A Nutrition Intervention for Migraines - New Study Indicates Elimination Diet May Work

Dietary modification to eliminate triggers and help prevent migraine attacks is nothing new. Many of us take dietary supplements, such as magnesium and/or CoQ10, at the advice of our doctors in the hopes of reducing our migraines. Most of us also have some foods or drinks we avoid on a regular basis because ingesting them nearly always guarantees we’ll be laid up in bed with the lights out before dark.

Of course, everyone’s triggers are different, and that can make figuring out which foods – if any – trigger a particular person’s migraines exceedingly difficult, especially when compounding triggers means a food might trigger an attack one day but might not another.

To get around these difficulties, some migraine treatment plans recommend following a complete elimination diet, in which you remove from your diet all of the foods and chemicals most often associated with migraine and then gradually re-introduce them one at a time to see which ones cause an increase in migraine severity and/or frequency.

Foods and chemicals most often excluded in elimination diets include:

  • Caffeine
  • Alcohol
  • Aged cheeses
  • Chocolate
  • Dried fruits
  • Deli meat
  • Hot dogs
  • Sausage
  • Jerky
  • Pepperoni
  • Corned beef
  • Soy
  • Nuts
  • Citrus fruits
  • Vinegar
  • Tyramine
  • Phenylethylamine
  • Nitrates
  • Nitrites
  • MSG
  • Tannins (found most often in red-skinned apples and pears, red wine, and tea)
  • Sulfites
  • Aspartame (aka NutraSweet and Equal)
  • Yeast extract
  • Hydrolyzed or autolyzed yeast
  • Hydrolyzed vegetable protein (HVP)
  • Hydrolyzed plant protein (HPP)
  • Sodium caseinate, and
  • Kombu extract

If that list overwhelms you, you’re not alone.

Many migraineurs balk at the idea of following a complete elimination diet, thinking it’s too hard to stick to, especially in today’s busy world where few of us find the time to cook on a regular basis. Some also feel that there simply isn’t enough evidence to prove such a diet works. A new study, presented at this year’s American Academy of Neurology annual meeting in Philadelphia and published in April in Neurology, may help change that.

In “A Nutrition Intervention for Migraine,” Drs. A. Bunner, J. Gonzalez, F. Valente, U. Agarwal, and N. Barnard examined the effects of a low-fat, plant-based dietary intervention plan on migraine severity and frequency in chronic migraineurs. The study’s hypothesis was that a low-fat vegan diet would improve migraine pain more effectively than a dietary supplement regimen. The results, while not perfect, demonstrate that dietary modification in general and elimination diets in particular may indeed work to reduce the frequency and the intensity of migraine attacks.

The authors recruited 42 chronic migraineurs from the Washington, D.C. area to participate in the study. Once recruited, the migraineurs were randomly assigned to receive either a dietary instruction plan or a dietary supplement plan. The participants then followed the plan for 16 weeks.

Once the 16 weeks were over, the participants underwent a 4-week “washout” period during which time no treatment was given. Following the washout period, the participants were given the other treatment plan (either the dietary supplement or the dietary instruction plan, whichever they didn’t get the first time). They then followed it for 16 weeks.

“During the diet period, a low-fat vegan diet was prescribed for 4 weeks, after which an elimination diet was used to enable participants to identify possible specific pain trigger foods,” stated the authors in the study’s abstract. (The dietary supplement plan featured a mixture of omega3 and vitamin supplements.) “Dietary intake, headache number, headache intensity, visual analog pain measurements, body weight, and plasma lipid concentrations, were assessed at the beginning, midpoint, and end of each 16-week period.”

According to the study, participants reported significantly more improvement (p<0.05) during the dietary instruction period than during the dietary supplement period in visual analog pain scale, total cholesterol, LDL cholesterol, and body weight. Significant decreases in headache intensity and frequency were also reported during the diet period, but the results "did not reach statistical significance when compared with the supplement period.”

These results seem to indicate that an elimination diet may indeed act as a migraine preventative, perhaps even more so than regularly prescribed dietary supplements, if migraineurs start by eliminating all high-fat foods and animal products from their diets, and then gradually reintroduce them one at a time over the course of many weeks. The authors seem to agree.

“These results demonstrate the promise of a nutritional approach to migraine treatment. [Still] Further studies are needed to enable dietary pain triggers to be isolated from other triggers such as stress and hormonal changes,” stated the authors in their conclusion.1,2

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