The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review

Abstract

Background.-Migraine is a disabling primary headache disorder often associated with triggers. Diet-related triggers are a common cause of migraine and certain diets have been reported to decrease the frequency of migraine attacks if dietary triggers or patterns are adjusted. Objective.-The systematic literature review was conducted to qualitatively summarize evidence from the published literature regarding the role of diet patterns, diet-related triggers, and diet interventions in people with migraine. Methods.-A literature search was carried out on diet patterns, diet-related triggers, and diet interventions used to treat and/or prevent migraine attacks, using an a priori protocol. MEDLINE and EMBASE databases were searched to identify studies assessing the effect of diet, food, and nutrition in people with migraine aged ≥18 years. Only primary literature sources (randomized controlled trials or observational studies) were included and searches were conducted from January 2000 to March 2019. The NICE checklist was used to assess the quality of the included studies of randomized controlled trials and the Downs and Black checklist was used for the assessment of observational studies. Results.-A total of 43 studies were included in this review, of which 11 assessed diet patterns, 12 assessed diet interventions, and 20 assessed diet-related triggers. The overall quality of evidence was low, as most of the (68%) studies assessing diet patterns and diet-related triggers were cross-sectional studies or patient surveys. The studies regarding diet interventions assessed a variety of diets, such as ketogenic diet, elimination diets, and low-fat diets. Alcohol and caffeine uses were the most common diet patterns and diet-related triggers associated with increased frequency of migraine attacks. Most of the diet interventions, such as low-fat and elimination diets, were related to a decrease in the frequency of migraine attacks. Conclusions.-There is limited high-quality randomized controlled trial data on diet patterns or diet-related triggers. A few small randomized controlled trials have assessed diet interventions in preventing migraine attacks without strong results. Although many patients already reported avoiding personal diet-related triggers in their migraine management, high-quality research is needed to confirm the effect of diet in people with migraine.

A Review on the Triggers of Pediatric Migraine with the Aim of Improving Headache Education

“…Evaluating the role of diet in migraine is complex because multiple triggers and variables can modify the pain threshold in an individual, and this factor is frequently neglected in favor of preventive drug therapy for pediatric patients [ 75 ]. Although chocolate is the most frequent dietary trigger for migraines in children [ 23 , 74 ], a recent review article found insufficient evidence of chocolate being described as a definitive migraine trigger [ 76 ].…”

“…Current research on adults shows that high folate diets, low-fat diets, low-sodium diets, foods high in high omega-3 fatty acids, and ketogenic diets are effective in reducing migraines [ 79 , 80 ]. However, there is a lack of scientific evidence to support these diets as a therapeutic recommendation [ 75 ]. Even chocolate lacks sufficient evidence of being labeled a proper trigger, as per a recent systematic review [ 76 ].…”

“…Even chocolate lacks sufficient evidence of being labeled a proper trigger, as per a recent systematic review [ 76 ]. Certain dietary interventions may improve clinical outcomes in some individuals with migraines; these associations need to be confirmed by high-quality longitudinal studies [ 75 ].…”

A Bidirectional View of Migraine and Diet Relationship

“…21 In the following sections, some examples from the current literature are presented to highlight what we already know about the effects of diet on migraine and the effects of migraine on dietary choices, and what remains unknown to stimulate further research. Therefore, the purpose of this targeted review is not to provide a comprehensive systematic review of the current literature on the role of diet in migraine; since several excellent reviews are already available (eg, 9,[22][23][24][25][26] ). PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies using keywords of diet, migraine, food, and lifestyle with the aim of providing the current overview, and a viewpoint to the potential future directions.…”

The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment

“…This type of primary headache usually presents with recurrent, typically unilateral and pulsating attacks of severe headaches, lasting from 4 to 72 h, with accompanying symptoms including photophobia, phonophobia, nausea, and vomiting [ 3 ]. Caffeine has been linked with migraine for many years, on the one hand as a trigger, and on the other as a cure [ 4 , 5 , 6 , 7 , 8 ]. As most of the population, including migraine sufferers, consume a considerable amount of coffee and other caffeinated drinks and foods daily, a question arises as to whether it influences their headaches.…”