Diet can affect headaches, as certain foods may act as triggers for migraines. Common dietary triggers include tyramine, alcohol, nitrates, MSG, and artificial sweeteners. An elimination diet removes potential triggers for 4 weeks to identify personal triggers, which are then reintroduced one at one to test sensitivity. Maintaining regular meals helps control blood sugar levels and reduces dehydration. Supplements like magnesium, CoQ10, and riboflavin may also help lower migraine frequency. Tracking triggers and making lifestyle modifications can help manage headaches without a cure.

1. How Diet Affects Headache
Management of Headache Triggers
Bridgette Linehan, APRN
Neurology Nurse Practioner
Norton Headache and Concussion Center

2. If I change my diet, will I cure my headaches?
• There is no cure for migraine
• However, you can potentially reduce some
headache frequency and severity by avoiding
headache triggers
• Discovering and eliminating headache triggers
can help adopt a healthy lifestyle with less
burden of headaches

3. Migraine Triggers
If summation of triggers are greater than threshold – a headache happens

4. Migraine Triggers
• Most frequently reported triggers
– Stress
– Menstruation
– Changes in sleep
– Skipping meals
– Changes in weather
– Diet
• Time from trigger to onset of headache can be up to
72 hours - hard to track

5. Migraine Triggers
• Can be difficult to track
• Sometimes the “perfect storm” of triggers not
just one single item
– Explains why sometimes can have a glass of wine
and sometimes not
– Weather change + menstruation + sleep
deprivation + glass of wine = migraine
– Glass of wine alone = no migraine

6. Stress
• Stress – When we are stressed, our bodies
react physically: Muscles tense and hormones
become elevated — two physiological changes
that can lead to migraines.
• Coming up soon will discuss some strategies
to control stress — and discover other lifestyle
changes you can make.

7. Hormones
• Hormonal changes. Because estrogen and
progesterone are such potent migraine
triggers, women are nearly three times more
likely than men to experience migraines.
• Will be discussed later

8. Physical Exertion or Abrupt Lifestyle Changes
• Physical exertion or abrupt lifestyle changes.
Jumping into an extreme exercise program can
cause migraines, as can changing sleep
patterns, alternating work shifts, or any other
sudden deviation from your normal routine
that disrupts or alters your body’s physiology.

9. Intense Sensory Stimuli
• Intense sensory stimuli. Bright light, loud
noises, and strong smells — such as cleaning
chemicals, cigarette smoke, raw onions,
scented candles

10. Environmental Factors
• Environmental factors. Some people get
migraines when there are changes in the
atmosphere: sudden thunderstorms, abrupt
changes in altitude or barometric pressure,
windstorms, seasonal changes, even increased
pollen levels. Others are sensitive to the
switch to daylight savings time or travel across
time zones.

11. The Top 10 Diet Related Migraine Triggers
• 1. Tyramine
• 2. Alcohol
• 3. Leftovers
• 4. Nitrates
• 5. Tannins
• 6. Sulfates
• 7. Common Additives
• 8. Artificial Sweeteners
• 9. Caffeine
• 10. Dehydration & Low Blood Sugar

12. Lower triggers Raise threshold
Ways to reduce headache

13. Trigger Modification
• Non-modifiable
– Genetics
– Gender
– Weather
– Some stressors
– Menstruation
(somewhat)
– Air pollution
• Modifiable
– Lack of sleep
– Missing meals
– How stress is handled
• Stressors are there, but
the way it is handled can
be modified
– Foods

14. Diet and Migraine
• Regular meals
• Normalize blood sugar
• Reduction in Omega-6 fatty acids
– Red meats, fast foods
• Increase in Omega-3 fatty acids
– Fish oil

15. Prehistoric 1900 2000
1:1 4:1 25:1
Omega-6 FA
Omega-3 FA
Changes in fatty acid intake over time

16. MSG
• Flavor enhancer commonly added to Chinese food,
canned vegetables, soups and processed meats
• MSG occurs naturally in ingredients such as hydrolyzed
vegetable protein, autolyzed yeast, hydrolyzed yeast,
yeast extract, soy extracts, and protein isolate, as well
as in tomatoes and cheeses
• The FDA requires that these products be listed on the
ingredient panel, the agency does not require the label
to also specify that they naturally contain MSG
• Take home message – MSG is hidden in foods

17. Tyramine
• Here are examples of tyramine-rich foods:
– Aged cheese
– Beer on tap
– Meats that have been fermented or air-dried, such as
summer sausage
– Red wine
– Sauerkraut
– Soy sauce
• Other foods that may contain tyramine include:
– Sauces containing fish or shrimp
– Miso soup
– Yeast extract

18. Leftovers
• Tyramine content increases over time
• Especially if stored improperly
• Frequently foods at work / parties
• Be careful with airtight containers and proper
refrigeration

19. Alcohol
• Alone or with congeners (in wine / liquor) can
induce headache in certain individuals
• Red wine probably most implicated
• Distilled vodka probably least causative
• Migraineurs more susceptible to hangover
headaches
• Alcohol leads to dehydration
– Can trigger migraine

20. Nitrates and nitrites
• Mostly used as a preservative for added flavor
• Have vasodilatory effects on the body
• Commonly found in
– Hot dogs
– Deli meats
– Pepperoni
– Sausage
– Cured, smoked, canned meats

21. Sulfites
• Sulfites are another type of preservative
• Commonly found in most dried fruits
(including prunes, figs, and apricots)
• Wine (white and red)
• Many processed foods
• Check labels carefully to avoid this sneaky
migraine trigger.

22. Artificial Sweeteners
• Inconsistent reports
– As with all of this, depends on the individual
• Aspartame (NutraSweet)
• Sucralose
• Various others

23. Caffeine
• Overuse of caffeine can lead to more frequent
headaches
– Check medicines: Excedrin, Fioricet
• Abrupt withdrawal of caffeine often times
leads to more headaches
• Some physicians say zero caffeine, probably
around 100mg/day is ok

24. Caffeine
• Soda 12oz (Regular and sugar-free)
• 30–50mg
• Coffee 6oz
• 103mg
• Decaffeinated coffee
• 6oz=2mg
• Tea
• 6oz=30mg

25. Caffeine
• Starbucks “grande” coffee
• 330mg of caffeine

26. Chocolate
• Frequently reported migraine trigger
• Evidence in inconsistent
• Some believe that “craving” chocolate is a
premonitory symptom of migraine
– ie. headache was inevitable
• Some evidence of blood sugar dip after
chocolate causes headache

27. Missing Meals / Dieting
• Low blood sugar
• Fluctuations in blood sugar
• Dehydration

28. Plan of attack
• Frequent, small meals
– Normal blood sugar
– Avoid dehydration
• 2.5 Liters of water per day (about 80oz)
– Elimination diet

29. Elimination Diet
• Eliminate common triggers from diet
– Caffeine, cheese, nuts, chocolate, shellfish,
artificial sweeteners, onions, alcohol, dairy,
processed meats
– After elimination from diet (4+ weeks) begin to
reinstate items in to diet one at a time
• 4 weeks each item and record headache frequency
– If having more headaches, remove this item

30. 7 Healthy Habits to Reduce Migraines
• Eat regularly
• Maintain a healthy weight
• Quit smoking
• Exercise gently but regularly
• Practice relaxation
• Get enough sleep (yet not too much)
• Consider physical therapy along with
acupuncture, biofeedback, or massage

31. A Quick Eating Out Survival Guide
• Avoid buffets: They may leave food sitting too
long or use suspect ingredients.
• Chinese food: Possible triggers are MSG and
soy sauce. Japanese food: Possible triggers
are soy sauce, tofu, and miso.
• Mexican food: Possible triggers are beans
(fava, navy, broad), cheese, sour cream,
guacamole, and (in rare instances) tomato-
based

32. Quick Survival Guide
• Restaurants to enjoy include:
• High-Quality American: order the chicken (grilled, baked,
roasted, steamed, boiled, or broiled -- request no MSG,
vinegar, or citrus juice); vegetables (steamed or sautéed in
olive oil and garlic); rice or potatoes, plain (baked, boiled,
or roasted),
• Seafood: have any fish (grilled, baked, roasted, steamed,
poached, or broiled — request no MSG, vinegar, or citrus
juice); vegetables (steamed or sautéed in olive oil and
garlic); rice or potatoes, plain (baked, boiled, or roasted),
• Italian: order pasta with broccoli and grilled chicken or
seafood tossed in an olive oil–based sauce

33. Quick Survival Guide
• Desserts:
• Treat yourself to strawberries with whipped
cream; rice pudding; or herbal tea with plain
biscotti.
• Avoid chocolate, unless you have confirmed that
chocolate is not a personal migraine trigger.
• Keep in mind these suggested meals are free
from all of the most common migraine triggers.

34. Quick Survival Guide
• After keeping a migraine diary, you’ll probably
find that you are sensitive to only a handful of
foods. Once you’ve identified your personal
triggers, it will be much easier to order a wide
variety of dishes in most ethnic cuisines.

35. Dietary Supplements
• Coenzyme Q10
• Feverfew
• Omega fatty acids
• Vitamin B2 (Riboflavin)
• Magnesium

36. Coenzyme Q10
• Coenzyme Q10 (CoQ10) is a vitamin-like
substance that helps enzymes create energy at
the cellular level. Without it, cells can’t work
properly.
• Daily dose of 300-400milligrams daily.
• Few side effects, can be costly

37. Feverfew
• Feverfew is a traditional medicinal herb
• It relaxing blood vessels and decreasing
inflammation to improve circulation in the brain.
• Feverfew is also found in combination with
riboflavin and magnesium in supplements
formulated specifically for migraine prevention.
Women who are pregnant or trying to become
pregnant and individuals taking blood thinners
should not take feverfew due to undetermined
safety in these populations.

38. Omega 3 Fatty Acids
• Inconsistent reports on effectiveness in
migraine
• Natural anti-inflammatory effects
• Reduce Omega-6 FA (fast foods, red meat)
• Increase Omega-3 FA (fish or fish oil
supplements)

39. Riboflavin (B2)
• Mitochondrial defect in migraine leading to
impaired oxygen utilization
• Riboflavin used in mitochondria
• 200mg twice per day
• May take 3 months to see difference
• Will turn urine yellow

40. Magnesium
• Blood levels do not adequately measure
magnesium stores in the body
• Migraine patients often deficient in
magnesium
• Lack of magnesium leads to more
hyperexcitability of the brain (more migraine
attacks)

41. Magnesium
• Used IV for severe migraine attacks in hospital
or outpatient infusions
• Oral magnesium readily available
• At least 400mg per day
• Can lead to diarrhea / upset stomach

42. Take Home Message
• Trigger awareness to change the balance of
threshold vs triggers leading to migraine
attacks
• Foods may play an important role in trigger
management of migraine
• Elimination and slow reintroduction is the best
strategy to really identify triggers
• Dietary supplements may improve migraine
frequency and severity

43. Take Home Message
• Remember, there is no cure for migraine
• Management is the key to success
• Reduce triggers
• Raise threshold
• Do not overuse rescue medications

44. NortonNeuroscienceInstitute.com