Migraine is a neurological condition that has been estimated to affect over a billion people globally.
In today’s blog post, curated by my Kaleigraphy writing intern Kathryn Durston, we explore some of the dietary strategies that could help mitigate either the onset or symptoms of migraine.
If you haven’t already, please do also take a look at Kat’s post on the most effective supplements for migraine relief.
Strategy #1 – More Dietary Folate
Folate, or vitamin B9, is an essential B-vitamin we must obtain through our diet and is commonly known for its role in DNA synthesis and cellular metabolism.
The relationship between migraine and folate appears to likely be due to folate’s ability to lower an amino acid in our blood called homocysteine, which is relevant because high levels of homocysteine is reported to be a potential risk factor for migraine attacks.
A 2016 study out of the journal of Advanced Biomedical Research found that migraine patients had a significantly lower intake of dietary folate compared to non-migraine patients, even though their overall energy intake was the same.
An even deeper look into the connection between migraine and folate showcases a common denominator between migraine occurrence and folate metabolism within our body- a specific gene called the methylenetetrahydrofolate reductase gene or MTHFR gene.
A deficiency in folate coupled with a mutated MTHFR C677T gene can cause even greater deviance in DNA methylation that evidence has shown may contribute to an increase in migraine frequency.
Therefore the current science suggests that migraine patients with a variant MTHFR gene might reap even more benefits from raising their folate levels, such as this 2015 RCT out of the journal Headache that concluded migraine frequency was significantly linked to folate consumption in individuals with the MTHFR gene variant.
A genetic test for the MTHFR gene and/or checking your homocysteine levels may be an appropriate next course of action, especially if you have other conditions associated with the MTHFR gene mutation such as infertility, bipolar disorder, cardiovascular diseases, and colon cancer.
While more research needs to be conducted on this intricate process, incorporating high-folate foods into your diet such as dark leafy greens, edamame, mango, broccoli, asparagus, nuts, and legumes (lentils,chickpeas) is a seemingly low-risk dietary strategy for migraine patients to keep in mind.
Strategy #2 – Trigger Food Awareness
“Trigger foods” is a phrase used to characterize certain foods that have been reported to provoke migraine attacks in either a general population of migraine patients or on an individualized basis.
Recent literature defines a food as a potential trigger if a headache occurs in more than 50% of instances within 12-24 hours of consuming that food.
How trigger foods specifically interact with migraine pathogenesis is still largely unknown, and differs amongst food groups, but the current literature infers that the complex link has to do with meningeal inflammation, vasodilation, and cerebral glucose metabolism.
The available evidence on migraine food triggers is primarily anecdotal, however one randomized trial found that migraine patients saw a significant decrease in attack frequency, severity and duration after eliminating potential dietary trigger foods for four months.
And while an overarching goal of identifying your own personal triggers seems applicable, a logical starting place would be limiting/cutting out foods that research has shown are a possible migraine trigger among a large portion of migraine patients.
A 2020 systematic literature review out of the Journal of Head and Face Pain identified this non-exhaustive list of common trigger foods:
Alcohol (especially red wine)
Chocolate (although this study says otherwise)
Fatty & fried foods
It is important for me to note that due to the convoluted and non-linear relationship between food triggers and migraine, it is not a simple case of cause-and-effect.
Therefore it is possible to have multiple (or even no) food triggers and a diet recall strategy is often advised, such as a comprehensive food diary to help record & recognize specific triggers as they appear.
If this concept seems daunting and you are apprehensive about doing it on your own, don’t hesitate to reach out to a registered dietitian like Andy to help guide you along the way.
Strategy #3 – Omega-3 Fatty Acids
An appropriate dietary intake ratio of essential fatty acids alpha-linolenic acid (omega-3) and linoleic acid (omega-6) has been shown to be beneficial for optimal health in a variety of areas.
While the typical Western diet is high in omega-6 fatty acids and low in omega-3, this can be especially problematic for migraine patients on account of how fatty acids regulate pain-related biochemical pathways in our body.
It has been shown that lipid meditators derived from omega-6 fatty acids have pronociceptive properties (processing pain) while omega-3 fatty acids have antinociceptive properties (blocking pain).
Due to this, ensuring migraine patients have a high omega-3 to omega-6 ratio (about 4:1) through dietary interventions may be beneficial in reducing unwanted migraine pain.
A 2013 randomized controlled trial published in the journal Pain saw a significant improvement in headache frequency & severity, as well as quality of life, with a 12-week diet intervention high in omega-3 fatty acids and low in omega-6.
In order to facilitate an adequate balance it is recommended to incorporate foods with a high amount of omega-3’s, such as flax, chia, hemp, salmon, sardines, trout, walnuts and soy.
Strategy #4 – Reduced Sodium Intake [DASH Diet]
There has been an increase in interest in the role sodium intake plays in migraine/headache occurrence due to a disruption of sodium homeostasis seen in migraine patients.
In certain scenarios, a weak association between high blood pressure and headache was also observed (1,2), which opened the door for dietary interventions that lower blood pressure to be considered for migraine treatment.
A few common dietary approaches to lowering blood pressure is limiting sodium intake and partake in diets such as the DASH (Dietary Approaches to Stop Hypertension) Diet.
While I am not going to go in-depth about the specific components of the DASH Diet, lucky for you Andy has written a whole book on the topic and you can find out more info here!
He has also written blogs that cover all the key components of the DASH Diet:
How To Increase Potassium Intake
A 2018 study out of the journal Nutritional Neuroscience found that subjects with the highest adherence to the DASH diet saw a 36% decrease in overall headaches and were 46% less likely to suffer from a severe headache.
Another 2014 clinical trial out of BMJ found that a reduction in sodium intake via the DASH Diet resulted in a significantly lower risk of headache compared to the control group.
While more research needs to be done, controlling sodium intake appears to be a logical approach to migraine treatment, especially for those who are hypertensive or pre-hypertensive.
Today’s blog post represents a sampling of the best available literature in the realm of migraine prevention and management.
If the dietary recommendations presented in today’s blog post seem daunting and you feel like you’d benefit from further professional support, consider reaching out to Andy to discuss working together.
Other than that, I hope you enjoyed today’s article!
Reviewed and edited by Andy De Santis RD MPH