Food Allergy Testing for Migraine Triggers
Is food allergy testing a good way to test for migraine triggers? This is a common question when people are overwhelmed by the details of an elimination diet. The answer is: it’s complicated. Food allergies usually cause some sort of reaction every time the trigger food is eaten, though the symptoms may vary from one reaction to the next, according to the American College of Allergy, Asthma, and Immunology.1Food-related migraine triggers are notorious for sometimes causing a reaction and other times not (this is one reason finding migraine triggers can be so frustrating).
It’s far more common for a food intolerance—not an actual allergy—to be a migraine trigger. There’s no accurate test for food intolerance. There are so many different reasons a person could have a food intolerance (reactions can be immunological, physiological, or biochemical in origin) that it’s impossible to create a test to assess all of these factors, many of which cannot be tested.2 An allergist I consulted said that food intolerances are a mystery. They enter your digestive tract and some magical alchemy that’s unique to your own body happens. And there’s no way to see what, exactly, is happening. My dietician backed this up and added that food intolerances aren’t well-studied because there is no funding from pharmaceutical companies for the research.
Even testing for food allergies is not as straightforward as it may seem. Allergists test for food-specific immunoglobulin E (IgE) antibodies in a patient’s body. Their presence indicates an allergy, though 50% to 60% of blood and skin tests for food allergies result in false positives.3 Food challenges, where a person is given increased amounts of a food and assessed to see if a reaction occurs, are considered the best way to test for food allergies.1 True food allergies can cause anaphylactic shock. If you suspect an allergy, rather than an intolerance, please see an doctor for testing and guidance.
Some food allergy tests also look for IgG or IgA antibodies. Professional organizations of allergists say that these are tests are inaccurate and unreliable for testing food allergies.4-7 However, a couple studies published in migraine-related journals have found that eliminating foods that provoke IgG responses reduced migraine attacks in participants.8-9 IgG responses may also be connected to irritable bowel syndrome, which is a condition that’s comorbid with migraine.10-12 Additionally, celiac disease is associated with IgA and IgG antibodies.
In short, allergy testing might help you determine what your food-related migraine triggers are, but it might not. Your insurance is far more likely to cover IgE testing than IgG or IgA tests, unless celiac disease is suspected. You can see a traditional allergist for IgE testing, but will most likely need to find a naturopath to do IgG or IgA testing for anything other than celiac disease. The tests generally cost between $X and $X.
If you can afford the testing and aren’t ready to commit to a complicated and restrictive migraine elimination diet, food allergy testing might be a good place to start. If you do eliminate foods based on the test results and have an improvement in your migraine frequency or severity, talk to your doctor about an oral challenge of foods on the list. Even if your test results say you’re allergic to 12 foods, you might find that only two are actually problematic for you. (Only do this with your doctor’s supervision.) If eliminating the foods doesn’t help and you’re still convinced foods are a trigger for you, then an elimination diet is probably the next step.
How much has your migraine disease changed or evolved over time?