Years ago, my headache mentor at Columbia, Dr. Green, compared a migraineur’s brain to a fancy sports car’s engine. He meant that the brain becomes sensitized to the slightest stimulation and like the engine of a fine sports car, it revs up with the slightest stimulation.
In migraine the 0-60 mph equivalent is a phenomenon of brainstem activation followed by a wave of depolarization (depression of neuronal activity), which originates in the occipital lobes in the back of the head and slowly spreads forward at a rate of 2-5 mm per minute.
This phenomenon is called Cortical Spreading Depression and while we do not understand the exact mechanism of how it is triggered, we know that it can be caused by subtle changes in diet, sleep, stress, dehydration, medications, upper respiratory illness, chronic medical conditions and that it leads to inflammation and pain through blood vessel dilatation. This image of the sensitive migraineur’s brain has stayed with me and is a helpful reminder that modification of these lifestyle risk factors can decrease the frequency of migraine attacks.
As a resident, I conducted a study aimed to assess the prevalence of migraine in 728 subjects – patients with celiac disease (gluten intolerance) and healthy controls. We were somewhat surprised to find out that 33% of patients with celiac disease suffered from migraine!
The number is probably much higher – possibly up to 45-50% as in our surveys we came across 8 patients with celiac disease who had suffered from debilitating headaches, which were completely resolved with a strict gluten-free diet.
I should point out that Celiac disease may present without any GI symptoms whatsoever. It could often manifest as lack of energy, skin problems, numbness in the extremities or face, headaches or balance difficulties.
Lactose is another common offensive agent, particularly in those who are intolerant. Refined sugar is pro-inflammatory and high-sugar diet invariably causes sugar lows due to increased insulin release.
Hypoglycemia is a known migraine trigger. Other known dietary triggers are tyramine-rich foods such as aged cheeses, beer and wine, chocolate, soy sauce, MSG.
I am not saying that migraine sufferers should all be gluten, lactose and refined sugar-free, however an elimination trial of 4-6 weeks (one food category at a time) is reasonable as they may be hidden triggers for migraine.
Dietary Changes to Prevent Migraine
- Celiac disease testing with any unexplained GI or neurologic deficits
- Trial of lactose-free diet
- Avoid chocolate and tyramine-rich foods
- Avoid alcohol, especially beer and wine
- Avoid concentrated sweets and diets high in sugar
- Eat small, frequent meals to avoid hypoglycemia
- Limit caffeine consumption to 1 cup per day, eliminate altogether if possible
Lifestyle Modifications to Prevent Migraine
- Moderate exercise activity of 30 min 3-4 times per week
- Maintain normal weight
- Sleep 7-8 hours a night with a regular sleep schedule (undersleep and oversleep both can trigger migraines)
- Stress reduction is key – incorporate relaxation and meditation techniques on a daily basis, even if it means slowed, focused breathing for 5 min per day
- Quit tobacco as it is pro-inflammatory and can be a trigger
Alexandra Dimitrova, MD is an Assistant Professor in Neurology at OHSU, who sees patients with headache and pain in the Neurology Wellness Clinic. In her practice she integrates traditional neurologic treatments with acupuncture, dietary and lifestyle changes and other complementary and integrative treatments.