Migraine Diet Modifications: What Really Works?
For many people who have migraine, figuring out whether certain foods play a role in their migraine attacks can be a frustrating task.
“There are lots of dietary triggers out there,” says Mark W. Green, MD, the president of the World Headache Society and a professor of neurology, anesthesiology, and rehabilitation medicine at the Icahn School of Medicine at Mount Sinai in New York City. To make matters more complicated, says Dr. Green, “one day they may trigger a headache, and another day they may not.”
Dietary modifications for migraine generally fall into two categories — cutting out foods that play a role in triggering your headaches, and making broad changes to the way you eat in an effort to reduce the frequency or intensity of your headaches. Unfortunately, neither approach is guaranteed to work for any given person.
Diet represents just one area of potential migraine triggers. “In most people, diet isn’t that important,” says Green. “But you should be careful at times when other triggers come into play, like a stressful time.”
Still, by experimenting with some dietary changes and keeping track of potential triggers, you may be able to see some improvement in the frequency or severity of your migraine attacks. Here are the most promising approaches, according to top migraine experts.
Start by Eating Right & Staying Hydrated
A healthful diet and attention not just to what you eat but also when you eat could help reduce migraine attacks.
Anti-inflammatory diet One promising approach for migraine, says Vincent T. Martin, MD, a headache specialist and a professor of clinical internal medicine at the University of Cincinnati College of Medicine in Ohio, is an anti-inflammatory diet — which incorporates foods known to reduce inflammation in the body, and avoids foods that encourage inflammation.
In practice, this means a diet that includes a colorful variety of fruits and vegetables — especially green leafy vegetables and berries — and non-farm-raised fish and meats or grass-fed beef as much as possible, and excludes highly processed foods.
Some research has found that foods high in omega-3 fatty acids, in particular, reduce the number of headache days in people with migraine. These include fatty cold-water fish such as salmon, cod, and lake trout, as well as plant-based sources such as flaxseed, chia seeds, and walnuts.
There is also some evidence that a high-fat, low-carbohydrate ketogenic (keto) diet may help some people with migraine, according to Dr. Martin. But, he says, “Not everyone can actually follow these diets. People just don’t stick with them long-term.” And due to certain health risks, Martin recommends a keto diet only under the supervision of a dietitian.
Grazing, not fasting An important, but often overlooked, dietary consideration that can affect migraine is food timing, according to Green. “We want people to avoid fasting,” he says. “Particularly when people [typically] wake up with a headache or have it early in the morning, we really want them to eat a late-night dinner or snack.”
Smaller meals throughout the day can help you avoid the potentially headache-triggering effects of not eating for long stretches. “I think we were meant to be grazers,” says Green. “So eating multiple small meals each day is preferable to three large meals. You don’t want your blood sugar to fall.”
Hydration Staying hydrated is important, since dehydration can contribute to headaches. Martin recommends, as a rule of thumb, eight 8-ounce (oz) glasses of water throughout the day.
Alcohol & Caffeine: The Usual Migraine Suspects
Even when you’re following a healthy lifestyle, certain foods and drinks can trip you up.
Alcoholic beverages — particularly beer and wine — are well-established migraine triggers, but the role they play isn’t always straightforward in a given person.
For example, Green says, a person may realize she can have one glass of wine without developing a headache — but during her menstrual period, that glass of wine can be a migraine trigger. “It’s often more than one factor,” he notes, that contributes to the onset of migraine attacks.
Even a potent migraine trigger may not cause a headache every time. “If 40 percent of the time when you ingest alcohol you have a migraine, then that probably is a trigger for you,” says Martin. If you suspect that alcohol in general or a particular beverage is a migraine trigger, a food and symptom diary can help you figure out whether cutting it out leads to improvement.
Caffeine, on the other hand, may play a more complicated role. “When people ask me if caffeine is good or bad for headaches, the answer is yes,” says Green. That’s because while too much caffeine can be a migraine trigger, so can skipping the caffeine you regularly consume.
And caffeine can also act as a migraine remedy. “If you get a bad headache and take a swift slug of caffeine, it can be a helpful treatment,” says Martin.
Both Green and Martin recommend limiting your daily caffeine intake to less than 200 milligrams (mg) — about the amount in two standard-brewed 8 oz cups — and to consume caffeine at roughly the same times and in the same amounts each day.
Fermented Foods, MSG, & Nitrites: Potential Migraine Triggers
Three of the most widely discussed food ingredients or components that can be migraine triggers are tyramine — a chemical that occurs naturally in preserved and fermented foods — as well as monosodium glutamate (MSG) and nitrites, both of which are often found in processed foods.
It can be difficult to identify these components, because in most cases, you won’t see them in ingredients lists.
When it comes to MSG, “food manufacturers often hide the name,” says Green. “You’ll see terms like natural flavor, or hydrolyzed vegetable protein.” Complicating the matter is that MSG occurs naturally in certain foods, including hydrolyzed vegetable protein, autolyzed yeast, hydrolyzed yeast, yeast extract, soy extracts, and protein isolate, as well as in seaweed, tomatoes, and cheeses, and products containing naturally occurring MSG are not required to list it on the label.
Tyramine isn’t added to foods, but it exists in several foods including aged cheeses, processed or cured meats, and pickled or fermented foods like sauerkraut, kimchi, and tofu, according to the Mayo Clinic.
Nitrites are found in processed or cured meats, as well as some other processed foods.
The best way to identify possible food triggers — especially when the ingredients may be unclear — is to keep a food and symptom diary, according to both Green and Martin. “If a food is linked to twice your normal headache frequency, it’s probably a trigger,” says Martin.
If you’re having trouble noticing a pattern between foods and your headaches, your doctor may be able to help — but it’s also possible that there isn’t much of a link between the two.
Chocolate, Sweets, & Sweeteners: Weak Evidence of a Migraine Connection
One of the most commonly misunderstood foods in connection to migraine is cocoa or chocolate, according to Green. “There’s very little evidence that chocolate is actually a trigger,” he says.
But many people notice a connection between eating chocolate and the onset of migraine symptoms, possibly due to what’s known as a migraine prodrome — early symptoms that develop a day or so before the headache phase. These warning signs may include yawning, cold hands or feet, and food cravings, according to Green.
“I tell my patients, if you’re dying for chocolate, get your meds ready,” says Green. “It’s almost irrelevant if you eat it or not — there is a good chance you are going to get a migraine.”
Research has also shown that chocolate is unlikely to be a migraine trigger. One review of studies on this topic found that while a small percentage of people identified chocolate as a migraine trigger, all provocative studies — in which participants consumed either chocolate or a similarly flavored alternative, without knowing which one they received — failed to find any connection between chocolate and migraine symptoms.
When it comes to both sugar and artificial sweeteners, the evidence of a migraine connection is either weak or anecdotal. “Really sugary foods can trigger headaches,” says Martin, but many people eat sugar so often that it’s difficult to detect this connection.
The artificial sweetener aspartame may trigger headaches in some people, while there is less evidence of a connection to the sweetener sucralose, according to Green. The sweetener stevia appears not to be linked to migraine.
But like any possibly weak trigger, sweeteners may play only a partial role in migraine symptoms. “In my experience, when I’m vulnerable — such as on a rainy day — this would not be a good day to drink a diet soda,” says Martin.
IgG Antibody Testing for Migraine Food Triggers
A potentially useful tool to identify migraine food triggers is an IgG antibody test, which looks at a specific immune response in your body to tiny amounts of many different food substances. One version of this test looks at about 270 different foods, according to Green.
The results of IgG food testing can be used to guide an elimination diet, Martin says, and evaluate whether your symptoms improve. Foods can then be gradually reintroduced, and you can document any increase in headaches that happens as a result.
In a study published August 5, 2021, in the Journal of Pain Research of 89 people with migraine, the 67 participants who had one or more food-specific IgG antibodies tended to have more frequent and severe headaches, and were more likely to experience anxiety and gastrointestinal symptoms.
In another study, 21 adults with both migraine and irritable bowel syndrome (IBS) underwent IgG food testing. Out of 270 possible food sensitivities, the average number of positive results was 23.1. An elimination diet based on these results led to a significant reduction in attacks of both migraine and IBS, along with a shorter duration and lower severity of attacks that did occur.
Diet Is Only 1 Part of a Migraine Prevention Plan
It’s worth remembering that your diet is only one part of a healthy lifestyle — along with regular physical activity, maintaining a healthy body weight, reducing stress as much as possible, and adequate and consistent sleep.
“There’s a good chance you’ll reduce headache frequency by your lifestyle choices,” says Martin. “A healthy diet in general, and living a healthy lifestyle, is probably good for migraines.”