How does food affect migraines?

Do certain foods 'trigger' migraines? Neurology expert Dr Peter Goadsby discusses which foods to avoid, and why chocolate and cheese might not be off the menu...

Does food affect migraines?

The NHS describes a migraine as 'a moderate or severe headache felt as a throbbing pain on one side of the head'. Symptoms vary but can include nausea, vomiting and increased sensitivity to light or sound, as well as 'aura', such as visual disturbances, dizziness or numbness. Migraine usually starts in early adulthood, affecting around one in five women and one in 15 men. In the past, certain foods such as cheese and chocolate have commonly been cited as migraine triggers - but is this really true? We asked Dr Peter Goadsby, Director of the NIHR-Wellcome Trust Clinical Research Facility at King's College London, to tell us more. Here are seven things you need to know about food and migraines...

1. Specific foods don't trigger migraines - with two exceptions...
 
In general, specific foods themselves aren't considered migraine triggers, with the exception of two broad categories - alcohol, which is a well recognised trigger of migraine, and foods which contain nitrates. Nitrates are used in medicine to treat heart problems such as coronary heart disease, but are found in some foods as well. Cured meats and American hot dogs both contain nitrates and they’re fairly reliable triggers of migraine that have been well explored in research. After that, it’s quite difficult to label anything that we can give blanket advice about.


2. It's important to distinguish between symptom and cause...

We now know that food cravings are part of the early stages of the migraine, which calls into question foods (such as cheese and chocolate) that have traditionally been considered 'triggers'. Before the aura or headache actually start there’s a phase of migraine called the premonitory phase. It can last for up to a day and includes symptoms such as concentration impairment, tiredness, neck discomfort, mood change, passing more urine, yawning or craving particular things. I often see people who crave sweet or savoury things in the day or hours before their attack, but before this is pointed out to them, these cravings aren't something that they’re conscious of. From their point of view, they eat something sugary and they end up with a migraine so they ascribe cause and effect, when actually, the sugar craving was a symptom of the migraine starting anyway. This is backed up by research - for example, chocolate was previously considered a trigger, but when tested carefully in a study, chocolate was no more likely to trigger an attack than other foods. There’s no doubt that some people are more sensitive to certain foods, but as we understand things better, we’re beginning to see that some of the commonly accepted 'triggers' are actually behaviours that manifest in the earliest part of the migraine attack.

3. Food intolerances also have an impact...

One example of this is what I would call 'aggravation'. For example, if you’ve got coeliac disease and you eat gluten your migraine might play up, but only because migraine is susceptible to any biological or physiological change in the body. People don’t get migraines because they have a gluten sensitivity, but the biological change brought about by the gluten sensitivity triggers their underlying migraines. Very often when the migraineur avoids these triggers, something else turns the headache on because the problem is not the trigger, so much as the underlying condition.
 
4. Each individual will have different susceptibilities.
 
The really reliable triggers such as alcohol and nitrates aren't unique to the individual, but the things that aggravate migraine are because it depends on what they are sensitive to.

5. Caffeine withdrawal, rather than consumption, may be an issue...
 
Regular consumption of caffeine doesn’t trigger migraine, but withdrawal from caffeine may. A very common phenomenon is that someone who works from Monday to Friday will have their coffee at a regular time during the week, but may sleep in later on Saturday and have their coffee later, so they get the withdrawal effect. If you’re a migraine patient and this caffeine withdrawal is enough to alter your physiology, what happens? You get a migraine.

6. Fluctuating blood sugar levels have much the same effect...
 
You want normality – if your blood sugar drops too low or if it goes too high, then it causes the physiological triggering of a migraine. Migraine is not caused by low or high blood sugar but it can be aggravated by it. It's the same for dehydration and food additives - it all depends on what the individual is sensitive to, and whether the change in physiology is enough to trigger the underlying condition.

7. Overall, the key is normality, and avoiding anything that disrupts your physiological balance...
 
Migraineurs need to have regular sleep, regular meals, regular exercise - regularity in everything. And when you deviate from regularity – have some drinks, have a late night, skip a meal – that’s when you're more likely to have an attack.
 
Where can we find more information?
 
Visit the Migraine Trust Website - they’re very well informed about new research and have self-help pamphlets as well, so they’re a really good place to start.


This article was last reviewed on 14th July 2018.

Professor Peter Goadsby is Professor of Neurology, King's College London, and Director of the NIHR-Wellcome Trust Clinical Research Facility at King's College Hospital, London. He is an Honorary Consultant Neurologist at the Hospital for Sick Children, Great Ormond St, London, and in the Department of Neurology, University of California, San Francisco. He is currently Chair of the British Association for the Study of Headache.

All health content on bbcgoodfood.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. If you have any concerns about your general health, you should contact your local health care provider. See our website terms and conditions for more information.

Do you suffer from migraines? Do you find that what you eat or drink affects the condition? Let us know in the comments below...

 

Comments, questions and tips

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rebeccaecfc
19th Nov, 2017
Garlic is my main migraine trigger too, and my sister's. It's now got to the stage where onions, chives, leeks and spring onions also give me the same problem, the migraine starts within minutes of me eating any of these things, I can always tell whether there is any in the food I eat.

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