Headache and Migraine
Research on the dietary connection
Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe that all you can think about is finding a dark, quiet place to lie down.
Some migraines are preceded or accompanied by sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
The studies listed below are organized by date, with the most recent date first. Some of the full texts will need a password because they are kept in a locked file to protect their copyright. For educational purposes only, we are allowed to share the password with you if you write to us.
If you are trying to find a particular author, see the Index below which lists all the primary authors alphabetically with their publication dates.
- Alam 1997
- Anderson 1995
- Egger 1983
- Egger 1985
- Egger 1989
- Egger 1992
- Hadjivassiliou 2001
- Inomata 2006
- Leira 1996
- Lucarelli 1990
- Millichap 2003
- Newman 2001
- Novembre 1992
- Pelsser 2010
- Trotsky 1994
- Vaughan 1994
- Wendorff 1999
Note Prior to 1990 to be uploaded
Pelsser 2010: Diet for sleep & physical complaints
Effects of food on physical and sleep complaints in children with ADHD: a randomised controlled pilot study. Pelsser LM, Frankena K, Buitelaar JK, Rommelse NN. European Journal of Pediatrics, 2010 Apr 17. [Epub ahead of print]
“Attention deficit/hyperactivity disorder (ADHD), a common behavioural disorder in children, may be associated with comorbid physical and sleep complaints. Dietary intervention studies have shown convincing evidence of efficacy in reducing ADHD symptoms in children. In this pilot study, we investigated the effects of an elimination diet on physical and sleep complaints in children with ADHD. A group of 27 children . . . were assigned randomly to either a diet group (15/27) or a control group (12/27).The diet group followed a 5-week elimination diet; the control group adhered to their normal diet. Parents of both groups had to keep an extended diary and had to monitor the behaviour and the physical and sleep complaints of their child conscientiously. . . The number of physical and sleep complaints was significantly decreased in the diet group compared to the control group . . . Specific complaints that were significantly reduced were in three domains: headaches or bellyaches, unusual thirst or unusual perspiration, and sleep complaints. . . An elimination diet may be an effective instrument to reduce physical complaints in children with ADHD, but more research is needed to determine the effects of food on (functional) somatic symptoms in children with and without ADHD.”
Inomata 2006: Case study - food dyes & headache etc.
Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl.Inomata N, Osuna H, Fujita H, Ogawa T, Ikezawa Z., Allergology International 2006 Jun;55(2):203-5.
” … We present a 5-year-old girl who suffered from recurrent reactions accompanied by urticaria, angioedema, headaches, dyspnea, loss of consciousness, and abdominal pain … Her diet diary revealed that symptoms occurred after ingestion of colorful sweets such as candies and jellybeans. Open challenge tests with food additives and nonsteroidal anti-inflammatory drugs (NSAIDs) were performed after elimination of these items. … Consequently, intolerance to azo dyes and NSAIDs such as aspirin was diagnosed.However, she appeared to react to multiple chemical odors such as those of cigarette smoke, disinfectant, detergent, cleaning compounds, perfume, and hairdressing, all while avoiding additives and NSAIDs. On the basis of her history and the neuro-ophthalmological abnormalities, a diagnosis of severe MCS was made and she was prescribed multiple vitamins and glutathione. CONCLUSIONS: The present results suggest that in pediatric MCS, food and drug additives containing azo dyes might play important roles as elicitors. ”
Millichap 2003: Review on dietary factors
The diet factor in pediatric and adolescent migraine. Millichap JG, Yee MM. Pediatr Neurol. 2003 Jan;28(1):9-15.
. . . The diet factor in pediatric migraine is frequently neglected in favor of preventive drug therapy. . . Dietary triggers affect phases of the migraine process by influencing release of serotonin and norepinephrine, causing vasoconstriction or vasodilatation, or by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. Treatment begins with a headache and diet diary and the selective avoidance of foods presumed to trigger attacks. . . . Long-term prophylactic drug therapy is appropriate only after exclusion of headache-precipitating trigger factors, including dietary factors.
Newman 2001: Case report - Aspartame and headache
Migraine MLT-down: an unusual presentation of migraine in patients with aspartame-triggered headaches., Newman LC, Lipton RB., Headache. 2001 Oct;41(9):899-901.
The Headache Institute, St. Lukes-Roosevelt Hospital Center, 1000 Tenth Avenue, Suite 1C10, New York, NY 10019, USA.Aspartame, an artificial sweetener added to many foods and beverages, may trigger headaches in susceptible individuals. We report two patients with aspartame-triggered attacks in whom the use of an aspartame-containing acute medication (Maxalt-MLT) worsened an ongoing attack of migraine.
Note: What could have possessed the good doctor to give a medication containing aspartame to a patient suffering from aspartame-induced headache in the first place?
Hadjivassiliou 2001: Headache and gluten
Headache and CNS white matter abnormalities associated with gluten sensitivity. Hadjivassiliou M, Grunewald RA, Lawden M, Davies-Jones GA, Powell T, Smith CM. Neurology 2001 Feb 13;56(3):385-8
” The authors describe 10 patients with gluten sensitivity and abnormal MRI. All experienced episodic headache, six had unsteadiness, and four had gait ataxia. … Symptomatic response to gluten-free diet was seen in nine patients.
Wendorff 1999: Study on children with migraine and allergy
Allergy effect on migraine course in older children and adolescents, Wendorff J, Kamer B, Zielinska W, Hofman O., Neurologia Neurochirurgia Polska, 1999;33 Suppl 5:55-65
…The studied group comprised 30 children and adolescents aged 11-17 years with the diagnosis of migraine with or without aura by IHS criteria. … two groups were isolated: with and without allergy. The allergic children were given antiallergic treatment for 6 months (pharmacological or diet restriction). RESULTS: In the allergy group the migraine index decreased significantly from 2.45 to 0.33. Headache intensity decreased as well. 1. In 40% of cases migraine was associated with allergy. 2. Treatment results suggest that allergy and antiallergic treatment may influence the course of migraine attacks.
MedLine (article in Polish)
Alam 1997: PST and migraine
Platelet sulphotransferase activity, plasma sulphate levels and sulphation capacity in patients with migraine and tension headache, Alam Z, Coombes N, Waring RH, Williams AC, Steventon GB, Cephalalgia 1997 Nov;17(7):761-4
Activity of both the M- and P-forms of sulphotransferase (ST) was measured in platelets from patients with migraine, tension headache and controls…. The results suggest that PST activity may be a factor in the aetiology of migraine.
Leira 1996: Diet and migraine
Diet and migraine, Leira R, Rodriguez R, Revista de Neurologia 1996 May;24(129):534-8
.. an improvement in symptoms by eliminating some food(s) from our diet does not necessarily mean an immunologically based allergic reaction. … substances in food may be the cause of modifications in vascular tone and bring migraine on in those so prone. Among such substances are tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate, aspartame) and caffeine. Another recognized trigger for migraine is hypoglycemia. Such foods as chocolate, cheese, citrus fruits, bananas, nuts, ‘cured’ meats, dairy products, cereals, beans, hot dogs, pizza, food additives (sodium nitrate, monosodium glutamate in Chinese restaurant food, aspartame as a sweetener), coffee, tea, cola drinks, alcoholic drinks such as red wine, beer or whisky distilled in copper stills, all may bring on a migraine attack. For every patient we have to assess which foodstuffs are involved in the attack … to try to avoid their consumptions as a means of prophylaxis for migraine.
MedLine (article in Spanish)
Anderson 1995: Study on prostaglandins & histamine in migraine
Mechanisms in adverse reactions to food. The brain, Anderson JA, Allergy 1995;50(20 Suppl):78-81
Specific chemical mediator release such as histamine and the prostaglandins (PG2a or PGD2) associated with headaches has been found in a few patients who were repeatedly challenged with specific foods, using DBPCFC [double blind placebo controlled food challenge] techniques.
Vaughan 1994: Review of the link between food and migraine
The role of food in the pathogenesis of migraine headache, Vaughan TR, Clinical Reviews in Allergy 1994 Summer;12(2):167-80
Recent textbooks of neurology and internal medicine cite food, or pharmacologic agents in foods, as provokers of migraine (1,2). Nevertheless, this area remains controversial. Many authorities recognize foods containing pharmacologic agents, such as tyramine, as possible provokers of migraine. However, the importance of foods lacking these properties is less clear .During the 1980s, there was renewed interest in food-induced migraine. Studies have attempted to address the incidence of food-induced migraine and have recently begun to study potential mechanisms. This paper will review the general features of migraine, including prevalence, differential diagnosis, and known provokers, and then focus on the link between food and migraine.
Trotsky 1994: Diet or neutralization for headaches
Neurogenic vascular headaches, food and chemical triggers, Trotsky MB, Ear Nose Throat J 1994 Apr;73(4):228-30, 235-6
…Food and chemicals in foods can act as a precipitating factor in the food-sensitive neurogenic vascular headache patient. … The food-sensitive migraine patient and cluster headache patient must give a good history and food diary to go along with active challenges and provocative testing in order to determine the causative foods. Any concomitant allergies of inhalants or environmentals must also be treated. The treatment modalities of elimination and rotation diets or provocation neutralization may successfully control the headaches without the need for continuous medications.
Novembre 1992: Case studies of reactions to food additives
Unusual reactions to food additives, Novembre E, Dini L, Bernardini R, Resti M, Vierucci A, Pediatria Medica e Chirurgica 1992 Jan-Feb;14(1):39-42
…In this study, we report two cases of unusual reactions to food additives (tartrazine and benzoates) involving mainly the central nervous system (headache, migraine, overactivity, concentration and learning difficulties, depression) and joints (arthralgias), confirmed with diet and double blind challenge. The possible pathogenetic mechanisms are also discussed.
MedLine (article in Italian)
Egger 1992: Diet & double-blind test on children with ADHD / migraine & enuresis
Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior, Egger J, Carter CH, Soothill JF, Wilson J, Clinical Pediatrics (Phila) 1992 May;31(5):302-7.
“Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. [daytime or nighttime bed wetting] On diet, the enuresis stopped in 12 of these children and improved in an additional four. [76%] … Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods.”
MedLine || Full Text || Get Password
Lucarelli 1990: 87% of 49 children with migraine improved on diet
Hemicrania and food allergy in children, Lucarelli S et al., Minerva Pediatrica 1990 Jun;42(6):215-8
40 [87%] of 49 children with migraine who had positive skin tests to one or more foods improved after following an elimination diet for 4-6 weeks. They “were positive for at least one challenge test for the same types of foods which resulted in positive skin tests. Thirty-one children were cured following the elimination diet and 9 improved.” The children were able to reintroduce the suspected foods 6 – 12 months after implementing the elimination diet.
MedLine (article in Italian)
Egger 1989: Double-blind study on children with ADHD/ migraine/ GI pain & seizures
Oligoantigenic diet treatment of children with epilepsy and migraine, Egger J, Carter CM, Soothill JF, Wilson J, Journal of Pediatrics 1989 Jan;114(1):51-8.
Of 45 children with epilepsy and recurrent headaches, abdominal symptoms, or hyperkinetic behavior [old name for ADHD], 36 [80%] improved on an oligoantigenic diet . . . “Headaches, abdominal pains, and hyperkinetic behavior ceased in all those whose seizures ceased, and in some of those whose seizures did not cease.” . . . “Of 24 children with generalized epilepsy, 18 [75%] recovered or improved (including 4 of 7 with myoclonic seizures and all with petit mal), as did 18 of 21 [85%] children with partial epilepsy. In double-blind, placebo-controlled provocation studies, symptoms recurred in 15 of 16 children, including seizures in eight; none recurred when placebo was given. Eighteen other children, who had epilepsy alone, were similarly treated with an oligoantigenic diet; none improved.”
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Egger 1985: Controlled trial diet in ADHD (& headache, GI pain, seizures)
Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome, J.Egger, P.J.Graham, J.F.Soothill, C.M.Carter, D.Gumley, The Lancet, March 9, 1985
Egger 1983: Double-blind study of diet & migraine (& GI pain, behavior, seizures, asthma, eczema)
Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment, Egger J et al., Lancet 1983 Oct 15;2(8355):865-9
“93% of 88 children with severe frequent migraine recovered on oligoantigenic diets; … the role of the foods provoking migraine was established by a double-blind controlled trial in 40 of the children. … Associated symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. . . .”
The Diet Connection
According to Dr. Millichap in 2003, foods can cause headache by influencing the release of neurotransmitters causing dilation or constriction of the blood veins, or by directly stimulating one of several parts of the nervous system. According to him, long-term drug therapy (in an effort to prevent migraine) “is appropriate only after exclusion of headache-precipitating trigger factors, including dietary factors.”
In one study published in 1983, Dr. Egger showed that 93% of children treated by a few-foods diet for migraine recovered. In several other studies using a few-foods diet for other symptoms, he also noted that headache was consistently improved.
Headache After Wine
Harry’s headaches had started out slowly, and had gradually increased in frequency and severity until reaching the point where he was sick several times a month. At these times, all he could do was lie in a dark room for the three days or so that the attack lasted. He went from doctor to doctor in search of help, but each new doctor simply asked what pain pills he was taking, and handed him a prescription for more. Nobody ever questioned why he got the headaches in the first place.
Meanwhile, his wife, Jane, had read Dr. Feingold’s book looking for help for her daughter, but the thought of tossing out “perfectly good” food went against the grain. She figured if she followed the diet 50%, she should see a 50% improvement. It didn’t work that way, and there was no improvement in the child, but Harry began to suspect that food additives could be triggering his dreadful headaches, and he began to pay more attention to what he ate.
As the headache-free time lengthened, Harry was able to identify other culprits, and he soon added MSG (monosodium glutamate) and sodium benzoate to the list.
Jane’s commitment to the diet was still only partial since her effort until then had made no improvement in her daughter.
Then one day when Harry came home from work, he told her about the lunch he had eaten. He had selected a cottage cheese salad and had discarded the bright red cherry, but a little bit of juice from the cherry had colored the cottage cheese pink in one spot. It was just a drop or two, and he figured such a little bit wouldn’t hurt, so he ate it. About two hours later he could feel the start of a migraine. The pain pills were strong enough to stop the headache, but it made a profound impression on him that such a tiny amount of dye could be so potent.
It made a tremendous impression on Jane as well. A drop or two! The next day when her daughter came downstairs for breakfast, she gave her very plain foods — some scrambled eggs, bread and butter, and a glass of milk. She did her best with the other meals, too, keeping things plain and free of obvious synthetic additives.
“The following morning,” Jane says, “Laura’s behavior surprised and delighted me. Instead of her attention being in the next county, she was right there, hearing and responding to me. Her eyes didn’t dart all over the room, but connected with mine, and her responses were reasonable. She made sense! She behaved normally, and I was amazed. Previously, when I saw normal behavior I didn’t know why. Now I had something to go on.”
It’s been many years since that infamous maraschino cherry, and not only have the Herseys benefited tremendously with good health, calm children and wonderful grandchildren, but Harry has not had a migraine since 1975!