secret to a fitter, healthier, leaner and longer life – although intermittent fasting is the total opposite of what Sardinians do? In an area like nutrition, separating out a single variable for study in a strictly scientific setting is practically unachievable. And that is one reason why assumptions differ so much, even when they represent the latest research.

Migraine: a single root cause, multiple triggers

In migraine, you need to distinguish clearly between what causes the underlying condition and what triggers attacks. Recent headache research demonstrates that migraine is genetic. A tendency to migraine is something a person is born with. Some people are prone to get attacks while others are not. And to get a migraine, a person with that genetic predisposition has to be exposed to certain triggers, which may be individual and differ from person to person.

Brain on overdrive

Classic migraine attack triggers include external stimuli such as light, noise and smells, unusual physical or psychological stress, disruptions of your daily routine, and changes in hormone levels (during menstruation, for example). Current medical thinking is that the migraine brain is over-responsive to sensory stimuli. It picks up impulses sooner and processes them faster, soon sending the migraine brain into overdrive. This predisposition means the migraine brain has special energy requirements. When an energy deficit develops in the brain of a person prone to migraine, potential triggers are more likely to cause migraine attacks because existing energy supplies are insufficient to meet the higher energy demand required to deal with those triggers. Bottom line: fluctuating blood sugar levels are a fundamental risk factor for a migraine attack.

Brain fuel: what we know

In addition to avoiding your triggers, a consistent energy supply is a basic way to prevent migraine attacks. To avoid supply deficits, you need regular meals that give your brain its energy fix. Glucose is the brain’s energy source. Despite needing a lot of energy, the brain does not have large reserves to draw on. Our metabolism steps in with ready supplies of glucose, and an intricate network of blood vessels carries this fuel to where it’s needed.

Complex carbohydrates for blood sugar

Current research indicates that eating several carbohydrate-containing main meals and snacks spread throughout the day is the most reliable prevention strategy. The key is to consume complex carbohydrates, meaning the kind of carbohydrates that take longer to digest and deliver a stable source of energy. wholegrain products (wholegrain bread, wholegrain pasta, oatmeal) and legumes (chickpeas, lentils, peas and beans) are classic suppliers of complex carbohydrates that keep blood sugar levels constant. The simple carbohydrates (sugars) contained in sweetened foods and beverages provide you with a short-lasting source of carbohydrates. When you eat simple carbs, the sugar level in your blood rises rapidly and insulin is released very quickly to move the sugar from your blood to where it’s needed. When all the sugar is gone, your blood glucose levels drop very fast. These fluctuations are risky for migraineurs. Regular fluid intake is essential for migraine sufferers.

What we don’t know (yet)

The evidence on the direct impact of certain dietary practices on headache and migraine is ambiguous. Opinions differ greatly on the effects of a ketogenic diet or intermittent fasting on headache and migraine burden. In line with the latest science around migraine, migraine experts almost unanimously advise migraineurs to avoid diets that involve prolonged fasting or reducing all carbohydrates, including complex carbohydrates. Several studies agree that the Mediterranean diet benefits migraineurs, partly because it is high in legumes and olive oil, which contains a healthy mix of omega-3 and omega-6 fatty acids. There is no clear evidence so far that avoiding specific foods reduces your migraine burden. One exception is monosodium glutamate (MSG), the most popular flavor enhancer. There is broad agreement that MSG can trigger attacks in some migraineurs.

A brain-friendly diet – key principles

A balanced, whole-food diet with regular meals consisting of fresh, minimally processed foods and a stable supply of complex carbohydrates continues to be considered the gold standard of migraine prevention. If you are a migraineur, never skip meals, especially breakfast. Your brain does a lot of hard work all night and needs its energy reserves replenished fast to prevent an energy deficit that could trigger a morning migraine attack. A bedtime snack is a good way to beat that nighttime and morning energy deficit. Eating a small snack containing complex carbohydrates (a slice of wholegrain bread or an unsweetened muesli bar) half an hour before going to bed is a good way to reduce migraine frequency, morning attacks in particular.

Take a hard look at your diet

If you want to understand how the way you eat affects your migraine, it pays to keep a nutrition and migraine diary for a while. Write down the timing of your meals (and what they contain), and your fluid intake as well. Did you skip meals in the days leading up to an attack? Are there are any other patterns you can identify? The Headache Hurts app is a helpful tool to track your eating and drinking and keep a record of other factors as well. Analyzing the data identifies patterns and helps you recognize possible links to your migraine attacks.

Chocolate-covered myth

To finish, here’s some feedback on the biggest migraine legend of them all. Many people believe chocolate is a top migraine trigger. Current medical thinking is that a craving for something sweet – with chocolate being a popular choice – is a classic sign of an impending migraine attack. In other words: chocolate doesn’t trigger an attack, it just predicts one that is already on the way.