Does food affect migraines?

1. Specific foods don't trigger migraines – with two exceptions

In general, specific foods aren't considered migraine triggers, with the exception of two broad categories – alcohol and foods which contain nitrates. Nitrates are used in medicine to treat heart problems such as coronary heart disease, but are also found in some foods. Cured meats and American hot dogs both contain nitrates and they’re fairly reliable triggers of migraine, subject to much research. After that, it’s quite difficult to give blanket advice about any other specific food.

2. It's important to distinguish between symptom and cause

We now know that food cravings are part of the early stages of the migraine, which calls into question foods, such as cheese and chocolate, that have traditionally been considered 'triggers'. Before the aura or headache starts, there's a phase called the premonitory phase. It can last for up to a day and includes symptoms such as concentration impairment, tiredness, neck discomfort, mood change, passing more urine, yawning or craving particular things.

I often see people who crave sweet or savoury things in the day or hours before their attack, but before this is pointed out to them, these cravings aren't something they’re conscious of. From their point of view, they eat something sugary and they end up with a migraine so they ascribe cause and effect, when actually, the sugar craving was a symptom of the migraine starting. This is backed up by research – for example, chocolate was previously considered a trigger, but when tested carefully in a study, chocolate was no more likely to trigger an attack than other foods. There’s no doubt that some people are more sensitive to certain foods, but as we understand things better, we’re beginning to see that some of the commonly accepted 'triggers' are actually behaviours that take place in the lead up to a migraine attack.

3. Food intolerances also have an impact

One example of this is what I would call 'aggravation'. For example, if you’ve got coeliac disease and you eat gluten, your migraine might play up, but only because migraine is susceptible to any biological or physiological change in the body.

People don’t get migraines because they have a gluten sensitivity, but the biological change brought about by the gluten sensitivity triggers their underlying migraine. Often, when the individual avoids these triggers, something else turns the headache on because the problem is the underlying condition, not the perceived ‘trigger’.

4. Each individual will have different susceptibilities

The reliable triggers, such as alcohol and nitrates, aren't unique to the individual. The things that aggravate your migraine will depend on what you are sensitive to.

5. Caffeine withdrawal, rather than consumption, may be an issue

Regular consumption of caffeine doesn’t trigger migraine, but withdrawal from caffeine might. A very common phenomenon is that someone who works from Monday to Friday will have their coffee at a regular time during the week, but may sleep in later on Saturday and have their coffee later, so they get the withdrawal effect. If you’re a migraine patient and this caffeine withdrawal is enough to alter your physiology, guess what? You get a migraine.

6. Fluctuating blood sugar levels have much the same effect

The body likes equilibrium so if your blood sugar drops too low or if it goes too high, it causes the physiological triggering of a migraine. Migraine is not caused by low or high blood sugar but it can be aggravated by it. It's the same for dehydration and food additives – it all depends on what the individual is sensitive to, and whether the change in physiology is enough to trigger the underlying condition.

7. Overall, the key is equilibrium, and avoiding anything that disrupts your unique physiological balance

Individuals who suffer from migraines need to have regular sleep, regular meals, regular exercise – regularity in everything. And when you deviate from regularity – have some drinks, have a late night, skip a meal – that’s when you're more likely to have an attack.

Where can I find more information about how to manage migraines?

Visit the Migraine Trust Website. It's well informed about new research, and there's self-help pamphlets available as well, so it's a good place to start.

Professor Peter Goadsby is Professor of Neurology, King's College London, and Director of the NIHR-Wellcome Trust Clinical Research Facility at King's College Hospital, London. He is an Honorary Consultant Neurologist at the Hospital for Sick Children, Great Ormond St, London, and in the Department of Neurology, University of California, San Francisco. He is currently Chair of the British Association for the Study of Headache.

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Do you suffer from migraines? Do you find that what you eat or drink affects the condition? Let us know in the comments below...