Migraines affect about 1 billion people worldwide and are the 3rd most common disease behind dental caries and tension-type headaches. Severe migraine attacks are classified by the WHO as one of the most disabling illnesses, comparable to dementia and quadriplegia. Unfortunately, most migraineurs are dissatisfied with the efficiency of their treatment and choose to self-medicate with over-the-counter medication.
Migraines can seriously affect one's quality of life and cause anxiety about not being able to carry day-to-day activities at home and at work. They are also a huge financial burden on global economies with total annual costs ranging from $36 to $54 billion in the US (depending on the study) and from €18 to 27 billion in Europe. A 2019 report to the European Parliament even estimates that €95 billion are lost in productivity every year.
In this blog and the next one, I will list a number of alternative non-medicated options that have been proven to reduce the frequency and symptoms of migraines in many cases. Although each migraineur is different, these options could be worth considering, in cooperation with a qualified health practitioner.
Please note that this article is for educational purposes only. It is not a substitute for professional medical advice and is not intended to diagnose, treat, cure, heal or prevent any disease or medical condition. See full Disclaimer here.
What causes migraines?
Whilst the underlying causes of migraines are uncertain, many factors are known to trigger migraine attacks. Various studies report that about 80% of migraineurs can identify their personal triggers. The most frequent culprits are stress, hormones in women, skipping meals, changes in weather, sleep disturbances, smells, bright lights, loud noises, smoke, heat or sun exposure, but also certain foods and drinks.
Researchers have also identified other factors that the migraineurs may not be aware of, such as migraine medication overuse, genetic susceptibility, mitochondrial or metabolic dysfunction, vitamin and mineral deficiencies, high levels of inflammation and neurotransmitter imbalances.
Today, I will cover food and drink related triggers.
Identify your personal triggers
If you are a chronic migraine sufferer, the first advice is to keep a journal and write down the date, length, severity and symptoms of your migraines, as well as what your personal triggers might be. Did you do anything different before the attack occurred? Think about any activity, stress levels, food and drinks, dehydration, medicine, exposure to loud noises or bright light, long exposure to computer screen, quality or length of sleep, change in weather pressure or humidity...
If you identify potential triggers, try eliminate them to check whether they affect your migraines. Otherwise, consider eliminating the following foods and drinks, as it has been proven to work for many migraine sufferers. Try eliminate them one at a time for 3 weeks, and see whether it can reduce the frequency or severity of your migraines.
8 out of 10 migraineurs can associate their migraines with foods and drinks such as red wine and beer, caffeine (due to withdrawal), chocolate, fermented foods, cured meats, aged cheeses, MSG and also with skipping meals. Gluten should be on the list as well, but most migraineurs are unaware of their gluten sensitivity.
Gluten
Several studies showed that migraine sufferers who have celiac disease or gluten sensitivity could either get rid of their migraines entirely or get significant relief after giving up gluten.
In one study, 25% of migraineurs with gluten sensitivity got total relief and 75% improved the frequency, duration and intensity of their migraines. In 2 other studies, the proportions are reversed (75% total relief and 25% improvement). In any case, they agree that 100% of the migraineurs with gluten sensitivity achieved a significant improvement.
You may not have celiac disease but you may have an undiagnosed gluten sensitivity. So try a gluten-free diet for 3 weeks and see whether you can feel any improvement. Then, slowly re-introduce foods containing gluten. Continue to pay attention to the way you feel. Depending on your level of sensitivity, you may be able to eat some gluten containing food without triggering symptoms.
Any food containing wheat, barley or rye contains gluten: bread, pasta, pizza, pastries... but also a lot of processed, packaged or canned foods, sauces, and even medication and supplements. A tiny scrap of gluten could be enough trigger a reaction, so be very vigilant. Check the labels when buying ready-made food and ask the waiter when eating out.
Caffeine withdrawal
Withdrawal from high or frequent caffeine intake is a common trigger, reported by 50% of migraineurs.
If you regularly drink coffee or caffeinated soft drinks, skipping your daily dose may cause withdrawal symptoms for several days, including headaches with symptoms similar to those of a migraine. Headaches typically start within 12 to 24 hours after your last cup of joe, Coke or Pepsi and peaks after 1 or 2 days.
The more caffeine you drink, the more withdrawal headaches you can have, but even 1 cup of coffee a day is enough to cause headaches upon withdrawal.
If this is your case, you have 3 options: keep on drinking the same amount of caffeine everyday to avoid withdrawal symptoms ; gradually lower your caffeine intake over the course of a few weeks ; or quit caffeine altogether. The choice is yours. For more information, you can read my blog: Is Coffee good for you?
Red wine and beer
About 1/3 of migraineurs believe that alcohol may trigger a migraine attack, especially beer but also red wine. This might be due to their histamine content.
Eliminating both red wine and beer might be difficult for those who enjoy going out and socialising. But swapping red wine for white wine, beer for cider or trying other alcohols for a few weeks might not be too much of a compromise if they happen to trigger your migraines.
Alternatively, if you want to indulge in a glass of red wine or a pint of beer without suffering the consequences, studies have shown that taking an anti-histamine before drinking significantly reduced the frequency of headaches.
Other foods high in histamine
In addition to red wine and beer, histamine-rich foods include aged cheeses, chocolate or cocoa powder, yeast extract, fermented foods and pickles, processed meats and some fish. They may cause allergy-like symptoms such as sneezing, flushing or skin itching but also headaches.
A study showed that 18% of patients with histamine sensitivity had total remission from headaches and 73% improved considerably with a decrease in the frequency, duration and intensity of their headaches, when avoiding histamine-rich foods.
If you have histamine sensitivity, you can either eliminate these foods or take anti-histamines when you want to eat them.
Processed meat
Processed or cured meat is a trigger for about 5% of migraineurs. This might be due to histamine contents or to the nitrites or nitrates that are used as preservatives.
This includes sausages, ham, bacon, salami, deli meats, hot dogs, corned beef, patés, canned meat, beef jerky but also smoked salmon and dried fish.
MSG and preservatives
MSG (monosodium glutamate) is a common flavour enhancer used in certain Asian foods, soy sauce, packaged and canned foods. MSG as well as other artificial flavours or preservatives can trigger migraines. This might be due to the fact that MSG can raise blood levels of glutamate, an excitatory neurotransmitter.
MSG is often disguised under other names such as monopotassium glutamate, autolysed yeast, hydrolysed protein and sodium caseinate.
Other potential triggers
The list of other foods that could trigger migraines is quite long, but with a much lower risk of triggering migraine attacks. So, this is more for you to keep in mind when trying to identify your own personal triggers.
They include: peanuts, peanut butter, almonds, other nuts and seeds ; pizza or other tomato-based products ; potato chips ; organ meats ; sourdough bread and fresh baked yeast goods ; brewer's yeast ; beans ; onions and garlic ; avocados ; certain fruits (ripe bananas, citrus fruits, papayas, red plums, raspberries, kiwis and pineapples) ; dried fruits (figs, raisins and dates) ; canned soups ; cultured dairy products (sour cream, buttermilk and yogurt)...
A few studies have also associated aspartame and sucralose (Splenda) with an increased frequency of migraines.
A ketogenic nutrition could help
A ketogenic diet is very low in carbohydrates, high in healthy fats and moderate in proteins. It produces ketones that can be used for energy instead of glucose, which can have multiple benefits for migraineurs.
Ketones have been shown to inhibit pain pathways, enhance mitochondrial energy metabolism, reduce oxidative stress and counteract abnormalities in the gut microbiome and neural inflammation, that are all underlying factors found in migraines. Ketones also have a calming effect as they activate enzymes that convert glutamate (an excitatory neurotransmitter) into GABA (a calming and relaxing one).
In several studies, the adoption of a ketogenic diet resulted in a 60% to 80% reduction in migraine frequency
and severity, and in use of medication. So, if you are ready to replace processed foods by meat/fish/eggs with a lot of healthy fats (avocados, olives, nuts and seeds, coconut, and their oils, as well as butter) and a small serving of non-starchy vegetables, this could be a great option for you.
Last but not least, don't skip meals and stay hydrated
Fasting or skipping meals is a frequent trigger, for 1/3 to 2/3 of migraineurs, depending on the study. If this is your case, keep a healthy snack with you (such as nuts and seeds, canned salmon, olives, ham or cheese...), if you know you might miss a meal.
Not drinking enough water can also trigger migraines or headaches or prolong attacks. A study showed that 2 thirds of people experiencing water-deprivation headache got total relief within 30 minutes of drinking 0.5 to 0.75 litres of water and the other third within 1 to 3 hours. So, it might be worthwhile drinking a few cups of water the next time you feel a migraine coming.
In my next blog, I will cover the other most successful non-medicated options to reduce the frequency and severity of migraines. So consider eliminating the foods and drinks mentioned in this article and stay tuned for more!
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