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.
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:
-- Aged cheeses. Aged or strong cheeses tend to contain higher levels of a compound called tyramine, which has been associated with migraine headaches.
-- 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.
-- Processed meats. Processed meats contain tyramine, which can trigger migraines.
-- Chocolate. Tyramine is also thought to be the reason why chocolate triggers headaches in some people.
-- 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 of 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 instead 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 migraineurs 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:
-- Natural sweeteners.
-- Brown rice.
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. Focus on fruits and vegetables and plenty of leafy, green vegetables to supply riboflavin and antioxidants. 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 2020 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.
Therefore, 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.
But, you have to go all-in to get the benefit, 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.
"Regardless of the specific diet, being overweight is associated with poorer outcomes in people with migraine. 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.