What are Migraine Food Triggers? 2023
Migraine is a complicated neuronal/chemical process that occurs in persons who have a Migraine genetic/familial link. The whole event is still not completely understood and whether foods trigger allergic or vasoactive effects in the brain is uncertain. What is known is that the Migraine process releases three inflammatory neurochemicals that affect the thalamus (brain pain center), cerebral arteries, and the trigeminal nerve.
Migraine affects 12% of the world population. 25% of women and 6% of men have migraine. The condition consists of recurrent moderate to severe headache which is usually one-sided, throbbing, and associated with nausea and vomiting and sensitivity to light and sound.
There is a need for migraineurs to learn to avoid food triggers.
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This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, migraine textbook author, podcaster, YouTube video producer, and blogger.
As a general rule the treatment of Migraine triggered by food is clinically identifying the specific food that causes headache for that person and then avoiding eating it.
Treatment for this still uncertain medical situation is trial and error identification of the food that triggers migraine for that person and then avoiding consuming that food trigger.
A Migraine may be set off by a trigger with some persons reporting the trigger influence as being a mild problem and others reporting the trigger to be strongly related to the occurrence of a migraine headache. Migraine triggers cause headache to start up within 24 hours after the trigger.
Related questions.
What is the incidence of food-triggered Migraine?
This is a controversial area. Between 12 and 60% of persons report foods as triggers. These percentage numbers are far apart which reflects the conflicts in the study of food triggers. However, a lot of the data is based upon self-reporting and the data is not firm or conclusive enough to prove or disprove any specific trigger.
What is the explanation of how foods trigger Migraine?
Some writers on migraine think that a clear explanation for why food triggers migraine is lacking. Researchers have offered vasoactive and allergic mechanisms to explain the relationship between certain food ingestion and the occurrence of Migraine headache.
A vasoactive reaction produced by a food product would cause vasodilatation of cerebral arteries.
An allergic mechanism would consist of the food item acting as foreign protein, like an antigen, which activates the immune system in the human body with histamine release by mast cells.
Article regarding the hypothesis of mast cell involvement with Migraine.
Dan Levy PhD, Rami Burstein PhD, Andrew M. Strassman PhD wrote in Headache on Mast Cell Involvement in the Pathophysiology of Migraine Headache: A Hypothesis Volume46, Issues1, June 2006, Pages S13-S18.
Abstract
Migraine attacks are triggered by a variety of conditions including endogenous and exogenous factors. Evidence suggests that activation and sensitization of primary afferent meningeal nociceptive neurons, the peripheral arm of the trigeminovascular system, constitutes one of the earliest events promoting the intracranial pain of migraine. However, the link between the varied triggering factors and activation of meningeal nociceptive neurons is not completely understood. Local inflammation with release of mediators from local immune/inflammatory cells is thought to play a critical role in such neuronal response. Meningeal mast cells may play such a role by virtue of their proximity both to meningeal blood vessels and nociceptive axons and their ability to release a host of proinflammatory/algesic mediators. This paper reviews data relevant to the hypothesis that mast cells, upon activation by migraine triggers, contribute to the genesis of migraine headache. Epidemiologic findings, clinical data, and observations on anatomical and physiological characteristics of mast cells converge to suggest an important role of these immune cells in the pathogenesis of migraine. Migraine triggers might directly or indirectly promote mediator secretion from meningeal mast cells, and thereby cause inflammation and activation of the trigeminovascular system. While consistent, the evidence supporting mast cell involvement in the genesis of migraine is largely circumstantial to date. Further studies are needed to test directly the nature of mast cell involvement in the pathogenesis of migraine headache.
What about “Allergy headaches?”
Allergy headaches are clearly a myth, but hard to ignore or put down because so many TV ads and internet articles talk about it. However, the word “Allergy” is not in the International Classification of Headache Disorders V3.
Allergic rhinitis is the proper name for the lay terms of “sinus,” “allergies,” or “hay fever.”
The diagnosis off allergic rhinitis is based on a history of seasonal or continuous symptoms of nasal and ocular itching, sneezing, nasal stuffiness, nasal drainage, and cough. It is usually familial.
The diagnosis can be confirmed by demonstration of IgE antibodies by either skin testing or radioallergosorbent testing (RAST). Skin testing is preferred because of greater sensitivity and decreased cost.
Migraine and Allergic Rhinits are comorbid.
Comorbid means that two separate medical problems come together more commonly than by chance. Many persons who have Migraine may also have Allergic Rhinitis.
Article relating the confluence of Migraine and Allergy
Hesna Bektas, Hayriye Karabulut, Beyza Doganay, Baran Acar wrote in Acta Neurologica Belgica 2017 Mar;117(1):91-95 on Allergens Might Trigger Migraine Attacks.
Abstract
Migraine is a common primary headache disorder. The mechanisms underlying the onset of a migraine attack are not completely understood. Environmental changes and a number of other factors could induce migraine attacks. The aim of this study was to investigate the relationship between the frequency of migraine attacks and allergens. Migraine patients without aura, and healthy individuals similar in age and gender without a history of headache and allergy were prospectively included in the study. The duration of migraine, the frequency of migraine attacks, the medication history, and the symptoms during attacks were questioned. Migraine disability assessment score (MIDAS) and visual analog scale (VAS) scores were obtained. Allergen extracts including dust, fungi, insect, animal epithelium, pollens, and food allergens were applied for allergy tests. 49 migraine patients and 49 healthy individuals were enrolled in the study. There was no significant difference in terms of age and gender. The median migraine disease duration, the number of attacks in a month, and the duration of attacks were, respectively, 5.5 years (1-44), 4 (1-10) day/month, and 24 (4-72) h. The mean MIDAS grade was 2.45 ± 0.14 (1-4), and mean VAS score was 7.89 ± 0.27 (4-10). The positivity of allergy tests was 55.1 % (27/49) in the migraine group and 32.7 % (16/49) in the control group (p < 0.05). The allergy tests were positive for house dust, red birch, hazel tree, olive tree, nettle, and wheat. The frequency of migraine attacks was higher in allergy-test-positive patients than in negative ones in the migraine group (p = 0.001). The migraine patients who had frequent attacks should be examined for allergies.
What is the list of possible food triggers?
Aged Cheese-cheddar, Brie, Camembert, Gruyere, Stilton (tyramine)
Bananas, figs, and raisins
Beer, wine (especially red wines), champagnes, vermouth, hard liquor,
Dairy products such as ice cream, milk, yogurt, whipped and sour cream,
Fermented and pickled foods such as pickled herring,
Most citrus fruits like oranges, grapefruit, and lemons (Octopamine)
Nuts, peanuts, peanut butter, Soya products, vinegar, Pods of broad beans-lima, navy, pea pods,
Yeast containing products such as fresh breads, sourdough, and donuts
Avocados, Anchovies, Onions, and Sauerkraut, Pork, Pizza, chicken livers
Chocolate
Caffeine in coffee, tea, and colas, and over the counter medications such as Excedrin and BC Powder,
MSG (Monosodium glutamate) which is found in Chinese food, Accent seasoning, Lawry’s Seasoned Salt, canned soups, snack chips, some processed meats and nuts, and TV dinners,
Saccharin diet sodas, drinks, and foods
Sulfites found in shrimp and processed potatoes, store bought potato mix,
Benzoic acid which is a food preservative,
Nitrates used as a preservative in bologna, salami, pepperoni, and hotdog
Aspartame, a table top sweetener, used in foods and drinks (NutraSweet
In spite of the list and the inclusion of many of the food substances listed above in numerous articles on Migraine, some researchers deny a migraine trigger for tyramine – which is naturally present in chocolate, alcoholic beverages, most cheeses and processed meats.
Also, while monosodium glutamate (MSG) is frequently reported to be a provocative Migraine factor, some think the evidence does not consistently support that it is a dietary trigger.
How to keep up with all the food one eats and Migraine headaches?
Use a cell phone app for creating a migraine diary.
List suspicious foods and chemicals in the diary and see if the suspicious substance appears to consistently cause Migraine headaches.
Create a good nutritional history.
Migraine patients may have 1 or 2 foods that aggravate their headaches. Migraineurs are called to analyze the food they have eaten before a migraine occurs and see if they can see a consistent relationship. When they’ve done this, then they should avoid that food.
Article on Migraine and diet
J Gordon Millichap 1, Michelle M Yee wrote in Review Pediatr Neurol in. 2003 Mar;117(1):91-95 on The diet factor in pediatric and adolescent migraine.
Abstract
Diet can play an important role in the precipitation of headaches in children and adolescents with migraine. The diet factor in pediatric migraine is frequently neglected in favor of preventive drug therapy. The list of foods, beverages, and additives that trigger migraine includes cheese, chocolate, citrus fruits, hot dogs, monosodium glutamate, aspartame, fatty foods, ice cream, caffeine withdrawal, and alcoholic drinks, especially red wine and beer. Underage drinking is a significant potential cause of recurrent headache in today's adolescent patients. Tyramine, phenylethylamine, histamine, nitrites, and sulfites are involved in the mechanism of food intolerance headache. Immunoglobulin E-mediated food allergy is an infrequent cause. Dietary triggers affect phases of the migraine process by influencing release of serotonin and norepinephrine, causing vasoconstriction or vasodilatation, or by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. Treatment begins with a headache and diet diary and the selective avoidance of foods presumed to trigger attacks. A universal migraine diet with simultaneous elimination of all potential food triggers is generally not advised in practice. A well-balanced diet is encouraged, with avoidance of fasting or skipped meals. Long-term prophylactic drug therapy is appropriate only after exclusion of headache-precipitating trigger factors, including dietary factors.
Cinzia Finocchi & Giorgia Sivori wrote in Neurological Sciences volume 33, pages 77–80(2012 on Food as trigger and aggravating factor of migraine.
Abstract
A relevant proportion of patients say that their migraine attacks may be precipitated by dietary items, the percentage of patients reporting foods as trigger ranging in different study from 12 to 60 %. Fasting, alcohol, chocolate and cheese are the dietary precipitating factors more frequently reported. The finding that diet-sensitive migraineurs are usually sensitive to several and different foods, lead to the hypothesis of antigenic similarities between these disparate foods or common chemical constituents, but a clear scientific explanation of the mechanisms implicated in the development of migraine attacks supposedly precipitated by food is still lacking. The possibility that the elimination diets based on the hypothesis of food hypersensivity IgE or IgG-mediated improve migraine has been explored in different studies but the results are inconclusive. Fasting as trigger for migraine is frequently reported. Some migraineurs show reactive hypoglycaemia due to diet-induced hyperinsulinism. In conclusion, identification of environmental factors (including dietary factors) that consistently trigger migraine in some subjects may be helpful to reduce attacks frequency. The biological mechanism by means of triggers in general and food in particular precipitate migraine attacks remains obscure.
Summary
All migraine patients, learn to avoid the foods that give you a headache.
Check out my Big Book on Migraine Here.
Summary
So, everybody is different and food triggers and Migraine is a complicated subject. Watch out for foods that bother you, the foods that right away you know always give you a migraine and then avoid those foods.
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All the best.
Britt Talley Daniel MD
