Preventive Medicine and Nutrition
A Natural Approach to Migraines
Research has shown surprising links between migraines and food. Certain foods can cause migraines, while others can prevent or even treat them. Coffee, for example, can sometimes knock out a migraine and foods rich in magnesium, calcium, complex carbohydrates, and fiber have been used to cure migraines. Some reports suggest that ginger—the ordinary kitchen spice—may help prevent and treat migraines with none of the side-effects of drugs. The herb feverfew also effectively prevented migraines in placebo-controlled research studies.
A migraine is not just a bad headache. It has a characteristic pattern, usually involving just one side of your head. It is a throbbing pain rather than a dull, constant ache, often accompanied by nausea, vomiting, and sensitivity to light and sounds.
See your doctor to evaluate your headache, especially if headaches are new for you, are unusually severe or persistent, or are accompanied by any of these characteristics:
A change in your strength, coordination, or senses
Neck or back pain
A chronic run-down feeling with pain in your muscles or joints
Difficulty thinking or concentrating
Progressive worsening over time
The headache awakens you from sleep
The headache follows head trauma
Find Your Migraine Triggers
In 1983, researchers at the Hospital for Sick Children in London reported their results for 88 children with severe, frequent migraines who began an elimination diet. In this group, 78 recovered completely, and 4 improved greatly. In addition, some children who also had seizures found that their seizures stopped. The researchers then reintroduced various foods and found that they sparked migraine recurrences in all but eight. In subsequent tests using disguised foods, the vast majority of children again became symptom-free when trigger foods were avoided. Migraines returned when trigger foods were added to the diet.1
Since that time, additional research has confirmed that dietary factors can trigger migraines in children and adolescents.2
Anywhere between 20 and 50 percent of adults experience a reduction or elimination of their headaches when common trigger foods are avoided.
Pain-safe foods virtually never contribute to headaches or other painful conditions. These include:
Rice, especially brown rice
Cooked green vegetables, such as broccoli, spinach, Swiss chard, or collards
Cooked orange vegetables, such as carrots or sweet potatoes
Cooked yellow vegetables, such as summer squash
Cooked or dried non-citrus fruits: cherries, cranberries, pears, prunes (but not citrus fruits, apples, bananas, peaches, or tomatoes)
Water: Plain water or carbonated forms, such as Perrier, are fine. Other beverages—even herbal teas—can be triggers.
Condiments: Modest amounts of salt, maple syrup, and vanilla extract are usually well-tolerated.
Common triggers often cause headaches in susceptible people. Just as some food sensitivities manifest as a rash on your skin, migraine sufferers have a reaction in the blood vessels and nerves. Here are the common food triggers, also known as the "Dirty Dozen," in order of importance:
Wheat (bread, pasta, etc.)
Nuts and peanuts
* Includes skim or whole cow’s milk, goat’s milk, cheese, yogurt, etc.
** Includes beef, pork, chicken, turkey, fish, etc.
Certain beverages and additives are also among the worst triggers, including alcoholic beverages (especially red wine), caffeinated drinks (coffee, tea, and colas), monosodium glutamate, aspartame (NutraSweet), and nitrites.
Foods that are neither on the pain-safe list nor the common trigger list should be considered possible, but unlikely, triggers. Almost any common food, other than the pain-safe list, has triggered migraines in an isolated individual in a research study, so they cannot be considered completely above suspicion, but they are far from the most likely culprits.
The Two-Week Test
The first step in tackling your migraines is to check whether any of the common triggers are causing them. To do this, you simply avoid these foods. At the same time, include generous amounts of pain-safe foods in your routine and see whether migraines occur, and, if so, how often.
Here is how to start with anti-migraine foods. For two weeks:
Have an abundance of foods from the pain-safe list.
Avoid the common triggers completely.
Foods that are not on either list can be eaten freely.
The key is to be very careful in avoiding the common triggers. See Foods That Fight Pain by PCRM president Neal Barnard, M.D., for trigger-free recipes.
Confirm Your Food Triggers
If your diet change makes your headaches disappear or become much less frequent, the next step is to confirm which foods are your triggers. To do this, simply reintroduce the eliminated foods one at a time, every two days, to see whether any symptoms result. Start at the bottom of the list (bananas), and work your way up to the riskier foods, skipping any that you do not care for. If you wish, you can then check the beverages and additives on the common triggers list.
As you do this, have a generous amount of each new food, so you will know whether or not it causes symptoms. If it causes no problem, you can keep it in your diet. Anything that causes a headache should be eliminated again. Then, after a week or two, try the suspect food once again for confirmation. Keep your diet simple so you can detect the effect of each newly added food.
Meats, dairy products, and eggs are best left off your plate permanently. Aside from being among the worst migraine triggers, they also tend to disturb your natural hormone balance, which contributes to migraines, as we will see shortly.
Their cholesterol, fat, and animal proteins are linked to serious health concerns including heart disease, high blood pressure, osteoporosis, and cancers of the breast, prostate, and colon, so there is no need to welcome these problem foods back onto your plate.
Looking for Other Food Triggers
If two weeks on the basic anti-migraine diet does not reduce your headaches, the next step is to check whether a food that is not on the list of common migraine triggers may be causing your symptoms. This occasionally happens and, in fact, some people are sensitive to several different foods. An elimination diet will help you sort this out.
A Simple Elimination Diet
The elimination diet is designed to track down any unusual pain triggers. It is used for many other conditions, as well, particularly arthritis and digestive problems. Start by building your menu entirely from the pain-safe foods, avoiding all others for the moment.
Once your symptoms have gone or diminished, which may take a week or so, you can add other foods one at a time, every other day, to see which ones cause symptoms. Again, have a generous amount of each new food so you can see whether it causes symptoms. If not, you can keep it in your diet. Hold off adding any foods on the "Dirty Dozen" list and any of the beverage and additive triggers until last.
Here are some tips to help you identify triggers:
Foods that have caused headaches were usually eaten within three to six hours of the attack.
The offending foods can be ones you are very fond of, perhaps even foods for which you have cravings. They may be the ones you might least suspect.
Sometimes the headache will not show up until a large amount of the culprit is eaten, perhaps over a few days.
If you are affected by several foods, eliminating only one may make no difference at all. This sometimes leads people to believe that foods are not the problem.
You might find that you can have a small amount of a trigger food without getting a headache, while a larger amount brings on the headache.
Your tolerance might be different at different times. For example, a woman might normally be able to eat half a box of chocolates with no problem, but as she approaches her period a single piece might trigger the migraine. The reason, presumably, is that the natural changes in hormones that occur over the month affect her sensitivity.
Your triggers can change over time.
Your doctor can arrange special blood tests to detect food sensitivities. They can be rather expensive, but are faster than elimination diets. Information is available from Serammune Physicians Lab, 1890 Preston White Dr., Reston, VA 22091, 800-553-5472. Typical skin-patch tests are of little use for migraine triggers, since they detect only certain kinds of allergies.
Feverfew: The Anti-Migraine Herb
Feverfew is an herb whose name comes from the fact that the ancient Greeks and many later societies used it as a treatment for fever. Researchers at the City of London Migraine Clinic found that feverfew eliminated about two-thirds of migraines in a selected group of headache patients, which is similar to the effectiveness of most migraine drugs.4However, while some people get a pronounced effect, others get none at all. Averaging everyone together, it eliminates about one-fourth of all headaches.5 This does not mean that it will eliminate precisely one-fourth of your headaches. It will more likely either have a much more noticeable effect or no effect at all.
Feverfew is sold at all health food stores. The amount that has been shown to prevent migraines in research studies ranges from 50 to 114 milligrams per day. However, most practitioners use capsules containing about 250 milligrams of a standardized-potency feverfew, recommending one capsule per day taken on an empty stomach. If you find fresh leaves, the usual dose is two to three leaves per day.
Thousands of people have used feverfew over long periods with no apparent ill effects, and research studies have shown no serious risks. However, there has been little effort to systematically look for side-effects over prolonged periods. I would encourage you to avoid it if you are (or might be) pregnant; there is no indication that it causes birth defects, but not enough data are in to be sure. Also, people with clotting disorders or who are taking anticoagulant medicines should consult with their doctors about taking feverfew. Otherwise, our best information suggests that you can stay on it indefinitely.
Using Foods to Fight Migraines
Emphasize pain-safe foods: brown rice; cooked vegetables, such as broccoli, collards, spinach, and chard; and cooked or dried non-citrus fruits.
Avoid the common trigger foods completely. If your migraines have diminished or ceased, you can reintroduce the trigger foods one at a time to assess their effect.
If steps one and two did not diminish your migraines, an elimination diet can help you identify whether an unusual trigger is causing your problem.
Minimize hormone shifts by avoiding animal products, keeping vegetable oils minimal, and having plenty of high-fiber whole grains, beans, vegetables, and fruits.
Try these supplements, in consultation with your doctor:
Feverfew: 250 milligrams per day or two to three fresh leaves.
Ginger: 1/2 to 1 teaspoon (1 to 2 grams) of fresh powdered ginger per day.
Magnesium: 400 to 700 milligrams per day total (foods plus supplements, if used) or 200 milligrams per day as elemental supplement alone.
Calcium: Reduce calcium losses by avoiding animal protein, caffeine, tobacco, and excess sodium and sugar. If you wish, you can take 1,000 to 2,000 milligrams per day of elemental calcium, with 200 IU (5 micrograms) of vitamin D. Regular physical activity will keep calcium in your bones where it belongs.
If a Migraine Hits
If a migraine occurs, try the following:
Although caffeine can be a migraine trigger for some people, for others it works as a treatment. The dose is one to two cups of strong coffee at the first sign of an attack.
Have a starchy food, such as rice, potatoes, crackers, or bread. Yes, wheat products are migraine triggers for some people, but if you can tolerate them, they might actually help. Some people find that they actually crave starchy foods during migraines and that digging into toast, crackers, pasta, potatoes, or other starchy foods reduces the headache or nausea, and can even shorten the attack. Experience will tell you whether these foods help.
Fresh powdered ginger, 500 to 600 milligrams (about 1/4 teaspoon), in a glass of water has been helpful in anecdotal reports. It can be repeated every few hours, up to about 2 grams per day.
Calcium might be able to treat migraines as well as prevent them. Researchers reported a case of a woman who was able to stop an early migraine by chewing 1,200 to 1,600 milligrams of elemental calcium.4,5 Again, avoid the temptation to get calcium from milk, yogurt, or any other animal source. They cause much more trouble than they are worth.
Lie down in a quiet, dark room, and sleep if you can. Use hot or cold compresses, and massage the blood vessels at the temples.
Biofeedback and acupuncture have been helpful for many people as well.
1. Egger J, Carter CM, Wilson J, Turner MW. Is migraine a food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet 1983;2:865-9.
2. Millichap JG, Yee MM. The diet factor in pediatric and adolescent migraine. Pediatr Neurol. 2003 Jan;28(1):9-15.
3. Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr. 2000 Dec;3(4A):509-14.
4. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J 1985;291:569-73.
5. Murphy JJ, Heptinstall S, Mitchell JRA. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet 1988;2:189-92.
6. Thys-Jacobs S. Vitamin D and calcium in menstrual migraine. Headache 1994;34:544-6.
7. Thys-Jacobs S. Alleviation of migraines with therapeutic vitamin D and calcium. Headache 1994;34:590-2