November/December 2021 Issue
Integrative Nutrition: Nutrition for Headaches and Migraines
By Lisa Andrews, MEd, RD, LD
Vol. 23, No. 9, P. 16
Certain lifestyle and dietary factors may affect incidence and severity.
A wicked headache can ruin an entire day. Severe headaches, such as those characteristic of migraines, can result in loss of work, reduced social time, and decreased activities of daily living. From the pounding pain to the accompanying nausea and light sensitivity, relief from this type of headache is worth its weight in gold.
Primary headaches—those not caused by underlying disease such as brain tumors, aneurysm, or brain injury—are common and are diagnosed based on certain criteria and patterns of occurrence. Examples include migraines, cluster headaches, and tension headaches. Migraine headaches are recurrent and typically impact one side of the head, and may be accompanied by nausea or vision changes. Cluster headaches are severe and tend to happen over a period of a few weeks; they’re marked by pain that occurs on one side of the head. Tension headaches are the most common type of headache, often brought on by stress or emotional conflict.1
Migraines affect more than 15% of US adults and are considered one of the most common forms of disability globally. Roughly 3% of visits to the emergency department in the United States are related to severe headaches.2
According to a 2018 national health interview survey published by the Centers for Disease Control and Prevention, women were almost twice as likely to have had a severe headache in the past three months compared with men (20.1% vs 10.6%, respectively).3 Headache is particularly common among women of childbearing age; nearly 40% of women experience migraines during their reproductive years. The likelihood of migraine grows after the first menstrual cycle, during monthly menstruation, in the postpartum period, and throughout perimenopause. During pregnancy, prevalence of headache is lower in the second and third trimester than the first and generally lower post menopause.4
Children and teens also suffer from severe headaches at high rates. A systematic review from 1990 to 2007 showed prevalence of headache and migraine at 58.4% in this population.5 Headaches in kids may impact their social lives, as well as their ability to engage in extracurricular activities and pay attention in school. A recent global assessment estimates that migraine and tension headaches account for 37.5% of all headaches among children and teens. As with adults, headaches are more common in young females.5-7
Headaches are thought to have multiple causes. Some theorize that tight muscles and open or expanded blood vessels in the head are responsible. Migraines were initially posited to be due to dilated vessels in the brain but now are believed to be the result of alterations in neuropeptides (released by the trigeminal nerve in the brain), which trigger substance P, a compound linked with pain.7,8
Specifically, the neuropeptide calcitonin gene-related peptide (CGRP) has been investigated as a cause of headaches. When dispensed from central and peripheral nerve terminals, CGRP initiates a chain reaction that includes increased production of nitric oxide and sensitization of the trigeminal nerve. Drug therapy for headaches includes medications that block CGRP signaling in the trigeminovascular system. The brain’s hypothalamus may be linked with the progression of migraines through the regulation of neuropeptide Y, which controls fatigue, hunger, thirst, and body temperature; higher levels are seen in those with migraine.8,9
Women may be more susceptible to severe headaches due to fluctuations in the hormone estradiol, possibly related to the use of hormonal birth control methods throughout the reproductive years and hormone replacement therapy in menopause and post menopause. Furthermore, drops in estrogen may be the cause of menstruation-related migraine.10
In addition to their detriments to quality of life, migraines may impact risk of stroke, CVD, and all-cause mortality. A 2018 meta-analysis published in BMJ Open found that migraines were associated with higher rates of stroke and heart attack but not all-cause mortality. However, individuals who suffer from migraines with aura (seeing flashes of color or experiencing other sensations along with migraine) were at higher risk of CVD and all-cause mortality.11
Diet and Nutrition’s Potential Role
The following diet- and nutrition-related factors, as well as foods and food ingredients, are associated with greater incidence and severity of headaches:
• Dehydration. Nerve cells depend on fluid intake to function, and lack of fluid in muscles, nerves, and blood vessels in the brain causes pain. In addition, dehydration can cause the brain to contract or pull away from the skull, leading to pain and a dehydration headache.12
• Chronic lifestyle-related conditions. In studies using oral glucose tolerance tests, those with insulin resistance experienced more migraines compared with controls. However, people who experience migraines are less likely to develop type 2 diabetes, though some individuals with type 2 diabetes are less prone to migraines. Scientists believe the relationship between insulin resistance and migraine may be due to the action of two neuropeptides (CGRP and PACAP, or pituitary adenylate cyclase-activating polypeptide) involved with both migraine-related pain and release of insulin from beta cells. Manipulation of these neuropeptides may help treat both conditions. Obesity and hypertension also appear to be risk factors for migraine.13
• Caffeine consumption, as well as withdrawal, may trigger severe headaches. In a 2020 review of 28 studies, 17 found that caffeine withdrawal was a trigger for migraine in 2% to 30% of sufferers and that caffeine consumption, in addition to use of pain relief medications, is a safe and appropriate treatment for headaches. In caffeine users who suffer from headaches associated with caffeine consumption, 200 mg caffeine per day is considered a safe amount; caffeine cessation isn’t indicated for most.14
• Food additives and components. Sulfites (found in alcohol, some fruit, apple cider, and processed foods that contain certain preservatives), MSG, and artificial sweeteners are a few examples of ingredients that may produce headaches. Furthermore, tyramine, a compound formed from the breakdown of the amino acid tyrosine, may cause headaches. Tyramine, found in aged cheese, smoked fish, cured meats, liver, and certain types of beer, is broken down by the enzyme monoamine oxidase, which is precluded by monoamine oxidase inhibitor (MAOI) medications such as some antidepressants. Therefore, clients taking MAOIs may experience higher rates of migraine because they prevent the breakdown of tyramine. Experts suggest that tyramine may cause nerve cells to release norepinephrine, which causes chemical levels in the brain to change and lead to pain. Avoiding foods high in tyramine when taking MAOIs may help prevent headache and other unwanted side effects such as high blood pressure.15,16
As with other chronic conditions, diet may play a role in the prevention and treatment of severe headaches. The following nutrients, dietary patterns, and supplements may help avert or lessen headaches:
• Low-fat vegan diet. A small randomized crossover study with 16 weeks of treatment and four weeks of washout in between showed that a low-fat plant-based diet reduced average headache frequency and improved pain.17
• Low-carbohydrate diets. Keto and modified Atkins diets may aid in neuroprotection by improving mitochondrial function and energy metabolism, and reducing CGRP and inflammation. This type of diet also may help promote weight loss, which can be beneficial because obesity is a risk factor for migraines.18
• Omega-3 fatty acids. Balancing omega-3 and omega-6 fatty acid intake can help improve inflammation, platelet function, and vascular tone regulation. Including fatty fish, flaxseeds, chia seeds, and walnuts in the diet increases omega-3 intake.18
• Elimination of trigger foods. Kellie Blake, RDN, LD, IFNCP, co-owner of the private practice NutriSense Nutrition Consulting in the Charleston- Huntington region of West Virginia, says, “I address adverse food reactions in headache sufferers. Research has shown some specific trigger foods, including caffeine, chocolate, cheese, citrus fruits, alcohol, nitrates, and MSG, [but] clients can have sensitivities to any food. I start with an elimination diet to remove known food allergens, inflammatory foods, and food additives/dyes.” Eliminated foods tend to include common allergens such as gluten, eggs, shellfish, soy, fish, dairy, peanuts, and tree nuts, while inflammatory foods may include foods high in saturated and trans fat, alcohol, and added sugars. These foods may contain histamines, which have been found to cause migraines. Observational studies also suggest that gluten and alcohol may impact subgroups of people with migraines. The use of a food diary and expertise and assistance from RDs is important in monitoring symptoms and helping clients navigate various diet restrictions.15
• Dietary Approaches to Stop Hypertension (DASH) diet. In a study of 266 participants aged 18 to 45, researchers discovered that those with greater adherence to the DASH diet were 30% less likely to suffer from severe headaches compared with those with low adherence. Participants in the highest quartile of adherence were 46% less likely to experience severe headaches.19
• Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. This dietary pattern shows promise in reducing risk of migraines. In one study, subjects on the MIND diet with the greatest adherence were 36% less likely to have severe headaches compared with participants with the lowest adherence.20
• Vitamin D. A review of studies on vitamin D shows it may be beneficial in reducing the frequency of migraines, but mainly in those with vitamin D deficiency. More research is needed to support supplementation for those without deficiency.21
• Magnesium deficiency may cause neurological issues, including migraine; low serum and cerebrospinal levels of magnesium have been linked to migraine. Supplementation of magnesium may be oral, IV, or transdermal, but transdermal magnesium replacement hasn’t been well researched and isn’t advised for most.22,23
• Ginger. Danielle Aberman, RDN, CLT, CHWC, co-owner of Migraine Strong in Stuart, Florida, cites one study: “Ginger, in the form of supplement capsules, can be very helpful in treating an acute headache or migraine attack. A small study showed that ginger was successful when used in an emergency room setting for patients admitted for migraine episodes.” Those who received ginger plus a nonsteroidal anti-inflammatory drug reported less pain and greater function than participants who were administered the drug alone.24
• Turmeric. Susannah Juteau, MSc, RD, CLT, owner of Headache Nutritionist in the San Francisco area, says, “Turmeric has evidence that it’s effective at reducing symptoms and attacks. A recent study evaluated 100 people who regularly experienced migraine. Those who took curcumin (the active component in turmeric) and coenzyme Q10 experienced a reduction in headache days, severity, and duration.”25
Simply striving for a more balanced eating pattern can help some clients. Kelli Yates, RDN, LD, CLT, known as The Migraine Dietitian in Atlanta, says, “Major blood sugar fluctuations can contribute to headaches—striving for balanced meals that contain protein, fat, and fiber can help keep blood sugar steady. Headaches, and migraines in particular, have a link to the gut microbiome. Eating a high-fiber diet has the potential to reduce severity and frequency of migraine headaches.”26
Because there are nutrition-related causes and preventive measures of migraines, RDs are specifically poised to help treat this common condition. As more research becomes available, RDs must stay up to date on what’s best for their clients. And, as with all conditions, treatment of migraines should be individualized.
— Lisa Andrews, MEd, RD, LD, is a Cincinnati-based dietitian and owner of Sound Bites Nutrition. She shares her love of nutrition through cooking demos, freelance writing, and the creation of food pun swag for food insecurity programs. Follow her on Instagram @nutrigirl66 or on her website, soundbitesnutrition.com.
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