Medicine and Nutrition
Approach to Migraines
Research has shown surprising links between
migraines and food. Certain foods can cause migraines, while
others can prevent or even treat them. Coffee, for example, can
sometimes knock out a migraine and foods rich in magnesium,
calcium, complex carbohydrates, and fiber have been used to cure
migraines. Some reports suggest that ginger—the ordinary kitchen
spice—may help prevent and treat migraines with none of the
side-effects of drugs. The herb feverfew also effectively
prevented migraines in placebo-controlled research studies.
A migraine is not just a bad headache. It
has a characteristic pattern, usually involving just one side of
your head. It is a throbbing pain rather than a dull, constant
ache, often accompanied by nausea, vomiting, and sensitivity to
light and sounds.
See your doctor to evaluate your headache,
especially if headaches are new for you, are unusually severe or
persistent, or are accompanied by any of these characteristics:
a change in your strength, coordination, or
neck or back pain
a chronic run-down feeling with pain in your
muscles or joints
difficulty thinking or concentrating
progressive worsening over time
the headache awakens you from sleep
the headache follows head trauma
In 1983, researchers at the Hospital for
Sick Children in London reported their results for 88 children
with severe, frequent migraines who began an elimination diet. In
this group, 78 recovered completely, and 4 improved greatly. In
addition, some children who also had seizures found that their
seizures stopped. The researchers then reintroduced various foods
and found that they sparked migraine recurrences in all but eight.
In subsequent tests using disguised foods, the vast majority of
children again became symptom-free when trigger foods were
avoided. Migraines returned when trigger foods were added to the
Since that time, additional research has confirmed that dietary
factors can trigger migraines in children and adolescents.2
Anywhere between 20 and 50 percent of adults
experience a reduction or elimination of their headaches when
common trigger foods are avoided.
Pain-safe foods virtually never contribute
to headaches or other painful conditions. These include:
Rice, especially brown rice
Cooked green vegetables, such as broccoli,
spinach, Swiss chard, or collards
Cooked orange vegetables, such as carrots or
Cooked yellow vegetables, such as summer
Cooked or dried non-citrus fruits: cherries,
cranberries, pears, prunes (but not citrus fruits, apples,
bananas, peaches, or tomatoes)
Water: Plain water or carbonated forms, such
as Perrier, are fine. Other beverages—even herbal teas—can be
Condiments: Modest amounts of salt, maple
syrup, and vanilla extract are usually well-tolerated.
Common triggers often cause headaches in
susceptible people. Just as some food sensitivities manifest as a
rash on your skin, migraine sufferers have a reaction in the blood
vessels and nerves. Here are the common food triggers, also known
as the "Dirty Dozen," in order of importance:
wheat (bread, pasta, etc.)
nuts and peanuts
* Includes skim or
whole cow’s milk, goat’s milk, cheese, yogurt, etc.
** Includes beef, pork, chicken, turkey, fish, etc.
Certain beverages and additives are also
among the worst triggers, including alcoholic beverages
(especially red wine), caffeinated drinks (coffee, tea, and
colas), monosodium glutamate, aspartame (NutraSweet), and
Foods that are neither on the pain-safe list
nor the common trigger list should be considered possible, but
unlikely, triggers. Almost any common food, other than the
pain-safe list, has triggered migraines in an isolated individual
in a research study, so they cannot be considered completely above
suspicion, but they are far from the most likely culprits.
The first step in tackling your migraines is
to check whether any of the common triggers are causing them. To
do this, you simply avoid these foods. At the same time, include
generous amounts of pain-safe foods in your routine and see
whether migraines occur, and, if so, how often.
Here is how to start with anti-migraine
foods. For two weeks:
Have an abundance of foods from the pain-safe
Avoid the common triggers completely.
Foods that are not on either list can be
The key is to be very careful in avoiding
the common triggers. See
Fight Pain by PCRM president Neal Barnard, M.D., for
Your Food Triggers
If your diet change makes your headaches
disappear or become much less frequent, the next step is to
confirm which foods are your triggers. To do this, simply
reintroduce the eliminated foods one at a time, every two days, to
see whether any symptoms result. Start at the bottom of the list
(bananas), and work your way up to the riskier foods, skipping any
that you do not care for. If you wish, you can then check the
beverages and additives on the common triggers list.
As you do this, have a generous amount of
each new food, so you will know whether or not it causes symptoms.
If it causes no problem, you can keep it in your diet. Anything
that causes a headache should be eliminated again. Then, after a
week or two, try the suspect food once again for confirmation.
Keep your diet simple so you can detect the effect of each newly
Meats, dairy products, and eggs are best
left off your plate permanently. Aside from being among the worst
migraine triggers, they also tend to disturb your natural hormone
balance, which contributes to migraines, as we will see shortly.
Their cholesterol, fat, and animal proteins
are linked to serious health concerns including heart disease,
high blood pressure, osteoporosis, and cancers of the breast,
prostate, and colon, so there is no need to welcome these problem
foods back onto your plate.
Other Food Triggers
If two weeks on the basic anti-migraine diet
does not reduce your headaches, the next step is to check whether
a food that is not on the list of common migraine triggers may be
causing your symptoms. This occasionally happens and, in fact,
some people are sensitive to several different foods. An
elimination diet will help you sort this out.
The elimination diet is designed to track
down any unusual pain triggers. It is used for many other
conditions, as well, particularly arthritis and digestive
problems. Start by building your menu entirely from the pain-safe
foods, avoiding all others for the moment.
Once your symptoms have gone or diminished,
which may take a week or so, you can add other foods one at a
time, every other day, to see which ones cause symptoms. Again,
have a generous amount of each new food so you can see whether it
causes symptoms. If not, you can keep it in your diet. Hold off
adding any foods on the "Dirty Dozen" list and any of the beverage
and additive triggers until last.
Here are some tips to help you identify
Foods that have caused headaches were usually
eaten within three to six hours of the attack.
The offending foods can be ones you are very
fond of, perhaps even foods for which you have cravings. They
may be the ones you might least suspect.
Sometimes the headache will not show up until
a large amount of the culprit is eaten, perhaps over a few days.
If you are affected by several foods,
eliminating only one may make no difference at all. This
sometimes leads people to believe that foods are not the
You might find that you can have a small
amount of a trigger food without getting a headache, while a
larger amount brings on the headache.
Your tolerance might be different at
different times. For example, a woman might normally be able to
eat half a box of chocolates with no problem, but as she
approaches her period a single piece might trigger the migraine.
The reason, presumably, is that the natural changes in hormones
that occur over the month affect her sensitivity.
Your triggers can change over time.
Your doctor can arrange special blood tests
to detect food sensitivities. They can be rather expensive, but
are faster than elimination diets. Information is available from
Serammune Physicians Lab, 1890 Preston White Dr., Reston, VA
22091, 800-553-5472. Typical skin-patch tests are of little use
for migraine triggers, since they detect only certain kinds of
The Anti-Migraine Herb
Feverfew is an herb whose name comes from
the fact that the ancient Greeks and many later societies used it
as a treatment for fever. Researchers at the City of London
Migraine Clinic found that feverfew eliminated about two-thirds of
migraines in a selected group of headache patients, which is
similar to the effectiveness of most migraine drugs.4
However, while some people get a pronounced effect, others get
none at all. Averaging everyone together, it eliminates about
one-fourth of all headaches.5 This does not mean that
it will eliminate precisely one-fourth of your headaches. It will
more likely either have a much more noticeable effect or no effect
Feverfew is sold at all health food stores.
The amount that has been shown to prevent migraines in research
studies ranges from 50 to 114 milligrams per day. However, most
practitioners use capsules containing about 250 milligrams of a
standardized-potency feverfew, recommending one capsule per day
taken on an empty stomach. If you find fresh leaves, the usual
dose is two to three leaves per day.
Thousands of people have used feverfew over
long periods with no apparent ill effects, and research studies
have shown no serious risks. However, there has been little effort
to systematically look for side-effects over prolonged periods. I
would encourage you to avoid it if you are (or might be) pregnant;
there is no indication that it causes birth defects, but not
enough data are in to be sure. Also, people with clotting
disorders or who are taking anticoagulant medicines should consult
with their doctors about taking feverfew. Otherwise, our best
information suggests that you can stay on it indefinitely.
to Fight Migraines
Emphasize pain-safe foods: brown rice; cooked
vegetables, such as broccoli, collards, spinach, and chard; and
cooked or dried non-citrus fruits.
Avoid the common trigger foods completely. If
your migraines have diminished or ceased, you can reintroduce
the trigger foods one at a time to assess their effect.
If steps one and two did not diminish your
migraines, an elimination diet can help you identify whether an
unusual trigger is causing your problem.
Minimize hormone shifts by avoiding animal
products, keeping vegetable oils minimal, and having plenty of
high-fiber whole grains, beans, vegetables, and fruits.
Try these supplements, in consultation with
Feverfew: 250 milligrams per day or two to
three fresh leaves.
Ginger: 1/2 to 1 teaspoon (1 to 2 grams) of
fresh powdered ginger per day.
Magnesium: 400 to 700 milligrams per day
total (foods plus supplements, if used) or 200 milligrams per
day as elemental supplement alone.
Calcium: Reduce calcium losses by avoiding
animal protein, caffeine, tobacco, and excess sodium and
sugar. If you wish, you can take 1,000 to 2,000 milligrams per
day of elemental calcium, with 200 IU (5 micrograms) of
vitamin D. Regular physical activity will keep calcium in your
bones where it belongs.
If a migraine occurs, try the following:
Although caffeine can be a migraine trigger
for some people, for others it works as a treatment. The dose is
one to two cups of strong coffee at the first sign of an attack.
Have a starchy food, such as rice, potatoes,
crackers, or bread. Yes, wheat products are migraine triggers
for some people, but if you can tolerate them, they might
actually help. Some people find that they actually crave starchy
foods during migraines and that digging into toast, crackers,
pasta, potatoes, or other starchy foods reduces the headache or
nausea, and can even shorten the attack. Experience will tell
you whether these foods help.
Fresh powdered ginger, 500 to 600 milligrams
(about 1/4 teaspoon), in a glass of water has been helpful in
anecdotal reports. It can be repeated every few hours, up to
about 2 grams per day.
Calcium might be able to treat migraines as
well as prevent them. Researchers reported a case of a woman who
was able to stop an early migraine by chewing 1,200 to 1,600
milligrams of elemental calcium.4,5 Again, avoid the
temptation to get calcium from milk, yogurt, or any other animal
source. They cause much more trouble than they are worth.
Lie down in a quiet, dark room, and sleep if
you can. Use hot or cold compresses, and massage the blood
vessels at the temples.
Biofeedback and acupuncture have been helpful
for many people as well.
1. Egger J, Carter CM, Wilson J, Turner MW. Is migraine a
food allergy? A double-blind controlled trial of oligoantigenic
diet treatment. Lancet 1983;2:865-9.
2. Millichap JG, Yee MM. The diet factor in pediatric and
adolescent migraine. Pediatr Neurol. 2003 Jan;28(1):9-15.
3. Ernst E, Pittler MH. The efficacy and safety of feverfew
(Tanacetum parthenium L.): an update of a systematic review.
Public Health Nutr. 2000 Dec;3(4A):509-14.
4. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy
of feverfew as prophylactic treatment of migraine. Br Med J
5. Murphy JJ, Heptinstall S, Mitchell JRA. Randomised
double-blind placebo-controlled trial of feverfew in migraine
prevention. Lancet 1988;2:189-92.
6. Thys-Jacobs S. Vitamin D and calcium in menstrual
migraine. Headache 1994;34:544-6.
7. Thys-Jacobs S. Alleviation of migraines with therapeutic
vitamin D and calcium. Headache 1994;34:590-2.