A migraine is an intense headache that may be accompanied by other symptoms such as nausea, vomiting, visual problems, feeling dizzy and/or an increased sensitivity to light or sound.1.

After a traumatic brain injury, 58% of clients will suffer with migraine-type, post-traumatic headaches for at least one year after their injury. 2

Triggers for migraines can vary widely and may include one or more of the following: tiredness/poor sleep patterns, strong emotions (eg. anger, worry), depression/anxiety, smoking, weather changes, hormonal changes (eg. menstrual cycle, menopause) and environmental factors (eg. bright lights, flashing lights, loud sounds, strong odours).3  The GP, or a consultant, can advise a client on the various pharmaceutical treatment options available. However, there is also considerable research being done into various dietary-related changes which can help.

Unfortunately, if a client Googles “diet and migraines,” a barrage of different options will come up which can be incredibly overwhelming.  There is no “one-size-fits-all” advice when it comes to diet and migraines.  Personalised advice is needed, especially if the client is suffering from other comorbidities such as disorders of the gastrointestinal tract.  A detailed food and migraine diary is required to try and detect patterns and spot potential trigger foods.  The aim should always be to implement the least restrictive option required to achieve the desired result.

Common dietary triggers for migraine headaches (4, 5)

1. Food allergies, intolerances and sensitivities  (eg. wheat, orange, egg, tea/coffee, chocolate, cheese and milk tend to be the most common offenders).  The quantity of these foods consumed and the frequency they are consumed, will also have an impact.
2. Foods high in amines (eg. tyramine, octopamine, phenylethylamine, and histamine) such as aged cheese.
3. Food additives (eg. nitrates, aspartame, MSG).
4. Insufficient fibre/probiotics to support a healthy gut microbiome.
5. Vitamin and mineral deficiencies (eg. magnesium).
6. Skipping meals – fasting has been found to trigger migraines in 44% of susceptible people and hunger triggers migraines in 53.9% of migraine sufferers.

It’s not yet certain exactly how the above dietary factors impact migraines — various mechanisms are suspected.

Top 4 dietary changes to try

Based on the available evidence, this is the order that various strategies should be tried (if there are no obvious triggers identified on the food and symptom diary):

1. Make sure clients are well hydrated (drinking over 1.5 litres per day), eating regularly and slowly stopping their caffeine intake.

A dietitian can give clients practical strategies on how to accomplish this and can also calculate a more precise fluid target.   The above dietary changes should occur alongside other lifestyle modifications, such as not smoking, getting adequate sleep, relaxation strategies and avoiding exposure to the environmental triggers mentioned above (eg. bright lights).3

2. Restrict the following most common dietary triggers:3, 4, 6

• • alcohol, especially red wine
  • caffeine (coffee, tea, cola) (particularly in people who have migraine-associated vertigo)
  • aged cheese (eg. cheddar, stilton, blue, brie)
  • aged, canned, cured or processed meat
  • chocolate
  • beans (fava and broad beans)
  • MSG (mono-sodium glutamate)
  • aspartame
  • pickles
  • yeast extract (eg. Marmite)
  • certain fruits (eg. citrus, ripe bananas)
  • tomatoes
  • canned soup
  • nuts

3. Consider implementing a more restricted diet (short-term):

option a) – an elimination diet with systematic food re-introduction;6

Food elimination needs to be short-term, systematic and overseen by a dietitian, to prevent malnutrition and ensure that foods are not being restricted unnecessarily. There are various ways a dietitian may decide which foods to exclude, including IgG blood tests and/or patterns identified on the food diary.

option b) – a low fat diet (~20-45 grams fat per day).7

Low fat diets have been found to reduce headache frequency and intensity.

Note: While you might also hear about other diets used to help treat migraines, such as the Lifestyle Eating and Performance (LEAP) diet or a ketogenic diet,  there is currently very limited research on these.

4.  Trial supplementation with riboflavin(8) or magnesium(9).

While a dietitian can ensure that clients are meeting their requirements for core vitamins and minerals, high dose supplementation with riboflavin (400mg per day) or magnesium (600mg trimagnesium dicitrate or 1080mg magnesium pyrrolidone carboxylic acid per day) has been found to reduce the frequency of migraines even more.  The high dose of these supplements will require the approval of the GP or consultant.

Dietary changes have the potential to not only reduce migraines in certain individuals, but they can also help improve a client’s overall health.  Internet searches leave clients with a long list of food that they shouldn’t eat.  Dietitians can help clients figure out what they CAN eat, and how to make meals varied, nutritious and delicious while also managing symptoms.

For more information or to refer a client, please contact Specialist Nutrition Rehab at office@specialistnutritionrehab.co.uk or 0121 384 7087.

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