Therapeutic use of diet in migraine

 A migraine is defined as "a severe form of headache". For some migraine sufferers this may seem like a generalisation and an underestimation. For those who suffer from attacks it can make life a misery. It also has more serious implications as it has a connection with life threatening conditions, such as stroke. 

Migraines have been classified according to their presenting clinical signs. A day or so before an attack there is often what is termed the prodrome, this consists of few subtle changes in mood and behaviour and can include excitability and cravings for certain foods.

Ten percent of migraine sufferers experience the classic migraine: an aura of visual and auditory disturbances may be present for 15-60 minutes prior to the onset of a migraine. This is accompanied by an intense throbbing headache, confusion, an inability to concentrate, difficulty in co-ordination, pins and needles and numbness.

The majority of migraine sufferers experience the common migraine: an intense throbbing headache often unilateral with nausea, vomiting, diarrhoea and an increased sensitivity to light, sounds and smells. The third type of migraine is the complicated migraine that has neurological signs associated with it, and is experienced by 10% of sufferers.

Although migraines have been classified each attack may be different and sufferers may experience more than one type. A migraine attack may last from 4-72 hours. It can be a severe and debilitating condition that affects many peoples lives. Currently, women experience this condition more frequently than men.

 Causes

There are many thoughts as to why and how migraines develop and it has certainly been shown that the cause can differ from person to person.

Some theories include:

Blood vessel instability - A common theory is that the pain of migraine is due to a constriction of small blood vessels and then dilation.

Nerve cell disorder - It is thought that nerve cells within the blood vessels release a compound that is associated with dilation of the blood vessels and the release of histamine from mast cells.

Platelet disorder –Some studies have found that there are significant differences in the platelets of migraine sufferers. Platelets are blood cells that aid in clotting. These differences include an increased tendency to clump together, structural differences and differences in the amount of serotonin release. Serotonin is a neurotransmitter that is involved in mood and plays a role in constriction and dilation of blood vessels. 

Deficiency of serotonin - Over 35 years of studies into serotonin levels and the effects on migraines has shown that migraine sufferers have an increased amount of a serotonin breakdown product in their urine. This is thought to be due to an increased breakdown of serotonin by an increase in the activity of an enzyme; mono amine oxidase.  This decrease in the overall serotonin levels is thought to lower the pain threshold. 

 Triggers

Triggers of an attack vary, and may be very specific for each sufferer. It is worth noting that one trigger may not provoke an attack, but if the susceptible person is exposed to two or three triggers then migraine may develop. For some people the onset of a migraine may have no obvious trigger.

Non dietary triggers

  • Stress or relief of stress
  • Muscle tension
  • Heavy metal toxicity
  • Toxicity
  • Head trauma
  • Temperomandibular joint syndrome
  • Lack of sleep
  • Hormonal changes in women during menstruation and oral contraceptive use
  • Environmental changes - high pressure, pressure changes, hot, dry wind and seasonal changes

Dietary triggers

  • Hypoglycaemia or poor blood sugar control
  • Caffeine
  • Dehydration
  • Reactions to additives - saccharin, MSG, aspartame and nitrites
  • Histamine rich foods - cheese, alcohol, fermented foods
  • Histamine releasing foods - alcohol, bananas, eggs, milk and chocolate
  • Tyramine (A tyrosine breakdown product) containing foods - cheese, wine, bananas, peanuts, citrus
  • Digestive disorders
  • Allergies and intolerances - wheat, milk/dairy
  • Alcohol - especially red wine and brandy 

 Medical treatment

Common medical treatment for a migraine is usually symptomatic, many people are prescribed pain killers, anti-sickness drugs and anti-inflammatory steroids. Some people are prescribed medications such as triptans that act on serotonin levels. 

Nutrient therapy

There is growing evidence that migraine can be controlled through diet and nutrient therapy. Specific nutrients that have been shown to benefit some migraine sufferers include magnesium, vitamin B2, omega 3 fatty aids, feverfew and probiotics.

Dietary changes that may be beneficial include:

Eliminate triggers

A complete avoidance of potential triggers, including:

  • Caffeine - tea, coffee, cola drinks, Red Bull and other energy drinks.
  • Additives - saccharin, aspartame, monosodium glutamate.
  • Nitrites in foods such as processed meats - bacon, hot dogs, salami.
  • Alcohol - especially wine.
  • Bananas, citrus, eggs, chocolate, peanuts.
  • Fermented foods - sauerkraut, vinegar, pickled vegetables, soy sauce.
  • Allergens - wheat, dairy - cheese, milk, cream, yoghurt, ice cream.

Avoid dehydration

Drink plenty of water and avoid salt.

Blood sugar level control and female hormone control

Hormonal control can be gained by:

  • Having a diet high in fresh fruits, vegetables and wholegrains. Complex carbohydrates encourage elimination of hormones and a slow release of energy into the blood stream. Wheat can be relied upon too heavily as a carbohydrate source, and is often implicated in allergy related migraine. It is better to reduce wheat in the diet and choose other carbohydrate sources such as rye breads, rice breads, quinoa, brown rice, barley, oats, amaranth, buckwheat, millet, lentils and beans.
  • Avoiding sugar and hidden sugar in foods.
  • Opting for home made meals with organic foods and avoiding pre-prepared meals and snacks, to reduce additives and sugar. 
  • Eating small meals frequently to avoid hypoglycaemia and the addition of protein to each meal slows digestion and the release of energy into the bloodstream. Good protein sources include: lentils, beans, nuts, seeds, fish, lean meat, soy. 
  • Increasing phyto-oestrogens in the diet such as soy, lentils, chickpeas and beans. These have the effect of mimicking oestrogen in the body. Soy has been implicated in allergy related migraine in some people and it may not be suitable for all individuals.
  • Reducing saturated fats from animal sources and dairy. Saturated fats have the effect of interfering with oestrogen regulation.

Boost probiotics

Eat prebiotics to feed probiotics in the gut and to encourage their colonisation. Foods such as Jerusalem artichoke, artichoke, oats, salsify, leeks and onions.

Increase essential fatty acids

Increase omega 3 consumption from oily fish such as herring, mackerel, salmon, sardines, pilchards, tuna and trout. Flax seeds and flax oil are also good sources of fatty acids.

Lifestyle alteration

Lifestyle factors also influence the onset, and duration, of migraine and they need to be addressed also. Stress reduction, a good sleeping pattern and good mental health are fundamental for a healthy lifestyle.

To view a PDF handout on diet and migraine please click here