(DougCookRD.com)
Guest contributor: Alida Iacobellis, Dietetic Intern and MHSc Candidate
Headaches and migraines affect about 1 out of every 6 Americans. 1 in 5 of those affected are women. Research shows that headache is consistently the fourth or fifth most common reason for visits to the emergency department, demonstrating the severe burden headaches and migraines can have on our quality of life (1). Similar numbers are also found in Canada where headache is a common reason why patients seek help from family physicians. Migraines are by far the most common type of headache that people seek help for (2).
Many people who suffer from chronic headaches and migraines often do so without much relief from traditional treatments and pain management techniques. When all else fails, many start to question whether diet may have a role to play in preventing the onset of headaches and migraines. When we look to the science, the relationship between diet and headache is complex and far from clear-cut. While some studies have linked food triggers as a key factor in the onset of headaches and migraines, others point towards food allergies, hypersensitivities, and eating patterns (3).
The Gut-Brain Connection
The gut-brain connection is one that has been presented in research time and time again as a contributing factor in many gastrointestinal disorders. Research shows that the gut and the brain are highly connected. The brain communicates with the gut, and the gut communicates with the brain too (4). This is done largely through the autonomic nervous system – the system which regulates body processes such as digestion, breathing and heart rate, all without our conscious effort.
Dietary Triggers and Migraines
Because of the close connection between the gut and the brain, it makes sense that food could have a role to play in the prevention and treatment of headaches and migraines.
Many people report that various foods trigger their headaches. The most commonly reported food triggers for migraines include: (3)
- Cheese
- Chocolate
- Citrus fruits
- Alcohol (especially red wine)
- Coffee (and other sources of caffeine)
Aside from the consumption of whole foods being related to the onset of headaches and migraines, certain ingredients and food additives have also been linked: (5)
- Monosodium glutamate (MSG)
- Artificial sweeteners
- Nitrates
- Gluten
- Histamine
Food Allergies and Migraines
For the past 80 years, there has been suspicion among the medical community as to whether headaches and migraines could be a symptom of food allergies. This suspicion is often confirmed in patients who are put on an elimination diet only to experience a reduction in the duration and severity of their headaches when their allergen is removed (6). IgE and IgG food allergy tests have also been used widely in research to identify potential allergens in patients who suffer with headaches and migraines with good success (3, 6).
Before you get your hopes up about food allergy testing being the answer to all your headache and migraine woes, it’s important to understand 2 things: (1) the difference between a food allergy and a food intolerance and (2) the validity of the IgE and IgG tests (or their ability to measure what they are intended to – the true presence of food allergies).
In today’s highly allergic and food intolerant society, it’s easy to get the terms mixed up, but there is an important distinction between the two. When we look at how our body’s systems respond during an allergic reaction (such as an anaphylactic allergic reaction to peanuts), we see symptoms like hives, itchy swollen tongue, wheezing, and swelling of the airway which can eventually lead to death if the allergic reaction isn’t treated in time (7).
In a true allergic reaction, the body is launching an immune response; it’s recognizing something you’ve consumed or been exposed to as a dangerous, foreign substance and launching an all-out attack in response. Food intolerances are a little different. There is no immune response here, and symptoms tend not to be as extreme. Food intolerances usually come along with gastrointestinal symptoms like nausea, abdominal pain, and diarrhea, in addition to symptoms like headache and migraine.
IgG and IgE Food Allergy Testing for Headache and Migraine Relief
IgG and IgE food allergy test are commonly used to identify food allergies. These tests analyze levels of antibodies present in your blood which are related to specific foods. These antibodies are a reflection of our immune system, so in theory they would be related to food allergies (not intolerances).
The IgE test is the one that is most commonly used by doctors as a part of the process of diagnosing a food allergy. IgE antibody levels are often high in people with food allergies who also exhibit traditional food allergy symptoms. IgE mediated allergic reactions are known as immediate type hypersensitivity reactions, since the allergic reaction occurs within minutes to hours after exposure to an allergen (8).
The IgG test is less helpful. With IgE, higher levels in response to specific foods are associated with the presence of an allergy. Here’s the difference: we know that people without allergies produce and maintain high IgG levels specific to the foods they eat on a regular basis. So really, the foods that come back with the highest values on an IgG test are usually just a reflection of what you normally eat, not an indicator of what you might be intolerant to. As a result, the results of these tests are difficult to interpret correctly, even by trained professionals. The bottom line: making changes to your diet based on IgG test results is not advised (9).
Anecdotally, many people who have had these tests done have reported significant relief from their headaches and migraines after eliminating the foods identified as allergens by the test, but the science behind the validity of these tests doesn’t provide such a strong case.
Elimination Diets for Headache and Migraine Relief
Given that headaches and migraines aren’t typically symptoms of food allergies, it doesn’t make a whole lot of sense to be testing for allergies in the first place. Food intolerances are more likely, and the best way to figure out your food intolerances is through an elimination diet.
An elimination diet can be done in a number of ways depending on how strict and strategic you want to be. A more relaxed approach is to eliminate one suspect food at a time for a period of a few days to a week without changing anything else about your diet, then add that one food back in to see if you notice a difference.
A stricter approach would be to eliminate all suspect foods for a period of time, then add one at a time back in to see which ones affect you and which ones are safe. This more extreme approach should be supervised by a dietitian or other health care professional to ensure your nutrient needs are being met.
Fasting and Migraines
Now that we’ve covered the topic of how what you’re eating could be contributing to headaches and migraines, it’s time to talk about how what you’re not eating could really be the problem. That’s right, fasting is also often reported as a trigger for headaches and migraines (3).
When we go long periods without eating our blood sugar drops, and there is evidence to support that low blood sugar could be a trigger for headaches and migraines. In migraine sufferers who experience low blood sugar, an intervention which had them eating 6 smaller meals evenly spaced throughout the day resulted in a 75% reduction in the frequency of their migraines (3).
With this evidence in mind, it’s safe to say that if you suffer from chronic migraines and headaches and have a tendency to skip meals or eat erratically, taking small steps towards a more balanced diet and regular eating pattern may be just what you need.
The Bottom Line
It is absolutely possible that food or some aspect of your dietary habits and eating patterns is contributing to your headaches and migraines. An individualized approach is needed to determine what your triggers are, and how best to manage them in order to reap the potential benefits of headache and migraine relief.