Managing migraines and other headaches: Diet's controversial role


Everyone gets headaches. For most of us, they' re only minor annoyances triggered by stressful situations--work deadlines, tax forms, traffic jams or busy airports. These headaches are from tense muscles. They aren't serious and are easily remedied with an over-the-counter pain reliever like aspirin, acetaminophen or ibuprofen.

However, according to the National Headache Foundation, a nonprofit clearinghouse for consumer headache information in Chicago, more than 45 million Americans seek medical attention for severe or chronic headaches. Among them are 16 to 18 million-nearly three-quarters of them female-who suffer migraines, the most debilitating type of headache.

Though about one-third to one-half of migraine sufferers say certain foods trigger their headaches, studies have largely been inconclusive. Most researchers believe the actual number of sufferers who respond to food triggers is small. Recently, for example, researchers found chocolate--one of the most often cited trigger foods--to be an unlikely culprit. What about other food-headache links?

What Are Migraines? Migraines are now considered a neurological disease, with a hereditary link. They can be triggered by many factors, including stress, anxiety, bright lights or any change in sleeping habits, hormone levels, barometric pressure or diet. The pain is intense and throbbing, usually on one side of the head, and often accompanied by nausea, vomiting, and sensitivity to light or noise Attacks, lasting from four to 72 hours, often leave a person incapacitated--unable to work, think clearly or do daily activities.

Experts used to think migraines were vascular headaches, with blood vessels dilating prior to a migraine, causing inflammation and pain, explains Lawrence Newman, M.D., director of the headache unit at New York's Montefiore Medical Center.

"We now know blood vessel changes are a result of the migraine, not a cause," says Newman. The latest theory on what causes migraines involves trigeminal nerve activation in the brain, which causes a drop in the level of serotonin, a brain chemical that affects pain receptors, and may also cause blood vessel changes.

Food-Headache Links. For years, certain foods have been reported as headache triggers, primarily for migraines. However, the new theory has many researchers now questioning the importance of diet as a cause of migraines. Studies both support and challenge the belief that foods or chemicals in foods can trigger migraines. That's not so surprising.

"A suspected food may not be a trigger 100% of the time," explains Frederick Freitag, M.D., of the Diamond Headache Clinic in Chicago. Often, foods are triggers only when combined with other triggers, such as stress or hormonal changes. A response may also depend on how much of the food is eaten. Complicating the picture, says Newman, is that a headache may not result for several hours to several days after eating a trigger food.

Here's what experts say about the most common suspected food triggers:

Chocolate. Chocolate was thought to be a trigger food because it contains substances called vasoactive amines that can reduce brain serotonin levels. But recently, University of Pittsburgh researchers studied 63 women who suffered from migraines or tensiontype headaches, and found chocolate no more likely to trigger headaches than carob (which contains no caffeine or vasoactive amines).

"Chocolate doesn't appear to play a significant role in triggering headaches, migraine or tension," concludes Dawn Marcus, M.D., the lead researcher of the study. Chocolate may, however, be masking the real migraine trigger, says Marcus. One possibility: Stress or hormonal changes--which may coincidentally also be causing chocolate cravings--may be the real triggers.

Caffeine. Caffeine is the one diet component that's consistently been shown tO trigger migraines. Too much or too little can set one off. Too little caffeine causes trouble by triggering a so-called caffeine-withdrawal headache in habitual consumers of coffee, tea, cola, coffeeflavored yogurt and ice cream, chocolate or over-the-counter pain medications that contain caffeine, like Excedrin. These rebound headaches occur in up to one-half of migraine sufferers.

Red Wine and Alcohol. Red wine is frequently cited as a headache trigger, because it contains tyramine, a vasoactive amine. Research now suggests that phenols, a type of flavonoid found in red wine, are the real headache triggers. For many people, however, drinking any kind of alcohol can provoke a headache. For migraine sufferers, other serotonin-depleting compounds found in beer, whiskey and wine may be the culprits. And, according to Newman, even a sip can be enough to trigger a headache in susceptible people. But anyone who drinks too much alcohol can bring on the well-known hangover headache, which is caused by dehydration that depletes fluids around the brain and causes painful pulling on the brain lining.

Tannins and Tyramine. Tannins are substances found naturally in foods, notably in apple juice, blackberries, coffee, tea, chocolate, carob, red wine, and alcohol matured in barrels. Tyramine is an amino acid with the ability to reduce serotonin levels. In addition to red wine, it is present in large amounts in avocados, overripe bananas, chocolate, beer and aged cheese, as well as nuts, seeds, pork, venison and soy-based foods. Evidence that foods containing tannins or tyramine cause migraines, however, is based on old research, and 'many experts doubt their importance.

Ice Cream. "Ice cream headaches" are not migraines; they are intense, shortlived headaches that affect migraine sufferers twice as much as other people. They are caused by rapid cooling of an area on the roof of the mouth, explains Montefiore's Newman. This affects nerve endings that trigger headaches.

Artificial Sweeteners, MSG and Other Additives. The artificial sweetener aspartame, monosodium glutamate (MSG) and nitrates have been cited as potential migraine triggers. However, headache specialists still do not agree on how much of a threat these additives pose for most migraine sufferers.

What to Do? To keep your head about you, EN suggests the following:

Perform a food challenge on yourself: Keep a diary of your food intake, exercise, sleep, menstrual cycle and emotional stress, along with a log of when your headaches occur. After a week or so, review the foods you ate up to 72 hours before each headache, identifying any trends. If you suspect a food, try eating it again for a week to see if it triggers a headache. If it does, then avoid it in the future.
Develop a schedule--diet, sleep, exercise-and stick to it. Changes in daily activities can trigger a migraine.
Limit caffeine intake to a moderate and consistent amount daily. If you cut back, do it gradually.
If your migraines are mild, you may get some relief from the herb feverfew or the B vitamin, riboflavin. Studies in Europe show that regular use of 125 milligrams of dried feverfew leaf extract a day may help prevent migraines by preventing plummeting serotonin levels. (Avoid it if you're allergic to ragweed.) Preliminary research has found that 400 milligrams a day of riboflavin results in fewer than half the migraines, and with less severity compared to a placebo, probably by influencing glucose metabolism in the brain.
Avoid smoking and second-hand smoke; both can bring on a migraine.
To avoid "ice cream headaches," eat frozen foods s-l-o-w-l-y, warming them in the front of your mouth first, so your palate has time to adjust.
Keep hydrated. Drinking fluids helps keep a constant blood volume, which reduces the likelihood of headaches triggered by dehydration.

By Julie Walsh, M.S., R.D.

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