Migraine Diet: Reintroducing Foods
How Long to Stay on the Diet
A migraine elimination diet is the first step in figuring out your food triggers. Ideally, you’d wait to reintroduce foods until you’ve had a period with no or few migraine attacks—some recommend as long as four months. Given that migraine can have many triggers, not just food, it may be impossible to go even a week without a migraine. In that case, you just need to stay on the elimination diet long enough to establish what your baseline is without those foods. This is easy and obvious for many people, but it’s murkier for others. From my own experience and the reading I’ve done, you need at least six weeks of following the diet strictly and tracking your symptoms and other triggers before reintroducing foods.
(If you stay on the diet for a few months and never reach a point where your migraine frequency, severity, or duration changes, you may want to consult a dietician. It’s possible that you don’t have any food triggers, that your triggers are foods that don’t appear on the common lists, or that you need a digestive enzyme or probiotic to aid digestion. I kept with the diets because I was so convinced that eating anything was a migraine trigger for me. That turned out to be true unless I use DAO, a digestive enzyme, and take probiotics. Even then, I still react to certain foods that don't show up on any of the lists.)
How Long it Takes for a Food to Trigger a Migraine
There’s debate on how long a food could take to trigger a migraine, though the American Council for Headache Education says it usually takes between 12 and 24 hours.1 Some resources say it can take up to three days, but unless your migraines are infrequent and you eat very little variety in your diet, that’s a tough timeframe to track. For me, if a food is going to trigger a migraine, it can take a couple hours, but it’s usually within 30 minutes of eating. Sometimes I can feel the migraine come on before I’ve even finished the meal.
How to Reintroduce Foods
Testing foods can be straightforward, but that’s not always the case. My basic rules are to try to isolate as many variables as possible when you test food, test the food multiple times before reintroducing it to your diet, and remember that no food is necessarily out of your diet permanently.
Test only one food at a time. Do not use any oil, sauces, seasoning, etc. If you start by reintroducing sweet potatoes, for example, eat the sweet potato plain. If you were to test chocolate, you’d need to be sure chocolate is the only restricted ingredient in the list.
Started with cooked foods, which are easier to digest than raw foods. This may reduce its nutritional content, but will be a quicker way to introduce more foods to your diet. This applies to fruit, produce, and even nuts. Peeling the food can make it easier to digest, as can juicing the fruit or vegetable.
Eat a regular serving size. Quantity can matter. You might be fine with a half cup of green beans, but two cups could trigger a migraine for you.
Choose what time of day to test foods. I prefer late afternoon—late enough that my entire day won’t be spent with a migraine, but early enough that I can see a reaction before I go to bed. Depending on how long it takes for you to react to a food, you may find a different time schedule is better for you.
Test a new food every few days at most. I found that I had to devote a week to testing each food. I’d eat a potato one day and, if a migraine didn’t follow, I’d eat another two days later, then do the same two days later. Three introductions can usually provide a good idea of whether or not you react to a food.
If the food triggers a migraine, you may still want to try testing it again. It could be that sweet potatoes are OK most of the time, but not when your other triggers are high (like during stormy weather or when you sleep is disrupted), or that they’re OK as long as you don’t eat them with other high tyramine foods, or you can only have the food every two weeks without a reaction. Or you may need a smaller serving size.
If it seems like you can’t reintroduce any foods without a reaction, consider dose response testing.2 On Day 1, eat a small amount of the food you’re testing between breakfast a lunch (say a 1/4 cup of peas). If you have no reaction four hours later, eat a 1/2 cup of the food between lunch and dinner. If you have no reaction four hours after that, eat a cup of the food. On Day 2, do not add any new foods to your diet, including the one you just tested. You will monitor for reactions to the food that day. On Day 3, you either test a new food or retest the first food. Day 4 is another day to monitor for reactions. If this schedule doesn’t seem to be working for you, you can stretch it out, only testing new foods every three or four days. (I’ve had the most luck testing three different new foods a week, then testing those same foods in the same order then next two weeks. I needed at least that many tests to feel sure that the food was an OK addition.)
Even after you’ve decided a food does not produce a reaction, keep an eye on it after adding it back to your diet. It could be that the food is totally fine or that you can only eat it every four days or that you can only eat it if you don’t combine it with another food.
In time, you’ll be able to figure out your body’s reactions and adjust the testing schedule accordingly. I’ve shared the generally accepted guidelines for testing for food intolerances and what has worked for me. You may find that you only need one test of a food to know if it is a trigger or that you don’t need as much time between tests. I recommend starting conservatively so you don’t undo all the work you did with the elimination diet.
When was your last migraine check-up?