MIGRAINE DIET

Timothy C. Hain, MD, Chicago IL. Page last modified: July 26, 2020 You may also be interested in our many other pages on migraine on this site

About 1/3 of all migraine sufferers are helped by avoiding certain foods or drugs. Like prevention treatment for migraine, diet treatment is a "trial and error" methodology - -not everyone will get headaches from MSG, or chocolate for example. Usually the best idea is to start by taking all of the high risk foods out of your diet for a few weeks, and if this works, add them back in one by one to see if there is a the critical one.

Monosodium Glutamate (MSG), also labeled Autolyzed Yeast Extract, Hydrolyzed Vegetable Protein, or Natural Flavoring: Major sources of MSG include certain soups, Chinese food and "fast" food, soy sauce, yeast, yeast extract, meat tenderizers (Accent), and seasoned salt. Many salad dressings also contain MSG. We advise you not to frequent restaurants that are unable to eliminate MSG from their food. Headaches an hour or so after eating is the most common timing. While the literature is not strong about MSG (Freeman, 2006), nevertheless MSG sensitivity is "common knowledge".

Alcohol. Red wine, beer, etc. Red wine is the most likely and vodka is the least likely alcoholic beverage to cause a migraine. Alcohol is the most common dietary trigger for migraine (29%, Peatfeld et al, 1984). No controversy.

Chocolate. Chocolate may cause a delayed effect -- the caffeine in chocolate prevents an early headache. The role of chocolate is weak and controversial (Holzhammer and Wober, 2006; Lippi G et al, 2014). Chocolate contains about 10 mg of caffeine/ounce (see following).

Cheeses, especially ripened or aged cheese (Colby, Roquefort, Brie, Gruyere, Cheddar, Bleu Cheese, Mozzarella, Parmesan, Boursalt, Romano). Cheeses less likely to trigger headache are cottage cheese and American cheese. Pizza may be a problem food. Headaches about 1 or 2 hours after eating are common pattern. The role of cheese in migraine is controversial (Holzhammer and Wober, 2006; Martin and Vig, 2016).

Caffeine. This is complicated. Caffeine lasts about 8 hours. Overuse of caffeine may increase headaches via rebound. Some very sensitive people may develop rebound from as little as 30 mg, but in most people it takes 500 mg of caffeine/day (5 cups coffee). The active ingredient in many OTC acute migraine medications is caffeine and aspirin and/or Tylenol. For example, Excedrin migraine (http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm203737.htm) has 65 mg of caffeine, 250 mg of acetaminophen, and 250 mg of aspirin. A large ice-tea, an aspirin and a non-extra strength Tylenol contains the same active ingredients. Add some sugar, and you can treat low blood sugar too. No controversy.

Caffeine Content:

Nitrates -- found in meat and certain medications for blood pressure and chest pain. Examples of foods are bacon, packaged lunch meats, sausage, hot dogs. Nitroglycerin, Isordil are examples of medications. No controversy (Cleophas et al, 1996)

Supplements that may help prevent migraine.

Magnesium. Supplementation with 500 mg daily is mildly helpful in preventing migraine. This is not especially controversial (Mauskop, 2012; Holland et al, 2012), but a longer discussion can be found here. We do think that magnesium is helpful for migraine. Generally the most convenient form is the "cal-mag (http://www.lef.org/Vitamins-Supplements/Item16026/CAL---MAG.html) " tablets. Another popular formulation is one called "calm". According to the manufacturer's website, it contains 325 mg of magnesium, in the form of a carbonate and citric acid, which when mixed together, produce magnesium citrate. The liquid form, in theory, improves absorption.

Spinach is an example of a food that has a lot of magnesium (78 mg/serving). Note that many medications for stomach acid reduce magnesium absorption, and it may help to stop them if you can. The US government has some very helpful data about magnesium here https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/.

Other "non-drug" migraine treatments that we are not sure of include vitamins (co-Q) and riboflavin (400 mg). Our guess is that they don't work. We say this because we have very few patients who keep taking these. We advise against use of Butterbur products, as some of them have been associated with liver damage. See https://nccih.nih.gov/health/butterbur. Herbal medications are not well standardized, and we are dubious that the small positive effect on headache is worth wondering about the risk of liver damage.

Supplements myths

Sulfites (Potassium Metabisulfite). Used as a preservative on salads, seafood, avocado dip. Found naturally in wine and beer. Usually causes asthma symptoms. There was no literature on sulfite sensitivity and headache as of 2015. It probably does NOT cause headaches.

Other resources

There are an immense number of books about migraine diets. We favor the one written by Dr. Bucholtz and Reich- -"Heal your Headache", if you want more details.

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