What dietary modifications are indicated for migraines?

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Clinical Inquiries

What dietary modifications are indicated for migraines?

J Fam Pract. 2006 January;55(1):62-66

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References

1. Peatfield RC, Glover V, Littlewood JT, Sandler M, Clifford Rose F. The prevalence of diet-induced migraine. Cephalalgia 1984;4:179-183.

2. Ziegler DK, Stewart R. Failure of tyramine to induce migraine. Neurology 1977;27:725-726.

3. Jansen SC, van Dusseldorp M, Bottema KC, Dubois AE. Intolerance to dietary biogenic amines: a review. Ann Allergy Asthma Immunol 2003;91:233-240.

4. Nicolodi M, Sicuteri F. Wine and migraine: compatibility or incompatibility? Drugs Exp Clin Res 1999;25:147-153.

5. Salfield SA, Wardley BL, Houlsby WT, et al. Controlled study of exclusion of dietary vasoactive amines in migraine. Arch Dis Child 1987;62:458-460.

6. Peatfield R. Relationships between food, wine, and beer-precipitated migrainous headaches. Headache 1995;35:355-357.

7. Marcus DA, Scharff L, Turk D, Gourley LM. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia 1997;17:855-862.

8. Harel Z, Gascon G, Riggs S, Vaz R, Brown W, Exil G. Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents. J Adoles Health 2002;31:154-161.

9. Schoenen J, Jacquoy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998;50:466-470.

10. Boehnke C, Reuter U, Flach U, Schuh-Hofer S, Einhaupl KM, Arnold G. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol 2004;11:475-477.

11. Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996;16:257-263.

12. Facchinetti F, Sances G, Borella P, Genazzani AR, Nappi G. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991;31:298-301.

13. Bic Z, Blix GG, Hopp HP, Leslie FM, Schell MJ. The influence of a low-fat diet on incidence and severity of migraine headaches. J Womens Health Gend Based Med 1999;8:623-630.

14. Hering-Hanit R, Gadoth N. Caffeine-induced headache in children and adolescents. Cephalalgia 2003;23:332-335.

15. Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache 2004;44:885-890.

16. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;55:754.Available at: www.guideline.gov/summary/summary.aspx?doc_id=2820. Accessed on December 7, 2005.

17. Mauskop A, Graff Radford S. Special treatment situations: alternative headache treatments. In: Standards of Care for Headache Diagnosis and Treatment. Chicago, Ill: National Headache Foundation; 2004:115. Available at: www.guideline.gov/summary/summary.aspx?doc_id=6588. Accessed on December 8, 2005.

Magnesium. A good-quality RCT of 81 adults given 600 mg of magnesium or placebo showed that by weeks 9 to 12 frequency of attacks was reduced by 41.6% in the magnesium group and by 15.8% in the placebo group compared with the baseline (P<.05; NNT=3.9). However, diarrhea was reported among 18.6% of magnesium recipients (NNH=5.2).¹¹ Additionally, a very small randomized trial of 20 women found that magnesium 360 mg/d in the luteal phase reduced the number of days with menstrual-related migraines (P<.03) when compared with placebo. However, the absolute magnitude of the difference was not reported, so it is unclear if this study is clinically useful or can be extended to all patients with migraines.¹²

FAST TRACK

No food or food additive has been proven to cause migraine, but some nutrients reduce their frequency and intensity

Low-fat diet. A prospective cohort trial of 54 patients evaluated the effect of lowering total fat intake per day. The dietary intervention successfully lowered fat intake from 65.9 to 27.8 g/d and was associated with statistically significant decreases in headache frequency (median decrease from 6 to 1 per week), intensity (median decrease 2.9 to 0.5 on a scale from 0 to 5), duration, and medication intake (P<.0001 for all measures, confidence interval not available).¹³

Caffeine. One case series found that adolescents and children ingesting over 1400 mg/wk of caffeine from cola drinks experienced resolution of headaches with gradual reduction in cola intake,¹⁴ but no prospective trials to confirm this observation have been completed. It is important to note that reduction in migraines may have been due to reduction in other ingredients, not just caffeine.

FAST TRACK

An empiric trial of magnesium and riboflavin is worth considering, as is a low-fat diet high in omega-3 fatty acids and olive oil

Riboflavin/magnesium/feverfew. One double-blind RCT compared a compound with daily doses of riboflavin 400 mg, magnesium 300 mg, and feverfew 100 mg with the proposed placebo of riboflavin 25 mg. There was no difference in response between the compound and the riboflavin placebo; however, response to riboflavin 25 mg was higher than expected for a placebo (44%). Further study with a placebo free of active ingredients is required to determine the ultimate effectiveness of this compound.¹⁵

TABLE
Effects of dietary compounds on migraine headaches

DIETARY COMPOUND OR DIET TYPE	EFFECT ON MIGRAINES	ADVERSE EFFECTS
Vasoactive amines	0	0
Chocolate	0	0
Omega-3 fatty acids	0	0
Low-fat diet (<20 g/day)	+	0
Riboflavin 400 mg/day	+++	+
Magnesium	++	++
Caffeine	?	?
Riboflavin/magnesium/feverfew	?	?
Key: 0=no effect, +=slight effect, ++=moderate effect, +++=large effect, ++++=very large effect.

Recommendations from others

The American Academy of Neurology makes no mention of dietary therapy in its most recent guideline on migraine, but it does identify both riboflavin (fair evidence) and magnesium (weak evidence) as safe options for preventing migraine.¹⁶ The National Headache Foundation makes no statement regarding dietary therapy for migraines, but it does identify riboflavin and magnesium as possible preventive therapies.¹⁷

Acknowledgments

The opinions and assertions contained herein are the private views of the author and not to be construed as official, or as reflecting the views of the US Air Force Medical Service or the US Air Force at large.

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