Dietary changes, from ketogenic to vegan diets, may help reduce the frequency and severity of migraines, offering a potential solution to cut down on medication use and improve the quality of life for sufferers.

The Evidence for Diet as a Treatment in Migraine—A Review. Image Credit: fizkes / Shutterstock

In a recent review article published in the journal Nutrients, researchers in Denmark reviewed the role of diets and specific foods in preventing and treating migraines. Their conclusions indicate that certain diets may trigger or reduce symptoms of migraine, modifying the need to use medication and the duration, frequency, and severity of attacks.

Background

Migraines are one of the most prevalent neurological disorders and a significant source of disability in people under 50. Symptoms that affect sight, including blind spots or seeing flashing lights, can be a sign of an oncoming migraine, but migraines without aura can start without warning. Studies also show that migraines significantly impact quality of life, with frequent attacks leading to social and occupational impairments.

Symptoms of migraines, which can be worsened by physical activity, include intense, throbbing, one-sided headaches, nausea, and sensitivity to light and sound. Treatment for migraines often involves managing acute attacks and using preventive medication if needed, but identifying and avoiding triggers may aid their management without medication.

The brain-gut axis connects the enteric and central nervous systems through pathways and nerves, influencing neuroendocrine processes related to migraines. Therefore, changes in diet could modify these communications. The mechanisms behind this are thought to involve vagal nerve signaling, inflammation, and changes in hormone levels, which may be influenced by dietary components.

Previous research suggests that foods like alcohol, caffeine, fruits, and chocolate may trigger migraines, while preventive diets that are plant-based, ketogenic, or low-fat may influence migraines. However, chocolate cravings, which are often blamed as a trigger, may instead be part of the early migraine phase rather than a cause. This nuance highlights the complex relationship between food cravings and migraine onset.

About the study

Researchers gathered evidence on whether specific diets can alter the intensity, duration, and frequency of migraine attacks. They searched medical databases using relevant keywords without applying restrictions on publication year. Notably, studies with different methodologies were included, from clinical crossover trials to controlled and pilot studies, adding to the diversity of the evidence base.

Studies with adult participants undergoing nutritional, dietary, or food interventions compared to a control group were included, with a focus on the role of diet in treating or triggering migraines. Studies that included children or interventions with medications or supplements were excluded, as were those with sample sizes of fewer than ten patients, those where data was not accessible, and non-English papers.

Findings

Researchers screened 669 records and reviewed 38 articles to identify 8 relevant studies. Seven focused on migraine prevention through diet, while one looked at specific food triggers. The sample included clinical crossover trials, controlled trials, and pilot studies.

Two studies focused on the role of ketogenic diets, finding that 3-week and 12-week diets reduced pain intensity and medication use as well as the duration and frequency of attacks. The ketogenic diet is believed to work by shifting the brain’s energy supply to ketone bodies, which may reduce neuroinflammation and oxidative stress in brain cells. Low-carbohydrate diets were not significantly different from ketogenic diets regarding these outcomes.

Dietary Approaches to Stop Hypertension (DASH) diets appear to reduce pain intensity and the duration and frequency of attacks. This diet’s high potassium, calcium, and magnesium content, alongside reduced sodium intake, may help regulate brain function and reduce inflammation, providing a protective effect against migraines. A gluten-free diet, based on one study, contributed to significant improvements in pain intensity and frequency for migraine patients, especially compared to people with tension-type headaches. Gluten-free diets may be particularly beneficial for those with celiac disease, as gluten has been shown to provoke immune responses that could exacerbate migraines.

Elimination diets showed mixed responses based on three studies. One paper found no impacts on attack intensity or duration but reduced medication use and attack frequency. Another decreased medication use, pain intensity, frequency, and duration of attacks. The third followed participants over 16 weeks, finding that low-fat vegan diets reduced pain intensity, attack duration, and frequency, and greater effects were seen for groups following stricter diets. Elimination diets, while showing potential, rely heavily on participants’ ability to identify and avoid trigger foods, which can be subjective and prone to recall bias.

Conclusions

The review’s findings indicate that certain diets, including gluten-free, low-fat vegan, DASH, and ketogenic, may reduce the severity, frequency, and duration of migraine attacks and associated medication use. Elimination diets that avoid specific foods may also be beneficial.

Researchers caution that many of the studies reviewed were short-term and relied on self-reported data, which introduces the possibility of recall bias and social desirability bias. The use of medication was allowed in many studies but not consistently reported, while methods to identify eliminated foods were not applied systematically. Furthermore, small sample sizes and varied study designs make applying these findings to clinical practice difficult. The studies also took place over short durations and drew conclusions based on self-reported data, which may be prone to errors of recall or a source of bias related to social desirability.

Thus, while there is some evidence that specific diets may help migraine patients, more robust research, particularly extensive, double-blinded studies and randomized controlled clinical trials, is needed to confirm the findings. Future research should aim to control for medication use, weight changes, and other factors, such as the menstrual cycle, that can influence migraine outcomes.