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You Are What You Eat: The Conundrum of Migraine and Food
Medical Review by Headache Specialist Dr. Jessica Kiarashi
Living with unpredictable Migraine attacks is frustrating enough. Add to it the mysteries of finding the best Migraine diet and avoiding reported Migraine food triggers, and you have a recipe for extra stress.
Food should be nourishing and enjoyable, not anxiety-inducing. But we’ve been there: overwhelmed by information and lists of foods and drinks we dare not eat. Or else.
This comprehensive guide is designed to take some of the stress out of figuring out Migraine triggers and making healthy food choices. You deserve to enjoy your life and every bite of your food!
In this guide, you will find evidence-based info to empower you to:
- Prevent Migraine attacks with evidence-based nutrition and hydration
- Identify and avoid your individual Migraine food triggers, instead of all of them
- Identify Migraine ‘safe’ foods you can enjoy without stress
First, a few caveats. Identifying your best diet and own Migraine food triggers is not an exact science, but more of a trial and error process. Every person with Migraine is unique, and clinical research on Migraine nutrition is fairly limited.
Let’s walk through what we do know to help you navigate Migraine and diet more effectively.
Migraine Food Triggers
The list of Migraine food triggers commonly reported by patients is long, but the list of solid, clinical evidence is short. One research theory proposes some people might develop Migraine attacks due to the way the body processes certain chemicals such as tyramine, nitrate, caffeine, and sodium (Cephalalgia, 33(11), 932–937. https://doi.org/10.1177/0333102413480755‘>1). These individuals may be susceptible to specific Migraine food triggers, while others may be less susceptible.
Common Migraine Food Triggers
Few migraine food triggers are proven by scientifically-accepted studies. Much of what has been reported about triggers is based upon self-reported perceptions. Some commonly reported food triggers include: (National Headache Foundation. Low Tyramine Diet. ‘>2)
- Food additives like aspartame (diet drinks), MSG (i.e. soy sauce), nitrates (i.e. processed meats), sulfites (i.e. red wine) and yeast extract (i.e. canned soup)
- Alcohol like red wine, beer, and hard drinks including Scotch and Whiskey
- Caffeine-containing products
- Certain dairy products like aged cheeses, yogurts, sour cream and buttermilk
- Aged, smoked, fermented, pickled or salted meats and fish, like hot dogs, bacon, and herring
- Certain fresh fruits like citrus, banana, avocado, and dried fruits like raisins
- Beans, nuts, and soy like fava or lima beans, nut butters, and tofu
- Certain vegetables like onions and tomatoes
What We Know About Tyramine and Migraine
Tyramine, typically found in aged or fermented food, is a widely reported Migraine food trigger. It’s a naturally occurring chemical that tends to increase as food ripens or ages.
Foods with high levels of tyramine include:
- Cheddar cheese, blue cheese and other aged cheeses
- Pepperoni, salami, and other cured meats
- Smoked fish
- Sauerkraut, kimchi, pickles and other fermented or pickled foods
- Beers on tap or home brews
- Dried fruit
- Fava beans, broad beans, snow peas
Some researchers suspect that some people develop Chronic Migraine when they’re unable to properly process tyramine (Cephalalgia, 33(11), 932–937. https://doi.org/10.1177/0333102413480755‘>3). A low tyramine diet is one of the most common Migraine elimination diets.
What We Know About Chocolate and Migraine
Chocolate is NOT a proven Migraine food trigger! Although chocolate is a commonly reported trigger, studies have not been able to show that chocolate consistently triggers attacks.
In fact, it actually may be healthy to eat in moderation. If you are getting a craving for chocolate, it may be a sign that a Migraine attack is already on its way. (See: Will Chocolate Trigger a Migraine? What the Research Says for the full scoop.)
However, if chocolate is a trigger for you, be sure to avoid it.
Caffeine and Migraine
Is caffeine a Migraine food trigger or a Migraine treatment? Both. Some people use caffeine as a successful Migraine treatment to ward off an attack, but caffeine withdrawal is also a common trigger.
Consistency is the name of the game with Migraine prevention. If you consume caffeine, it’s best to drink the same amount at the same time every single day.
If you want to use caffeine every once in a while, keep your intake to less than 3 servings a week. Anything more than that can lead to a withdrawal headache.
Although most people associate caffeine with coffee, there are many foods and beverages that contain caffeine like (National Headache Foundation. Does Caffeine Trigger or Treat Headaches? ‘>4):
- Chocolate and cocoa
- Sports and energy drinks, including those that include taurine
- Gum and candies
- Prescription and non-prescription medications like pain relievers, cold medicines and diuretics
If you are trying to cut back on caffeine, don’t quit cold turkey. Gradually reduce your caffeine intake until you no longer feel the negative effects.
How Sugar Affects Migraine
Ever feel like those sugary, yet delicious, desserts are causing you Migraine pain? Unfortunately, for some people, excessive sugar intake or low blood sugar (hypoglycemia) can trigger their Migraine.
If you are prone to sugar crashes or have them regularly, there may be something you can do about it. Be sure to eat good high protein and fiber meals throughout the day and eat often. Foods high in carbohydrates and sugars tend to lead to a blood sugar crash that can trigger an attack.
It’s known as reactive hypoglycemia, and it’s one of the least-known migraine triggers.
All About Migraine and Salt
Sodium intake and Migraine is a tricky topic for a few reasons. While too much sodium isn’t good for anyone, high or low sodium levels within the body can be a trigger for some Migraine attacks.
High salt meals can trigger Migraine attacks in some people. But some Migraine warriors find that their attacks are triggered by dehydration and having too little salt. One study found that when people consumed more sodium, reports of Migraine actually decreased (Headache, 56(4), 688–698. doi:10.1111/head.12792 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836999/‘>5).
What We Know About Gluten and Migraine
Gluten is a protein found in wheat products, rye, barley, and triticale (wheat and rye combination). It is found in many foods like bread, pasta, beer, food colorings, and cereals.
For many people with Migraine, gluten is not a problem. Research suggests, though, that those with celiac disease (CD) or other inflammatory bowel conditions may be at a higher risk for developing Migraine and may experience gluten-related Migraine. One recent study found an increase in reports of Migraine in people with CD or IBD.
One study found some evidence for gluten as a Migraine food trigger. It reported that Migraine frequency was reduced after using an IgG elimination diet (Headache. 2016 Oct;56(9):1543-1552. doi: 10.1111/head.12953. https://www.ncbi.nlm.nih.gov/pubmed/27699780‘>6).
To understanding how gluten affects you and your Migraine, you may need to undergo IgG antibody testing (Headache. 2013 Feb;53(2):344-55. doi: 10.1111/j.1526-4610.2012.02260.x. https://www.ncbi.nlm.nih.gov/pubmed/23126519‘>7). Talk to your doctor.
Other Dietary Triggers
According to the Migraine Trust, a drop in blood sugar after skipping meals, fasting or dieting, or eating food with high sugar content may trigger a Migraine attack (https://www.migrainetrust.org/about-migraine/trigger-factors/hypoglycaemia/‘>8).
You can avoid a blood sugar crash and the impending pain by eating nourishing meals throughout the day. Avoid skipping meals.
Getting dehydrated is a surefire way to invite a Migraine attack. Not drinking enough water, sweating, vomiting, and diarrhea are all causes of dehydration.
Learn to recognize signs that your body is dehydrated. It’s a little more complicated than just feeling thirsty. One study reported that headaches and moodiness were reported in women when they lost 1.4% of their body weight in fluid (The Journal of Nutrition, Volume 142, Issue 2, February 2012, Pages 382–388, https://doi.org/10.3945/jn.111.142000‘>9)
In most cases, drinking water will ease the symptoms of dehydration. As the award-winning actress and Migraine warrior Kristin Chenoweth said, “Pound the water, people!” She swears by it.
Food Cravings – A Warning Sign
Whether you are dreaming of a salty hamburger or a sweet chocolate bar, we all experience food cravings at some point! But for people with Migraine, food cravings can be a warning sign that an attack is on its way.
Food cravings can show up one to two days before the pain of a Migraine attack hits, says The Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201‘>10).
Some people misinterpret their cravings as Migraine food triggers.
“For example, many people identify chocolate as a trigger, but really it may be that early in the attack they are craving chocolate, they eat it, and then they feel that headache and painful part of the attack after eating it,” Dr. Andrew Charles of UCLA told Migraine Again.
“So they identify chocolate as the trigger when it’s actually the chocolate craving that’s the indication that they’ve already started their headache,” Dr. Charles explains.
A headache diary or app can highlight the connection between certain food cravings and the start of a Migraine attack.
How to Identify Food Triggers
Not everyone has the same Migraine food triggers. Triggers can also be additive, meaning: a specific food may push you over the threshold into an attack only when you’re exposed to other triggers at the same time, like poor sleep or extra stress.
To identify your personal food triggers, use a headache diary or app, such as Migraine Buddy or N-1 Headache (formerly Curelator Headache), for 60-90 days.
How to Keep a Food Diary
When keeping a food diary, it is important to write down everything you ate and when, along with any symptoms experienced. It is also important to jot down compounding factors like the details of your menstrual flow (if applicable), major weather events, outside stressors, and sleep patterns.
Mobile apps take the guesswork out since they often factor in weather in your area and perceived sleep patterns, saving you the effort of adding that data yourself. Because triggers are additive, you might be able to enjoy a triggering food one day, and find it problematic if consumed on a high-stress day when a storm is brewing outside.
Once you have a clearer picture of your own Migraine food triggers, you can choose to avoid them. There’s no need to avoid the whole laundry list of potential foods.
Migraine Again founder Paula K. Dumas gave up aged cheese for nearly 15 years before discovering it wasn’t necessary at all. For her, it wasn’t one of her personal migraine food triggers.
Is Food Sensitivity Testing Worth It?
If your Migraine triggers are attributable to food, or if the possibility exists, you may want to consider speaking with your doctor about food sensitivity or allergy testing.
Food sensitivity is not the same as food allergies. Testing for food sensitives is done through an IgG antibody test, which is different from a test to detect allergies. The science behind food sensitivity and IgG testing is promising but it’s still new, says Amy Sutton from Harvard University (11).
Comparing Popular Migraine Diets
What Is An Elimination Diet and Should I Try One?
An elimination diet consists of removing a long list of foods from your diet that may be triggering a Migraine attack.
Elimination diets are a hot topic of debate within the Migraine community. Despite little proof of efficacy, the American Migraine Foundation explains that an elimination diet can be considered to reduce Migraine triggers. But they should be done under medical guidance so that medical and nutritional support is provided (https://americanmigrainefoundation.org/resource-library/migraine-and-diet/‘>12).
Popular Migraine Elimination Diets
Some of the most popular Migraine elimination diets include:
Low Tyramine Diet
If you suspect tyramine to play a role in your Migraine attacks, a low-tyramine diet is worth a try.
Foods to avoid, according to the National Headache Foundation, include (https://headaches.org/2007/10/25/low-tyramine-diet-for-migraine/‘>13):
- Fermented sausages, meats that are improperly stored or not-fresh, processed meats and tofu/tempeh.
- Aged cheeses
- Vegetables like raw onions, fava or broad beans, sauerkraut, and fermented soy products
- Citrus based fruits like orange, grapefruit, tangerine, pineapple, lemon, and lime
- Caffeine-containing drinks
- Alcoholic beverages, including wine and beer
Some foods on the low tyramine diet should be consumed cautiously, like nitrate or nitrite-containing foods/beverages, concentrated yeast extracts, and food additives such as monosodium glutamate (MSG), sulfites, and aspartame.
The Heal Your Headache Diet
Heal Your Headache was written by John Hopkins neurologist David Buchholz, MD. The book seeks to offer a holistic guide to Migraine management, avoiding quick fixes and helping you raise your Migraine threshold.
A portion of the book outlines an aggressive elimination diet, based on 30 years of Dr. Buccholz’s clinical experience. There are no clinical studies at this time supporting its use, and it can be a difficult diet to stick to. It remains controversial among people with Migraine and the doctors who treat them.
Even so, the internet is full of people who have found relief after using the Heal Your Headache diet plan.
The ketogenic diet, or “keto” diet, is all the rage these days for weight loss. There are some theories that it can help Migraine, too.
The ketogenic diet aims to put your body into a state of ketosis, where your body uses fat as energy instead of carbohydrates. (Remember how sugar crashes can trigger attacks?)
Ketosis happens when you eat a large amount of fats, moderate amounts of protein, and very few carbs. In ketosis, your liver produces substances called ketones (https://www.huffpost.com/entry/less-carbs-more-fat-ketog_b_12672220‘>14).
“Ketone bodies have an anti-inflammatory effect,” says Cherubino De Lorenzo, researcher at the Sapienza University of Rome. Less inflammation makes increases the Migraine threshold, making the body less vulnerable to a Migraine attack.
While this sounds promising, the verdict is still out. Preliminary studies on the keto diet have shown positive results in lowering the frequency of Migraine, but we’re still waiting for conclusive results.
Note: The ketogenic diet requires close monitoring by a qualified physician
Low Histamine Diet
Histamine is not just responsible for seasonal allergies. It is a neurotransmitter within the central nervous system and a vasodilator that causes blood vessels to widen (Headache: The Journal of Head and Face Pain, 54: 246-259. doi:10.1111/head.12293 https://onlinelibrary.wiley.com/doi/full/10.1111/head.12293‘>15). During a Migraine attack, vasodilation of the blood vessels in the brain causes head pain.
Some people have an intolerance to histamine that triggers a Migraine attack when histamine levels increase. Histamine intolerance is caused by a low level of amine oxidase, an enzyme responsible for breaking down histamine (. Am J Clin Nutr. 2007 May;85(5):1185-96. https://www.ncbi.nlm.nih.gov/pubmed/17490952/‘>16).
Another enzyme, diamine oxidase (DAO), metabolizes histamine that has been eaten. Some people have a low level of DAO which prevents them from completely metabolizing histamine. This can lead to symptoms similar to an allergic reaction.
“Central H3 [histamine] receptors seem to have a role in migraine that merit further investigation. The histaminergic system may be a goal for novel migraine drug,” concluded one study on histamine and Migriane (The American Journal of Clinical Nutrition, Volume 85, Issue 5, May 2007, Pages 1185–1196, https://doi.org/10.1093/ajcn/85.5.1185‘>17).
A low histamine diet can offer relief in individuals sensitive to it. The low-histamine diet is similar to the low tyramine diet.
Foods high in histamine to be avoided include (https://www.histamineintolerance.org.uk/about/the-food-diary/the-food-list/‘>18):
- Pickled foods and vinegar
- Canned foods
- Aged-cheeses, smoked meats and beans
- Nuts (especially walnuts and cashews)
- Chocolates and cocoa products
- Ready-made/prepared meals
- Foods containing preservatives and artificial colors
Inflammation is a source of pain, and during a Migraine attack, the brain can become inflamed. Many people with Migraine will try an anti-inflammatory approach.
The Mayo Clinic explains that an anti-inflammatory diet includes balancing your diet with whole foods like (https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/the-truth-behind-the-most-popular-diet-trends-of-the-moment/art-20390062‘>19):
- Fresh fruits and vegetables
- Unprocessed foods
- Whole grains
- Dark chocolate
- Red wine
Some of these choices, however, may be a trigger. The best diet for you is based on your individual food triggers.
- Fatty fish like salmon, sardines, mackerel, herring, cod, white fish, tuna, anchovies
- Seeds especially hemp seeds, chia seeds, flaxseeds
- Egg yolks
Migraine-Friendly Foods and Recipes
Sometimes it’s easier to focus on what you can eat rather than what you can’t.
One of our most popular articles, The 10 Best Nutrient-Rich Foods that Help Migraine, dives into the essential foods to add to your diet. Most of them have vitamins and minerals that have been shown to help prevent attacks.
Migraine friendly foods that help fight off attacks include:
- Dark chocolate
- Olive oil
- Chia seeds
Many people with Migraine are magnesium deficient. Magnesium is known as the ‘relaxation mineral’ and it’s important for reducing tension throughout your body.
Many factors can contribute to magnesium deficiency like stress, low dietary intake, excessive magnesium excretion, inherited conditions, and absorption problems (21). Increasing dietary magnesium is essential for people who are fighting Migraine.
While adding magnesium-rich foods like greens to your diet, you may also want to consider limiting coffee, sodas, salt, sugars, and alcohol.
More foods rich in magnesium include:
- Pumpkin seeds
- Sunflower seeds
- Swiss chard
- Wheat germ
Many doctors recommended nutritional supplements, too. About 400 mg of magnesium a day is recommended for Migraine prevention (American Migraine Foundation. Magnesium for Migraine. ‘>22).
What to Eat During a Migraine Attack
What to eat during a Migraine attack depends on your symptoms and personal food triggers. Simple, yet nourishing foods without too much added salt or sugar are best.
Try some of our Migraine friendly recipes like:
For more Migraine friendly recipes, check out the Migraine Again Recipe Collection.
What to Drink During a Migraine Attack
Even if you don’t feel like eating or drinking, dehydration will definitely make your symptoms worse. Migraine attacks often come with nausea or vomiting, making food seem unappealing. Understand why here.
Even for people who don’t have nausea and vomiting, gastroparesis can occur during a migraine attack. It’s when your digestive system stops functioning.
What can you eat or drink during an attack? These drinks do double duty by helping you feel better and hydrating you at the same time:
GENERAL TIPS FOR HEALTHY EATING WITH MIGRAINE
Living with Migraine means living with a lot of choices. Every time you reach for a snack or drink, you have an opportunity to either nourish your brain or increase your risk for an attack.
Focusing on a few important points can help you prevent Migraine symptoms and relieve the stress of so many choices.
- Know your triggers and avoid them when possible
- Avoid skipping meals, especially breakfast
- Snack throughout the day to avoid hunger headaches and low blood sugar
- Avoid processed foods – focus on the edges of the grocery store instead of middle aisles
- Drink a lot of water
- Prepare meals fresh from home
- Consider taking supplements like Magnesium, Vitamin B2, and Coenzyme Q-10
- Maintain a healthy body weight
Start small. Take it one day, one snack at a time. Enlist your family to help.
After a while, healthy habits will become second nature and Migraine food trigger anxiety will melt away.
Do you have any Migraine food triggers? Have you tried a Migraine diet?
Talk to your healthcare provider about your diet and potential Migraine food triggers.
- D’Andrea, G., D’Amico, D., Bussone, G., Bolner, et al. (2013). The role of tyrosine metabolism in the pathogenesis of chronic migraine. Cephalalgia, 33(11), 932–937. https://doi.org/10.1177/0333102413480755
- National Headache Foundation. Low Tyramine Diet.
- D’Andrea, G., D’Amico, D., Bussone, G., Bolner, et al. (2013). The role of tyrosine metabolism in the pathogenesis of chronic migraine. Cephalalgia, 33(11), 932–937. https://doi.org/10.1177/0333102413480755
- National Headache Foundation. Does Caffeine Trigger or Treat Headaches?
- Pogoda, J. M., Gross, N. B., Arakaki, X., Fonteh, A. N., Cowan, R. P., & Harrington, M. G. (2016). Severe Headache or Migraine History is Inversely Correlated With Dietary Sodium Intake: NHANES 1999-2004. Headache, 56(4), 688–698. doi:10.1111/head.12792 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836999/
- Martin, VT and Vij, B. (2016). Diet and Headache: Part 1. Headache. 2016 Oct;56(9):1543-1552. doi: 10.1111/head.12953. https://www.ncbi.nlm.nih.gov/pubmed/27699780
- Dimitrova AK, Ungaro RC, Lebwohl B, et al. (2013) Prevalence of migraine in patients with celiac disease and inflammatory bowel disease. Headache. 2013 Feb;53(2):344-55. doi: 10.1111/j.1526-4610.2012.02260.x. https://www.ncbi.nlm.nih.gov/pubmed/23126519
- The Migraine Trust. Hypoglycaemia. (n.d.). Retrieved May 14, 2019 from https://www.migrainetrust.org/about-migraine/trigger-factors/hypoglycaemia/
- Lawrence E. Armstrong, Matthew S. Ganio, Douglas J. Casa, Elaine C. Lee, Brendon P. McDermott, Jennifer F. Klau, Liliana Jimenez, Laurent Le Bellego, Emmanuel Chevillotte, Harris R. Lieberman, Mild Dehydration Affects Mood in Healthy Young Women, The Journal of Nutrition, Volume 142, Issue 2, February 2012, Pages 382–388, https://doi.org/10.3945/jn.111.142000
- Mayo Clinic. Migraine: Overview. (2018, May 31). Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
- Harvard Medical School. Could a Hidden Allergy Be Causing Your Migraines?
- American Migraine Foundation. Migraine and Diet. (n.d.) Retrieved from https://americanmigrainefoundation.org/resource-library/migraine-and-diet/
- National Headache Foundation. Low-Tyramine Diet for Migraine. (n.d.) Retrieved from https://headaches.org/2007/10/25/low-tyramine-diet-for-migraine/
- Less carbs, more fat: ketogenic diet makes migraine patients’ headaches disappear. (2016, October 27). Retrieved from https://www.huffpost.com/entry/less-carbs-more-fat-ketog_b_12672220
- Alstadhaug, K. B. (2014), Histamine in Migraine and Brain. Headache: The Journal of Head and Face Pain, 54: 246-259. doi:10.1111/head.12293 https://onlinelibrary.wiley.com/doi/full/10.1111/head.12293
- Maintz L and Novak N. (2007) Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. https://www.ncbi.nlm.nih.gov/pubmed/17490952/
- Laura Maintz, Natalija Novak, Histamine and histamine intolerance, The American Journal of Clinical Nutrition, Volume 85, Issue 5, May 2007, Pages 1185–1196, https://doi.org/10.1093/ajcn/85.5.1185
- The Food List. (n.d.). Retrieved from https://www.histamineintolerance.org.uk/about/the-food-diary/the-food-list/
- Mayo Clinic. The truth behind the most popular diet trends of the moment. (2019, April 24). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/the-truth-behind-the-most-popular-diet-trends-of-the-moment/art-20390062
- Dr Axe. Omega-3 Foods.
- Mauskop, Alexander & Varughese, Jasmine. (2012). Why all migraine patients should be treated with magnesium. Journal of neural transmission (Vienna, Austria : 1996). 119. 575-9. 10.1007/s00702-012-0790-2. https://www.researchgate.net/publication/221715260_Why_all_migraine_patients_should_be_treated_with_magnesium
- American Migraine Foundation. Magnesium for Migraine.