how food can trigger migraine
understanding triggers is a great first step towards managing migraine.
6 minute read
understanding migraine triggers is a helpful tool for managing the condition. while triggers can be different for everyone and there is no single trigger that all migraine sufferers experience, there are some triggers that are common — especially when it comes to diet.
how many people report food triggers for their migraines?
according to studies, between 10 and 80 per cent of people report food triggers — quite a large variation. some people and cultures are more focused on identifying food as a trigger, which may explain the differences in findings. the delay — the time between eating a food item and onset of a migraine — can also explain some of the spread.
the international classification of headache disorders recommends 12 hours to establish a link between the intake of a certain food and a migraine attack. not everyone shares the same food trigger and their influence tends to be overestimated. for example, there is research showing that chocolate is not a food trigger for the vast majority of people.
dehydration: the first easy trigger to manage
many migraine patients cite dehydration as a trigger for their headaches. dehydration occurs when the body loses more liquid than it takes in and can be exacerbated by hot weather, physical exercise, drinking alcohol or caffeine, eating salty foods, or simply not drinking enough water. read more about dehydration.
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skipping meals/low blood sugar: an underestimated trigger
glucose, which comes from carbohydrate foods, is the body and brain’s preferred source of fuel. the hormones insulin and glucagon are responsible for the regulation of glucose levels in the blood. a drop in blood glucose levels can be caused by many factors, including consuming too many high-sugar foods, not eating enough calories, exercising on an empty stomach or skipping meals. there are many symptoms of hypoglycemia (low blood sugar), including the onset of a migraine attack.
to ensure blood-glucose levels are stable, follow these suggestions:
- limit high-sugar foods like candy, cookies, cakes, etc.
- replace refined grains (white bread, white pasta) with whole grain alternatives
- try to have breakfast within one hour of waking up, or at least some protein and slow carbs
- do not skip meals
- carry low-sugar / high protein snacks in your purse, bag, or car
- try to eat some fat (meat, cheese, nuts, seeds, coconut, avocados) and protein (meat, eggs, fish, nuts, seeds, tofu) with each meal and snack
remember that for the majority of people with migraine, cheese, nuts, fish and tofu are not triggers.
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alcohol: 20 to 50 per cent report it as a migraine trigger
the culprit mechanism leading to alcohol-triggered migraines is likely multifactorial, involving histamine, tyramine, sulphites, flavonoids, and 5-ht release.
red wine is often considered to be a common migraine trigger, but any alcoholic drink can be the cause. people report interesting selectivity: some are triggered only by white alcohols, while others find beer leads to their migraine. once again, there is a lot of variability in the migraine world.
do migraines make you prone to hangovers?
alcohol can trigger an immediate headache (within 30 minutes to three hours) or a delayed alcohol-induced headache (daih), the morning after alcohol was consumed (the hangover). two thirds of alcohol-triggered migraines fall into the daih category and people who experience migraines are more susceptible to this type of headache than non-migraine sufferers. usually, other factors are associated with hangovers such as lack of sleep and foods consumed during a party.
foods high in histamine
histamine is a chemical compound involved in the immune response and is most often associated with allergies. histamine can, however, be a trigger for migraine patients who have no known allergies. food that contain a high amount of naturally occurring histamines include: alcohol, tomatoes, eggplant, spinach, vinegar, shellfish (prawns, mussels, oysters, etc.), nuts, chocolate and citrus fruits. kiwis, limes, pineapples, plums, papayas and strawberries also contain histamines.
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foods high in tyramine
tyramine is an amine that regulates our blood pressure. some studies have shown that injection of tyramine can trigger migraines, but others did not show an association. foods that include tyramine include sauces, such as soy sauce, shrimp sauce, fish sauce, miso and teriyaki sauce; soybeans and soybean products; snow peas, broad beans (fava beans) and their pods; dried or overripe fruits, such as raisins or prunes, or overripe bananas or avocados; and leftovers
foods high in both histamine and tyramine
- pickled products like sauerkraut
- cured or smoked meats or fish, such as sausage or salami (also have nitrites)
- certain beans, such as fava or broad beans
- sourdough bread, yeast extract
- aged cheeses: cheddar, blue cheese, gorgonzola, camembert, parmesan (0 to 18%)
- fermented foods (yogurt, kefir, kombucha, sauerkraut, fermented soy products etc.)
other commonly reported food triggers
- ice cream (1 to 4%)
- food preservatives that contain nitrites and nitrates
- artificial sweeteners, aspartame (8 to 9%)
- msg (monosodium glutamate) (0 to 13%)
how can i identify my food triggers?
for any trigger identification you have to consider both your baseline migraine frequency — the more often you get attacks the more difficult it will be to establish clear relationships, and your trigger set. some people may have one key dominant trigger that is a food, but most people have many different triggers that combine and add up. read more about migraine triggers.
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a migraine sufferer may be triggered by more than one food. a food trigger is more likely to cause an attack if other triggers are present.
two ways to identify triggers
a migraine diary can help you figure out what it is that triggers your migraine. pay attention to the links between suspected food triggers and your attacks. how strong is the association? remember, we all are subject to cognitive biases that can make us pay more attention to something we believe.
if a food trigger is suspected, try eliminating this food completely from the diet for at least one month and see if there is a change in your migraine frequency. then, reintroduce the food and closely monitor how you feel. record the experience in your diary.
the elimination diet
one way to improve your migraine without pinpointing a specific trigger is to remove common triggers altogether for an observation period and see if you get better. first, start with unhealthy foods, like sodas, alcohol, cold meats, processed foods, artificial sweeteners. then there are healthy foods that are easy to avoid like eggplants, fermented foods, shellfish, smoked fish and pickled foods. there are also healthy foods that are less easy to avoid like onions, garlic, beans, nuts, fruits, soy, tempeh and tomatoes.
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overall, changing a diet is usually safe but you may consider consulting a registered dietitian or nutritionist to help you. some clinics offer migraine elimination diets, but be very careful of miracle cures and of any expensive product recommended.
lactose-free and gluten-free
some people decide to go lactose-free or gluten-free for a while to see if this will make their migraine better. this can be done safely. the most important aspect is to use a diary to observe the results. make sure that there is no other active treatment going on that could lead to a change — for example, new medication or therapy.
migraine attacks can be caused by multiple factors, so figuring out which foods trigger an attack can be an important step in controlling migraines. use a diary to make reliable observations. and remember that most people have different triggers.
if you are looking for more information on migraine or want to connect with others who share your experiences, get in touch with migraine canada.
references
- zaeem z, zhou l, dilli e. headaches: a review of the role of dietary factors. current neurology and neuroscience reports. 2016;16 (11): 101.
- finocchi c, sivori g. food as trigger and aggravating factor of migraine. neurol sci. 2012;33 suppl 1:s77-80.
- borkum jm. migraine triggers and oxidative stress: a narrative review and synthesis. headache. 2016;56(1): 12-35.
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