IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor. The content of the information articles and all illustrations on this website remains the intellectual property of Dr Raymond Mullins and cannot be reproduced without written permission.

What are migraines?
Migraines occur in around 1 in 10 people. They are often confused with other headaches like muscle tension headaches, "sinus" pain or symptoms of sinusitis. Some patients find that dietary factors will influence the frequency and severity of symptoms. By contrast, food allergy does not cause migraines, and allergy testing is no use in this condition.

Common symptoms
Headaches can last for days. The diagnosis is even harder to make in children, who may complain of stomach pains or nausea rather than headache. Other symptoms include:

1. Nausea
   

2. Pallor or sweating
   

3. Dislike of bright lights or loud noises
   

4. Flashing lights or altered vision
   

5. Numbness of the face or hands (occasional)
   

6. Migraine triggers
   

Diet is rarely the only factor involved in triggering migraines. Indeed, most migraine sufferers find that they have more than one trigger such as:

1. Fatigue
   

2. Sleeping in ("holiday headaches")
   

3. Hormonal changes of the menstrual cycle
   

4. Inhaled irritants (e.g. perfume, cigarette smoke)
   

5. Bright or flashing lights
   

6. Dehydration (insufficient dietary fluids)
   

7. Caffeine withdrawal headaches
   

8. Other dietary factors
   

Are tests necessary?
A diagnosis of migraine is usually made on the basis of the history and response to treatment. Unusual features or a lack of response to therapy may prompt a search for other diseases causing similar symptoms. These can usually be excluded with careful re-examination, x-rays or blood tests. Allergy tests are a waste of time. Neurology review is recommended if the cause of headache is uncertain or symptoms fail to respond to routine therapy.

Migraine treatment options
Migraine headaches are normally managed by GP’s and neurologists rather than allergy specialists. Some patients find relief with relaxation exercises, massage, biofeedback or acupuncture. Other options include:

1. Avoid trigger factors
   

2. Treat the episodes
   

3. Regular medication to prevent migraines
   

4. Diet manipulation
   

5. Avoid trigger factors. e.g. If you know that 2 glasses of red wine or insufficient sleep give you a headache, then refrain from the obvious!
   

Treating the episode

Pain-killers. Because the stomach often stops emptying once the migraine is established, it is best to take medication (like aspirin or paracetamol) with the first warning of a symptoms. Injections of strong pain killers such as pethidine or morphine are best avoided. These drugs act only for a short time, lose their effectiveness with repeated use and worsen nausea.

Anti-nausea medication (tablets or suppositories) is often helpful, but again should be taken early. Examples include prochlorperazine and metoclopramide. These are usually avoided in children because side-effects are common.

Anti-migraine drugs do not control pain, but rather dampen the migraine process itself by altering the activity of chemical "messengers" in the brain and perhaps altering blood flow as well. Examples include ergotamine, sumatriptan, naratriptan and zolmitriptan.

Preventative medication
When migraines are frequent, regular medication can be taken to reduce their frequency and severity. Examples include some antihistamines, blood pressure medications, tricyclic "antidepressants", anti-epileptic medications, and other drugs such as methysergide and pizotifen. They work by influencing the activity of "chemical messengers" within the brain. The most common side-effects are sleepiness and dry mouth. Others cannot be taken during pregnancy or if you have other medical conditions such as asthma. Your doctor will advise you of the most suitable medications for your condition. Some vitamin supplements have been studied with some evidence of benefit to reduce the frequency of attacks.

Dietary manipulation
Dietary factors trigger migraines in only a small proportion of patients. Wheat and milk are almost never implicated. When diet plays a role, it is doing so as an aggravant rather than as a cause of migraine. Where food is involved, the biochemistry of food "building blocks" is of greater interest than allergy. Known dietary triggers include:

1. Dehydration
   

2. Caffeine excess
   

3. Naturally occurring amines (e.g. in chocolate, cheese, wine, some fruits)
   

4. Glutamates (e.g. in tomatoes, mushrooms)
   

5. MSG or preservatives in meats (like nitrates and nitrites)
   

6. Propionates (bread preservatives 280/281)
   

Conclusion

Since migraines are not caused by allergies, allergy testing is of little use in identifying dietary triggers.The only reliable way to sort out whether diet is playing a role is by placing patients on a temporarily "elimination diet" under the supervision of a skilled dietitian. If the diet helps, this is followed by challenges with dietary factors under controlled conditions. The aim is to identify potential dietary triggers so that they can be avoided. Dietary restrictions based on the results of unproven unorthodox testing (such as IgG food antibodies) is not recommended.

References

Zencirci B. Comparison of the effects of dietary factors in the management and prophylaxis of migraine. J Pain Res. 2010 Jul 23;3:125-30.

Milde-Busch A, Blaschek A, Borggräfe I, Heinen F, Straube A, von Kries R. Associations of diet and lifestyle with headache in high-school students: results from a cross-sectional study. Headache. 2010 Jul;50(7):1104-14.

Eidlitz-Markus T, Haimi-Cohen Y, Steier D, Zeharia A. Effectiveness of nonpharmacologic treatment for migraine in young children. Headache. 2010 Feb;50(2):219-23.

Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52.

Crawford P, Simmons M, Hoock J. Clinical inquiries. What dietary modifications are indicated for migraines? J Fam Pract. 2006 Jan;55(1):62-3, 66.

Last reviewed 5 June 2020

Summary
Migraines occur in around 1 in 10 people. They are often confused with other headaches like muscle tension headaches or sinus pain. They are not due to allergic disease, and when diet factors seem to play a role, the mechanism is intolerance, not allergy.