Understanding migraine triggers is a helpful tool for managing migraine. While triggers can be different for everyone and there is no single trigger that all migraine sufferers experience, there are some triggers that are common, especially when it comes to diet.

How many people report food triggers? 

According to studies, between 10% and 80% of people report food triggers. Why would the numbers vary that much? Perception is one factor. Some people and some cultures are more centered on diet as a migraine trigger. 

One other thing to consider is the delay to include a food as a trigger. If you choose a short delay, less food will be potential triggers. If you decide to consider everything you ate over the last 48h as a potential trigger, well, it becomes a bit difficult to establish causal links. 

The international classification recommends a maximum delay of 12h to consider a link between a food intake and a migraine attack. 

What are the most commonly reported triggers? 

Remember that every food trigger is NOT a trigger for everyone. The influence of food triggers tend to be overestimated. For example, there is research showing that chocolate is not a food trigger for the vast majority of people. 

Dehydration: the first easy step

Many migraine patients cite dehydration as a trigger for their headaches.  Dehydration occurs when the body loses more liquid than it takes in, and can be exacerbated by hot weather, physical exercise, drinking alcohol or caffeine, eating salty foods, or simply not drinking enough water. Read more about dehydration here.

Skipping meals/Low blood sugar: an underestimated trigger

Glucose, which comes from carbohydrate foods, is the body and brain’s preferred source of fuel. The hormones insulin and glucagon are responsible for the regulation of glucose levels in the blood. A drop in blood glucose levels can be caused by many factors, including consuming too many high-sugar foods, not eating enough calories, exercising on an empty stomach, or skipping meals. There are many symptoms of hypoglycemia (low blood sugar), including the onset of a migraine attack.

To ensure blood-glucose levels are stable, follow these suggestions:

• Limit high-sugar foods like candy, cookies, cakes, etc.
• Replace refined grains (white bread, white pasta) with whole grain alternatives
• Try to have breakfast within 1 hour of waking up, or at least some protein and slow carbs
• Do not skip meals
• Carry low-sugar / high protein snacks in your purse, bag, or car
• Try to eat some fat (meat, cheese, nuts, seeds, coconut, avocados) and protein (meat, eggs, fish, nuts, seeds, tofu) with each meal and snack

YES we are aware that some of the healthy snacks proposed are in the trigger list. 

Remember that for the majority of people with migraine, cheese, nuts, fish and tofu are NOT triggers. 

Alcohol: 20% to 50% report it as a trigger

The culprit mechanism leading to alcohol-triggered migraines is likely multifactorial, involving histamine, tyramine, sulphites, flavonoids, and 5-HT release.

Red wine is often considered to be a common migraine trigger, but any alcoholic drink can be the cause.  People report interesting selectivity: some are triggered only by white alcohols, other by beer but not wine….once again, tons of variability in migraine world.

Does migraine make you prone to «hangovers»? 

Alcohol can trigger an immediate headache (within 30 minutes to 3 hours), or a delayed alcohol-induced headache, (DAIH) the morning after the alcohol was consumed (the «hangover»). Two thirds of alcohol-triggered migraines fall into the DAIH category, and people who experience migraines are more susceptible to this type of headache than non-migraine sufferers. Usually, other factors are associated with «hangovers» such as lack of sleep and foods consumed during a party. 

Foods high in histamine (% of people reporting as a trigger according to various studies)

Histamine is a chemical compound involved in the immune response and is most often associated with allergies.  Histamine can, however, be a trigger for migraine patients who have no known allergies. 

• Alcohol
• Tomatoes
• Eggplant
• Spinach
• Vinegar
• Shellfish (prawns, mussels, oysters, etc.)
• Nuts
• Chocolate (0 to 22%)
• Citrus fruits ((0 to 11%)
• Kiwi, lime, pineapple, plums, papaya, strawberry

Foods high in tyramine

Tyramine is an amine that regulates our blood pressure. Some studies have shown that injection of tyramine can trigger migraines, but others did not show an association. 

• sauces, such as soy sauce, shrimp sauce, fish sauce, miso and teriyaki sauce.
• soybeans and soybean products.
• snow peas, broad beans (fava beans) and their pods.
• dried or overripe fruits, such as raisins or prunes, or overripe bananas or avocados.
• Leftovers

Read more from Mayo Clinic.

Foods high in BOTH histamine and tyramine

• pickled products like sauerkraut
• cured or smoked meats or fish, such as sausage or salami (also have nitrites)
• certain beans, such as fava or broad beans
• Sourdough bread, yeast extract
• aged cheeses: cheddar, blue cheese, gorgonzola, camembert, parmesan (0 to 18%)
• fermented foods (yogurt, kefir, kombucha, sauerkraut, fermented soy products etc.)

Other reported food triggers

• ice cream (1 to 4%)
• food preservatives that contain nitrites and nitrates 
• artificial sweeteners, aspartame (8-9%)
• MSG (monosodium glutamate) (0 to 13%) 

How can I identify my own food triggers? 

For any trigger identification you have to consider: 

• Your baseline migraine frequency. The more often you get attacks the more difficult it will be to establish clear relationships. 
• Your own trigger set. Some people may have one key dominant trigger that is a food, but most people have many different triggers that combine and add up.  Read more.

A migraine sufferer may be triggered by more than one food. A food trigger is more likely to cause an attack if other triggers are present.  

There are two key approaches: 

The Headache and Food diary targeting specific foods

Observe the links between suspected food triggers and your attacks. How strong is the association? Remember, we all are subject to cognitive biases that can make us pay more attention to something we believe in than to facts that go against our beliefs. 

If a food trigger is suspected, try eliminating this food completely from the diet for at least one month, and observe I there is a change in your migraine frequency. Then reintroduce the food and closely monitor how you feel.  Record it in your headache and food diary. 

The Elimination diet 

One way to improve your migraine without pin-pointing a specific trigger is to remove common triggers altogether (see above) for an observation period and see if you do get better. 

Categories can be defined:

• Unhealthy foods that should be avoided by everyone, don’t eat them anyway!: sodas, alcohol, cold meats, processed foods, artificial sweeteners.

• Healthy foods that are usually easy to avoid, if you don’t miss them, just don’t eat them: eggplants, fermented foods, shellfish, smoked fish, pickled foods.

• Healthy foods that are more difficult to avoid, do you really need to remove those? onions, garlic, beans, nuts, fruits, soy, tempeh, tomatoes. 

Overall, changing a diet is usually safe. You may consider consulting a nutritionist to help you. Some clinics offer «migraine elimination diets». Be very careful of miracle cures and of any expensive product recommended. 

Lactose-free and Gluten-free

Some people decide to go lactose-free or gluten-free for a while to see if this will make their migraine better. This can be done safely. The most important aspect is to use a diary to really observe the results. Make sure that there is no other active treatment going on that could lead to a change (new medication, therapy). 

The ketogenic diet and immunoglobulin testing will be addressed in separate pages. 

Summary

Migraine attacks can be caused by multiple factors, so figuring out which foods trigger an attack can be an important step in controlling migraines. Use a diary to make reliable observations. Remember that most people have different triggers! 

REFERENCES

• Zaeem Z, Zhou L, Dilli E. Headaches: a Review of the Role of Dietary Factors. Current neurology and neuroscience reports. 2016;16(11):101.
• Finocchi C, Sivori G. Food as trigger and aggravating factor of migraine. Neurol Sci. 2012;33 Suppl 1:S77-80.
• Borkum JM. Migraine Triggers and Oxidative Stress: A Narrative Review and Synthesis. Headache. 2016;56(1):12-35.

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