Migraine headaches have been documented in ancient medical texts for thousands of years. Migraine is a debilitating condition characterized by moderate to severe headaches and nausea, about 3 times more common in women than in men.
The typical migraine headache is unilateral blinding pain (affecting one half of the head) and pulsating in nature, lasting from 4 to 72 hours; symptoms include nausea and vomiting, photophobia (increased sensitivity to light), phonophobia (increased sensitivity to sound), and is often severely aggravated by routine activity. Approximately one-third of people who suffer from migraine headaches perceive an aura; unusual visual, olfactory, or other sensory experiences that are a sign that the migraine will soon occur. If you or someone you know suffers from migraine, you understand just how debilitating this condition can be. Although there is no clear consensus on the mechanisms and causative factors of migraines, much information has been gather over the past few decades, which I will share with you in this article. While medications such as the triptans and analgesics such as acetaminophen can sometimes be useful for relief of migraine, preventing these headaches from occurring presents a major challenge. I wanted to share my knowledge and bring to light some interesting research and references to help people learn more about how to reduce the frequency and severity of migraine. Many factors may act as migraine triggers, including stress, odors, temperature, and hormonal changes, but the single trigger over which you have the greatest ability to control is the food that you eat. Over the past few decades, a numerous amount of research has reported a link between migraine and the food we eat. These effects are attributed to allergy and immune system dysfunction, as well as a chemical effect of food on the brain and vascular system. Migraine diets have been developed, but are of limited value for most people. They’re mostly based on an old idea that certain foods, such as cheeses, chocolate, nuts, etc., contain chemicals (such as tyramine) that produce changes in cranial blood flow, which trigger the onset of migraine. However, this theory has never been conclusive and at least two convincing studies have shown that tyramine was incapable of causing migraines, even when administered alone and in higher dosages (1, 2). Food allergies or hypersensitivities, however, have received much attention and research with respect to migraine headaches. Italian researchers found that people with food-induced migraine develop protein complexes in their blood in which food antigens (proteins) clump together with immune system antibodies (3). These antigen-antibody immune complexes circulate in the blood and trigger an intricate cascade of immune responses (4, 5). The culmination of this is that local blood flow in the brain is altered and a subsequent vascular spasm and migraine occurs. The significant of understanding that food allergy provokes migraine is the recognition that each individual’s ‘migraine diet’ is unique to their own immune system’s reactivity to foods. Many researchers have shown that taking the allergy medication sodium cromoglycate (Chromolyn, etc.) prior to meals can block the induction of food-induced migraine (6, 7, 8, 9, 10, 11) and appears to work by preventing the formation of the antigen-antibody immune complexes. The antibodies involved in the induction of migraines do not appear to be the conventional IgE antibodies that are normally associated with things like hay fever and anaphylactic reactions. In a recent double-blind, placebo-controlled study, it was demonstrated that dietary changes based on the presence of a different type of antibody, IgG, is an effective strategy for reducing the frequency of migraine attacks (12). In this study, patients with frequent migraine headaches had their blood screened for IgG sensitivity to 266 foods. Each individual was given a diet based on their specific IgG allergy in such a way that both the tester and the patient were unaware of the results of their tests. When people consumed a diet that eliminated their high sensitivity foods, the frequency of migraines was significantly reduced. Unfortunately, however, the severity of their migraines was not reduced significantly. IgG allergy testing is available from many different labs in North America. It is not a perfect test but it can certainly help migraine sufferers and their physicians create an individualized program to reduce migraine frequency. In addition to diet, there a several nutritional supplements that have been shown to decrease the frequency and intensity of migraines in controlled trials. The following are the few that have the most research to support their use, and that I have seen in clinical practice to work best: Magnesium citrate: 300mg per day Coenzyme Q10: 300-400mg per day Alpha-lipoic acid: 600 mg per day Riboflavin (Vitamin B2): 400 mg per day References 1. Forsyth W.I., Redmond A. “Two controlled trials of tyramine in children with migraine.” Dev Med Child Neurol 1974; 16: 794-799 2. Moffatt A. M., Swash M., Scott D. F. “Effect of tyramine in migraine; a double-blind study.” J Neurol Neurosurg Psychiatr 1972; 35: 496-499 3. Marteletti P., Sutherland J., Anastasi E., et al. “Evidence for immune-mediated mechanism in food-induced migraine from a study of activated T-cells, IgG4 subclass, anti-IgG antibodies and circulating immune complexes.” Headache 1989; 29: 664-670 4. Marteletti P. “T cells expressing IL-2 receptor in migraine.” Acta Neurol (Napoli) 1991; 13: 448-456 5. Marteletti P., Stirparo G., Rinaldi C. et al. “Disruption of the immunopeptidergic network in dietary migraine.” Headache 1993; 33: 524-527 6. Marteletti P., Bussone G., Centoze V. et al. “Prophylaxis of food-induced migraine with cromolyn sodium: efficacy of short- and long-term use.” Cephalalgia 1989 (suppl 10): 441-442 7. Mansfield L.E., Vaughan T.R., Waller S.F. et al. “Food allergy and adult migraine: double blind and mediator conformation of an allergic etiology.” Ann Allergy 1985; 55: 126-129 8. Monro J., Brostoff J.,Carini C., et al. “Food allergy in migraine.” Lancet 1980; 2: 1-4 9. Monro J., Carini C., Brostoff J. “Migraine is a food allergic disease.” Lancet 1984; 2: 719-721 10. Paganelli R., Levinsky R.J., Brostoff J. et al. “Immune complexes containing food proteins in normal and atopic subjects after oral challenge and effect of sodium cromoglycate on antigen absorption.” Lancet 1979; 1: 1270-1272 11. Doering P. “Drug therapy of food allergies.” In: Perkins J. E. (ed) Food Allergies and Adverse Food Reactions. Aspen Publishers, Gaithersburg, Maryland. 1990. pp 69-79 12. Alpay K., Ertas M., Orhan E.K., et al. “Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial.” Cephalalgia. 2010; 30: 829-37