The Migraine Diet

The new thinking is that people who get migraines have extra-sensitive, hyperreactive brains. Something sparks a region deep in the brain, dubbed the “migraine generator,” and that unleashes a cascade of brain chemicals that inflame nerve endings, dilate blood vessels, and flood the brain with pain signals. So what’s the “something” that triggers this reaction? That’s even more frustrating. Almost anything can cause a migraine, including weather changes, strong odors, stress, loss of sleep, and certain foods and drinks. A good many migraines are also related to fluctuations in estrogen levels, which is no doubt why three times more women than men get migraines (often coinciding with their periods) and why the headaches tend to disappear during pregnancy and after menopause.

Avoiding the foods that often trigger migraines while making a point of eating those that help prevent them may reduce the number-and intensity-of headaches you get. And compared to dying, that sounds pretty good.

Your Food Prescription

Fruits, vegetables, and legumes

This is good general advice, but it may be particularly helpful for women who get migraines with their periods-which may be due to a sudden drop in estrogen. The higher your overall estrogen level is to begin with, so the reasoning goes, the farther it can fall during the drop. The fiber in these foods helps by removing excess estrogen from the body along with waste, so it’s not recycled back into your bloodstream.

In addition, fruits, vegetables, and legumes all contain plant estrogens that blunt the negative effects of the estrogen our bodies naturally make. Another major plus of these foods: They’re low in fat. When you eat more fat, your body makes more estrogen.

Aim for: Getting the recommended 7 to 10 daily servings of fruit and vegetables is a great place to start.

Fatty fish

You know it as heart-healthy fare, but salmon and other fatty fish (like mackerel, trout, and herring) just may help reduce migraines, too. These fish are rich sources of the omega-3 fatty acids EPA and DHA. Some preliminary research on these anti-inflammatory compounds done at the University of Cincinnati showed that when they were taken in supplement form, they appeared to reduce the frequency and severity of migraines in some people over the course of six weeks.

Aim for: The University of Cincinnati study used capsules containing 300 milligrams of EPA and DHA and 700 milligrams of other oils. Four 125-gram (4-ounce) servings of fatty fish a week would provide about the same amount of the beneficial fish oils used in the study.

Coffee

Although caffeine may trigger migraines in some people, when a migraine strikes, a few cups of coffee do help relieve the pain. Caffeine is so effective at helping to shrink swollen blood vessels in the brain, it’s one of the key ingredients (together with acetaminophen and aspirin) in over-the-counter migraine medicines like Excedrin Migraine.

Aim for: A cup or two when a migraine hits.

Ginger

Research shows that this warming spice contains some potent compounds that are similar to the ones in nonsteroidal anti-inflammatory drugs. It may work against migraines by blocking inflammatory substances called prostaglandins. Ginger hasn’t been rigorously tested for headache relief, but even if it doesn’t stop your migraine, it should help relieve the nausea that often comes with it.

Aim for: There’s no recommended dose for ginger, but you might start using powdered or fresh ginger liberally in cooking or ordering dishes flavored with ginger when dining out. And when a migraine strikes, drinking a glass of water with a few teaspoons of powdered ginger mixed in every few hours may help alleviate the pain. You can also suck on dried ginger candy.

Whole grains, beans, leafy dark green vegetables, and other foods high in magnesium

What do these foods have in common? They’re all high in magnesium, which research shows is often deficient in people who get migraines. Low levels of magnesium are thought to make the brain extra sensitive to migraine triggers.

Aim for: The recommended daily amount for magnesium is 310 to 320 milligrams for women and 400 to 420 for men, though if you’re truly deficient, aiming for 400 to 700 milligrams daily may be better for preventing migraines.

Helpful hint: Roasted pumpkin seeds are among the richest sources of magnesium, with about 151 milligrams per 30 grams (1 ounce). Keep a bag in your purse, car, or desk for easy nibbling. Magnesium-rich nuts include Brazil nuts (107 milligrams per 30 grams/1 ounce) and almonds (78 milligrams per 30 grams/1 ounce). Or try some halibut, which contains 91 milligrams in 90-gram (3-ounce) portion, as well as a smattering of omega-3s.

Supplements for Migraines

Magnesium. People often complain that their migraines hit when they’re under stress, and a deficiency of magnesium may help explain why. Chronic stress drains our bodies of magnesium, and when levels are low, blood vessels are more likely to spasm. It’s estimated that about 50 percent of people who get migraines have low magnesium levels.

When given intravenously, magnesium can completely halt a migraine, often within minutes. Researchers suspect that the mineral relaxes overexcited nerves in the brain and helps serotonin receptors block migraine pain signals. That’s also how the newer migraine medications, known as triptans-sumatriptan (Imitrex) and almotriptan (Axert)-work.

Oral magnesium works well, too, but only for preventing migraines. In one three-month study, migraine frequency dropped by 42 percent in people who took 600 milligrams of magnesium, compared to 16 percent in those who took placebos. Supplementing with magnesium can even help triptan medications work better. In one small study of people who reported that Imitrex didn’t relieve their migraines, the medication started working when they corrected their magnesium deficiency. The only downside to increasing magnesium is possibly some mild diarrhea. DOSAGE: 400 to 600 milligrams daily in divided doses. Avoid magnesium hydroxide and magnesium citrate, which are more commonly associated with loose stools.

Riboflavin. Researchers are still sorting out how riboflavin (vitamin B₂) prevents migraines, but one theory is that the brains of people with migraines simply require a little extra energy for proper function. Riboflavin increases energy production in all cells, including brain cells. In a recent German study, volunteers taking riboflavin for six months got half the migraines they normally experienced, and they were able to reduce their migraine medication. The only side effect appears to be minor gastric upset. DOSAGE: 400 milligrams daily. Since B vitamins work best together, take a B-complex supplement or a multivitamin and, if necessary, make up the difference in dosage with a riboflavin supplement.

Omega-3 fatty acids. If you can’t seem to eat the four weekly servings of fish suggested above, look to fish-oil supplements to fill the omega-3 gap. DOSAGE: The University of Cincinnati study used 1 gram of fish oil a day in capsules that contained 300 milligrams of EPA and DHA and 700 milligrams of other oils.

Coenzyme Q10. Like riboflavin, CoQ10 increases cellular energy, and some preliminary research suggests it can prevent migraines. A small double-blind, placebo-controlled study of 42 people done in Switzerland found that over the three months of the study, taking CoQ10 reduced migraine frequency, duration, and accompanying symptoms such as nausea. The number of migraine attacks per month in the treatment group went from 4.4 to 3.2, compared with no change in the placebo group. The people who took CoQ10 also had shorter migraine episodes and fewer days with nausea. DOSAGE: 100 milligrams three times daily.

Off the Menu

Fatty foods and vegetable oils. If you’re serious about using your diet to help prevent migraines, get serious about cutting back on fat. As we mentioned earlier, eating fat increases estrogen levels, which may contribute to migraines. A small three-month study done at Loma Linda University in California found that when participants radically cut their fat intake-by 60 percent-to about 20 grams per day, they reported a 71 percent decrease in headache frequency, a 66 percent decrease in intensity, and a 74 percent decrease in duration.

This doesn’t mean you should cut out fat from fish, however, since omega-3 fatty acids help to reduce inflammation and pain. Instead take aim at saturated fat (meat, cheese, butter, and ice cream). You might also start pouring olive or canola oil instead of other vegetable oils like corn, sunflower, and safflower. These oils are high in omega-6s, which may promote inflammation and worsen pain (see page 27 for more details).

Trigger foods. It used to be that eliminating key foods from your diet was the primary prescription for preventing migraines. Now headache experts are less sure that specific foods per se cause migraines. Rather, it may be that certain foods eaten under certain conditions tip the balance when other factors like stress, lack of sleep, or hormone fluctuations make us more vulnerable to a migraine. It’s even possible that making dietary changes-any changes-has a sort of placebo effect. We feel as if we’re doing something, and that feeling of control has a positive effect.

Still, because food sensitivity is thought to be a factor in 10 to 30 percent of migraines, it can’t hurt to do a little sleuthing if you suspect that foods trigger your headaches. Oft-cited culprits include red wine, aged cheese, processed meats, dairy products, citrus fruits, wheat, chocolate, and food additives like monosodium glutamate and artificial sweeteners. Some studies show a connection with migraines; some don’t. That may be because migraines are so highly individual; what triggers one person’s headache may not trigger someone else’s.

The best way to determine if food is affecting your migraines is to keep a food diary. When a headache hits, try to remember what you ate in the previous 12 hours. If you see a pattern, avoid that food for two or more weeks, then add it back to your diet and see if there’s a change in your headache episodes. But remember, just as it’s important to avoid any foods that may cause migraines, it’s equally important not to skip meals, since irregular eating can bring on migraines, too.