Migraine headaches are super common.
Migraines can be a real pain in the, well, head. And they’re quite common.
“Migraine is a headache disorder characterized by attacks of head pain, which typically occurs on one side of the head and is accompanied by a variety of neurological symptoms including nausea and sensitivity to light and/or sound. Migraine has a strong genetic component and occurs in about 12% of people,” says Elizabeth Seng, a clinical psychologist and researcher in New York City who specializes in the study and treatment of migraine, headache disorders and chronic pain.
Understand migraine triggers.
For most people who get frequent migraines, there are certain factors that tend to precede their onset or trigger them. “Emotional stress is a big one, and diet is a big one,” says Dr. Kiran Rajneesh, a neurologist at the Ohio State University Wexner Medical Center in Columbus.
Other triggers include:
— Shift work, and the sleep disruptions that often accompany such.
— Fragmented or poor sleep.
— Obesity or being overweight.
— Sleep apnea.
— Exposure to bright lights or loud sounds.
— Use of recreational drugs or alcohol.
— Excessive consumption of caffeine, such as what’s contained in popular energy drinks.
— Hormone fluctuations.
These triggers can vary widely from person to person, Seng says. “People with migraine are more sensitive to changes in their environment or disruptions to their daily schedules.” Figuring out what your triggers are will help you better manage your condition.
Know your food triggers.
In addition to certain environmental factors, several foods have been linked to triggering migraines, says Dr. Kevin Weber, a neurologist at the Ohio State University Wexner Medical Center.
Common migraine-causing culprits include foods that are high in tyramine, a substance produced by the breakdown of the amino acid tyrosine. High-tyramine foods include:
— Aged cheeses.
— Cured meats, such as salami and prosciutto.
— Smoked fish.
— Soy sauce and other fermented condiments.
— Yeast extract spreads.
Other potential triggers include:
— Monosodium glutamate or MSG. This flavor-enhancing food additive is popular in Asian cooking and processed foods and has long been thought to be a trigger of migraines. However, definitive evidence of a link between MSG and migraines has been difficult to pin down.
— Caffeine. Too much or too little caffeine can set you up for a migraine.
— Alcohol. Too much alcohol can trigger migraines.
— Aspartame. This widely used sugar substitute has been linked to migraines in some individuals.
There are some simple dietary adjustments you can make to help reduce the frequency and severity of headaches.
Moderate your caffeine intake.
“Caffeine is found naturally in many foods and beverages, including chocolate, tea and coffee,” Seng says. But if consumed in excess, it can trigger migraines.
However, it can also alleviate migraine pain in some people. Because caffeine’s effects on migraines are so powerful, it’s often included in over-the-counter migraine pain relief. “When caffeine is combined with acetaminophen, it can be effective for migraine relief,” Seng says.
For anyone who’s dealing with migraines, tracking how much caffeine you’re consuming — including food, drink and medication — is important, so you don’t “inadvertently take more caffeine than you intend,” she says.
And talk to your doctor about your caffeine consumption. “Not every migraine patient has to stop drinking coffee,” Rajneesh says. But moderating intake might help. If you drink a lot of coffee, consider swapping in a couple cups of decaf in place of some fully caffeinated cups each day. Or consider adopting a tea habit, as black tea and green tea still contain some caffeine, but less than the standard cup of coffee.
Moderate your alcohol intake.
Similar to the effects of caffeine, alcohol can be both a trigger and a reliever of migraines in certain individuals, Seng says. “Some people find their migraine attacks improve significantly if they quit drinking alcohol all together, while others find that tracking alcohol use and consuming in moderation is helpful” for managing their migraines.
Red wine is a common culprit, so switching to white or rose might help.
Change your cheese choices.
Aged or strong cheeses that contain higher levels of tyramine include:
— Aged cheddar.
— Blue cheeses (including Gorgonzola and Stilton).
Cheeses made from pasteurized milk, such as American cheese, ricotta and other soft or cream cheeses, tend to be lower in tyramine. Consider swapping them in for stronger cheeses to help manage headache pain.
Rajneesh says a common double-whammy for some people who get migraines is red wine and cheese. “A lot of times we see patients who enjoy wine and cheeses together,” he says. But swapping that glass of red for a glass of white wine and choosing milder cheese options might help.
Beyond simply the food items you’re taking in, consider when you’re eating. “Often for people with migraine, it’s the timing of eating more than the specific food itself that contributes to a migraine attack,” says Seng. “Skipping meals is particularly problematic for people with migraine,” as the body craves routine.
And, she says migraineurs who drink coffee every morning should be careful to get up at the same time each day for that cup of joe. “It’s important not to sleep in and skip your morning coffee. Routine is an excellent migraine management strategy.”
Which are the best foods for migraines?
Dietary advice for migraineurs usually focuses on what to avoid rather than what to eat. But Seng says you can’t go wrong eating a healthy diet. “Eat healthy foods that make you feel good, and eat them frequently throughout the day without skipping meals. Consider a small healthy snack to tide you over between meals if you get hungry or if you start to feel the symptoms that typically happen for you prior to a migraine.”
Focus on whole, natural foods such as:
— Lean proteins like fish and poultry.
— Whole grains like brown rice, quinoa or oats.
— Fruits and vegetables.
And don’t forget the water. In addition to eating right, it’s critical that you remain well hydrated no matter what, but especially if you experience frequent migraine headaches. Dehydration is a common trigger, so be sure to drink up, especially in warm weather or when you’ve been exercising.
Best diet for migraines
“There’s no big study that shows certain diets are better for headaches,” Rajneesh says. But a healthy diet that provides all the vitamins and minerals your body needs is a good place to start.
In particular, make sure you’re taking in adequate levels of riboflavin and magnesium. Research has indicated that high supplemental doses of these two micronutrients were associated with a possible preventive effect. With riboflavin, also called vitamin B2, the National Institutes for Health reports that taking 400 mg daily for at least three months can help prevent migraines. For reference, the RDA for riboflavin for adults is 1.3 mg per day for males and between 1.1 and 1.6 mg per day for women depending on reproductive status.
Additionally, the American Migraine Foundation suggests taking 400 to 500 milligrams of a magnesium oxide supplement daily to prevent migraines. The RDA for adults over age 18 varies from 310 mg to 420 mg depending on age and sex.
While dietary intake of these micronutrients has not been found to have a strong connection to migraine experience, you should be getting adequate levels of them anyway. To do so, focus on eating plenty of fruits and vegetables, particularly leafy, green vegetables.
Nuts are a good source of protein that can help balance the nutrients you need while helping keep you feeling fuller longer because of their healthy fat content.
The Mediterranean diet is the best ranked diet overall on U.S. News & World Report’s Best Diets 2021 ranking and fits the bill for healthy eating for people with migraines. That said, “migraine is very personal in nature and can impact people differently, so the diet that works for one person may not work for another,” Seng says.
Use your knowledge of triggers to guide your food choices. Keeping a food and headache journal can help you make connections between which foods trigger headaches for you.
Should I go keto?
Though the selection of the best diet for those with migraines is highly individualized, Seng notes that there’s limited evidence suggesting that the ketogenic diet might be helpful for those with severe migraines. This very high-fat, low-protein and almost-no-carb plan is used to treat severe epilepsy in children and may be useful for other neurological conditions though it has not been studied as a potential migraine prevention protocol, so there’s no evidence to support its utility.
Without any evidence of benefit, the extreme measures required to adopt a keto diet could pose a significant burden and may not be worth the effort, she says. “This is not a diet that can be done in half-measure. Successfully attaining the physiological changes that are meant to occur during a ketogenic diet requires strict adherence and can be quite challenging.”
Manage your weight.
Lastly, Seng says that keeping your weight down can help reduce the frequency and severity of migraine headaches. One 2020 study noted that people with both obesity and migraines can experience “significant” reduction in headache frequency, pain severity, disability and attack duration through weight loss, regardless of whether the weight reduction occurred through diet and exercise or bariatric surgery.
“Regardless of the specific diet, being overweight is associated with poorer outcomes in people with migraine,” Seng says. “If you have migraine and are overweight, committing to a diet plan that makes you feel good and that you can stick to that will help you lose weight may also help you manage migraine.”
Tips to avoid a migraine:
— Understand your environmental triggers.
— Moderate your caffeine intake.
— Limit your alcohol consumption.
— Change your cheese choices.
— Stick to a regular eating and sleeping schedule.
— Stay hydrated.
— Eat a healthy, balanced diet, such as the Mediterranean diet.
— Consider trying a keto diet.
— Manage your weight.
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