May 2013 Issue
When Food Is a Headache
If you suffer from migraines, some of the foods you eat, such as cheese and chocolate, may be a trigger.
Pinpointing the cause of migraines—and the foods that may trigger them—is as random as finding a needle in a haystack. Migraines is a disorder in which the brain is highly sensitive to a variety of stimuli, producing pounding headaches so severe that they may prompt nausea and vomiting.
Migraineurs (those who suffer from migraines) are genetically prone—up to 90 percent have a strong family history, and women experience them more often than men. The first migraine typically occurs during childhood, adolescence, or early adulthood, usually increasing to an average of one per month. If you suffer from migraines you’re not alone; an estimated 13 percent of the population gets them.
What causes migraines? While there is no solid scientific understanding of how and why migraines occur, we do know triggers can be chemical, such as changes in the body’s normal production of chemicals in the central nervous system; electrolyte-based, due to shifts during stressful events, exercise or fasting; sensory, such as bright lights and strong odors; hormonal, including variations during the menstrual cycle; and dietary influences, due to intake of certain foods and beverages.
Migraine and pain management specialist Brian McGeeney, M.D., M.P.H., assistant professor of Neurology at Boston University School of Medicine, explains that the underlying problem for migraineurs is a super sensitive pain system: they have a greater tendency to experience a cascade of reactions in the brain which can trigger a migraine. “Dietary triggers won’t do that in most people, because it takes a trigger to pull the trigger—that is, the ‘gun’ has to be loaded with genetics and a super sensitivity to pain. Then, a variety of sensory input and diet might finally pull the trigger,” says McGeeney.
How can your diet trigger migraines? Research suggests that several foods, beverages and dietary habits may be a trigger if you’re susceptible to migraines, although not everyone has the same sensitivities.
- Fasting, such as skipping breakfast or going five or more hours without eating, has been reported as the most frequent food trigger, according to a 2012 study in Neurology Science.
- Alcohol, especially red wine and beer, runs a close second to fasting. One or two drinks may set off the pain cascade immediately or the following day, according to a 2008 study in the Brazilian journal, Arguivos de Neuro-Psiquiatria and a 2012 study in Neurology Science. - Tyramine, an amine compound found naturally in some foods, can cause blood vessels to dilate, which can begin the cascade towards a migraine in some people. According to McGeeney, the effects can be even worse the day after eating tyramine-containing foods, making it a challenge to identify which foods are triggers. Tyramine-containing foods include:
-Aged cheese, such as brie, blue, and Swiss, and dairy foods like milk, yogurt and ice cream.
-Pork and processed meats, such as hot dogs, deli meat, bacon, and ham.
- MSG (monosodium glutamate), a flavor enhancer used in Asian dishes, can impact migraines. It’s not known why, but one theory is that glutamate is a neurotransmitter that relays signals in the brain.
- Nitrates and nitrites, compounds found naturally in vegetables and often added to processed meats, like deli meat and hot dogs, may be a trigger for some individuals. Usually the nitrates we consume in vegetables, such as spinach, beets, radishes, celery and cabbage, are not a problem.
- Aspartame, the non-nutritive sweetener in NutraSweet and Equal, has been linked with trigger headaches in some people, possibly because the body breaks down the sweetener into formaldehyde (Dermatitis, 2008).
- Caffeine is controversial; it can be a trigger or a relief. McGeeney reports “Caffeine wears two hats: ‘Dr. Good,’ found in analgesics, like Excedrin Migraine and prescription medications, and ‘Dr. Evil,’ when too much caffeine is taken by migraineurs to reduce symptoms. In some, this leads to rebound, or recurrent, headaches.” If you depend on coffee to wake up, he recommends only eight ounces per day (about 200 milligrams of caffeine.) Soda drinkers should limit their caffeinated beverage intake to less than four 12-ounce cans per day. However, if you’re caffeine-free, do not start using it. And if you do consume caffeine regularly, don’t quit cold turkey.
Identify your dietary triggers. If you suffer from migraines, you’re probably willing to do most anything to be pain-free, but you certainly don’t want to give up your favorite foods needlessly. To find effective relief, migraineurs should identify their own unique triggers.
Keep a migraine log with all foods eaten, along with symptoms experienced. Most often, just reducing the amount or frequency of food triggers may leave you successfully migraine-free. It’s important to work with your health care team, including doctors, neurologists, dietitians and integrative specialists, to help find the best treatment.
Pain-free eating. While no foods have been proven to prevent migraines, some show promise. Magnesium and riboflavin supplements were found effective in some studies. Increasing your intake of magnesium-rich foods (halibut, almonds, soybeans, spinach, potatoes with skin, peanut butter, yogurt and brown rice) and riboflavin-rich foods (almonds, kale, legumes, mushrooms, spinach, tomatoes) may prove helpful. Vitamin E-rich foods, like wheat germ oil, almonds, and vegetable oils, show a reduction in pain severity and nausea and an increased ability to function during a migraine, according to some research. Omega-3 fatty acids, found in salmon, tuna, mackerel, halibut, sardines, flaxseed, and walnuts, have been linked with a reduction in headache duration, severity and frequency. In addition, other herbal supplements, such as feverfew and butterbur have shown beneficial results.
—Diana Cullum-Dugan, R.D., L.D.N