A Day in the Life of a Migraineur
Morning has arrived. As you lay there and tune into your head, a rush of relief washes over you. No migraine today! Thank goodness, you can't afford to miss another day of work. You go about your day and suddenly start getting that familiar warning, and here is where the cascade begins. There’s actually a name for this ‘warning’, it’s called a migraine prodrome. This early symptom comes in various forms, such as depression, stiffness in the neck, and or difficulty concentrating. Some people have a visual warning known as an aura where they see flashing lights or other visual disturbances[1]. Soon enough there is a rapidly growing root of pain spreading throughout your head. You reach for your prescription, hoping you caught it in time so you don’t have to face the painful torture that leaves you immobile with no ability to care for yourself. The kind of pain that's so severe that it pushes you to the brink of vomiting repeatedly and leaves you lying there wishing for tomorrow to come sooner. Does this sound like you? Am I right to say that everyday feels like a game of Russian roulette for a migraineur? It’s no wonder people with migraines experience higher rates of anxiety and depression [2]. This represents a typical pattern you've been accustomed to though. Although the doctor may have prescribed you medication, the merry-go-round ensues and you continue to ride your days in uncertainty. Well, what if I told you that you have more control over your migraines than you think? Your lifestyle choices can make all the difference, and your dietary habits play a huge role as a form of preventative medicine. I myself suffer from migraines, but over the years I’ve obtained knowledge that has helped me gain more control over them, by reducing their severity. As they say “Knowledge is power” and I hope that by sharing some knowledge with you, that you no longer feel like a migraine sufferer, but more like a migraine warrior.
What's Being Done to Help?
Let’s dive in and talk about how we can improve migraine care and ways we can manage living with migraine using dietary approaches. As you probably already know, this is a very stigmatized disease and I’m here to provide you with the care and tools to help you on your migraine management journey. The World Health Organization places migraine as one of the 10 most disabling medical illnesses on earth according to The American Migraine Foundation [3]. So, what is being done to help those with this disease? From my own experiences, I say not enough. I can recall many times where I felt misunderstood, unheard, and invalidated; Disappointing friends for not being able to make it to a special occasion, having to listen to the frustration in my boss’ voice when calling out of work due to my pain, being rushed in and out of the doctor's office, and having a doctor laugh in my face for suggesting unconventional preventatives like marijuana. In fact, the advice he did give me was to take a large amount of ibuprofen several times daily. That’s how my doctor approached migraine management. Luckily I was aware of the harm that could do to my body, and didn’t take his advice. As a migraineur you've probably had similar experiences. Now imagine going to the doctors and instead of sending you home with only a prescription, they order lab work, test you for different food allergies and sensitivities, and in addition to the neurologist, they also refer you to other specialists, such as a genetics counselor and a dietitian. What a difference that could make in your overall health and migraine management. Acknowledging its roots and triggers shouldn’t be overlooked. The seriousness of this illness calls for a more thorough assessment to help make the disease more manageable.
Possible Triggers
Studies have shown a correlation between migraines and diet. One such study measured serum antibodies to 108 specific food allergens from patients with migraine and those without. They found significant differences between the migraineurs and the control group, and elimination diets based off of these results successfully treated many of the migraineurs. These results led them to conclude that serum IGg antibodies to foods should be investigated when treating those with migraine [4]. Something to think about when you schedule your next doctor's visit, as it’s worth mentioning. A variety of foods can benefit someone with migraine or trigger an attack. Triggers can vary between individuals, but some of the common trigger foods for people with migraine are cured meats, aged cheese, aged fruit, and red wine. Yeah, watch out for those charcuterie boards my friends as these foods contain compounds that migraineurs are very sensitive to. There are many chemicals in foods that you want to look out for. Preservatives; such as nitrates and sulfites, artificial ingredients; such as MSG and aspartame, and aged or fermented foods that contain chemicals like tyramine and histamine [5]. What I'm referring to here are additives that are put into foods or overripe foods that are no longer considered fresh, such as a brown speckled banana. There are many fruits and vegetables that naturally have varying amounts of some of these compounds, which is why you'll see them on the elimination diet. I personally don't feel that a person should eliminate any fruit or vegetable. I think the benefits of consuming fresh fruits and vegetables by far outweigh the risks. However, everyone is different and it may be a good idea to test some of these foods if you suspect a sensitivity. You may also want to limit the amounts of saturated fats in your diet. An interesting trial using randomized, crossover intervention concluded that a diet particularly low in saturated fats significantly reduced the number and frequency of migraine attacks [6]. Now, I know it can be a little overwhelming trying to remember all this information, but as you become more mindful of what you're eating, you may notice that most triggers come from highly processed foods with a longer shelf life. Remembering this will also help you identify beneficial foods. I also came up with an acronym that can help; PAAS, which stands for preservatives, artificial, aged, and saturated. These are ingredients we want to “paas” on. I know I’m corny, but it helps you remember right?
Choosing Nutrient Dense Food
When it comes to your diet, fresh foods are your best friend. The fresher the better. This means eating your leftovers within a day or two, choosing frozen meats over unfrozen, and limiting aged, fermented, and highly processed foods. You also want to focus on eating foods that are rich in beneficial ingredients. A diet which supplies B vitamins, magnesium, and omega 3’s may benefit those with migraine, and can be obtained in foods such as green leafy vegetables, whole grains, legumes, and fish. If you’re feeling lost on where to start, The Mediterranean Diet or The Mediterranean-DASH intervention for neurodegenerative delay (aka The MIND diet) are great diets to follow. There are many resources out there on these two popular diets if you need more direction on what kinds of foods to incorporate onto your plate. One interesting study discusses how Mediterranean foods are associated with reduced oxidative stress, and omega 3s found in fish can help inflammation in the brain to benefit migraine. Additionally, they discuss how low brain magnesium; an abundant mineral in this diet, has been attributed to migraine attacks. This study examined the association between MIND diet and migraine headaches and found that participants who had a higher MIND diet score were less likely to suffer severe headaches. They also found an increased correlation between the MIND diet score and the frequency and duration of pain [7]. Other studies discuss the benefits of folate and other B vitamins in migraineurs' health. One study discusses the benefits of B12, B6, and folate and the association between migraineurs and a gene mutation known as Methylenetetrahydrofolate reductase or MTHFR. They found that 2 mg of folate, 25 mg of vitamin B6, and 400 mcg of B12 significantly reduced migraine disability from 60% to 30% after 6 months [8]. Another study found that 400 mg of vitamin B2 supplementation daily, reduced the use of migraine drugs from 7 to 4.5 units per month [9]. With this knowledge, we can see how important B vitamins are for a migraineur.
Balance is Key
As you can see, being mindful about what you eat may be helpful in preventing and reducing migraine attacks. Thankfully, there are many resources out there that you can utilize, such as a meal planning toolkit that you can download for free from The American Migraine Foundations website [10]. It’s important to acknowledge the fact that there is no one size fits all solution for migraine management. Each migraineur will benefit best from their own individualized plan. You also need to know that there are many foods that contain triggers, which is why I must caution you not to limit so many foods out of fear that you deprive yourself of nutrients. This nutrient deprivation can actually make your migraines worse. I myself have developed food phobias and caught myself before they took over to become an eating disorder. Focusing only on triggers is just not sustainable. I make sure my diet is balanced and nutrient dense, that is my top priority. You can eliminate a huge amount of triggers by just reducing highly processed foods and focusing of fresh, whole foods. I also want to warn you that there's a lot of misinformation out there. That’s why It’s best to speak with a healthcare professional to help guide you. Think about the beneficial foods discussed in this article and ask yourself if your diet lacks these ingredients. If so, start incorporating them into your diet. Adding more green vegetables to your diet and logging down what you eat is a great way to start. And remember it's more than just your diet that can contribute to your migraines. A variety of factors contribute to migraine, some of which we have no control over. We do however have control of what we eat and this can make a huge difference in our condition.
1. (2018) The timeline of a Migraine Attack. The American Migraine Foundation https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/
2. Minen MT, Begasse De Dhaem O, Kroon Van Diest A, et al Migraine and its psychiatric comorbidities Journal of Neurology, Neurosurgery & Psychiatry 2016;87:741-749.
3. (2019) The Facts About Migraine. The American Migraine Foundation https://americanmigrainefoundation.org/resource-library/migraine-facts/
4. Hernandez, C.M.A, Pinto, M.E., Montiel, H.L.H (2007) Food allergy mediated by IgG antibodies associated with migraine in adults Revista Alergia México 2007;54(5):162-8
5. Food list PDF for Migraine Elimination Diet. Retrieved from: https://migraine.com/wp-content/uploads/2015/02/elimination_diet_comprehensive.pdf
6. Ferrara, L.A., Pacioni, D., Di Fronzo, V., Russo, B.F.,Speranza, E., Carlino, V.,Gargiulo, F., Ferrara, F. (2014) Low-lipid diet reduces frequency and severity of acute migraine attacks. Nutrition, Metabolism & Cardiovascular Diseases (2015) 25, 370e375, An International Journal on Diabetes, Atherosclerosis and Human Nutrition http://dx.doi.org/10.1016/j.numecd.2014.12.006
7. Askarpour, M., yarizadeh, H., Sheikhi, A., Khorsha, F., Mirzaei, K. (2020) Associations between adherence to MIND diet and severity, duration and frequency of migraine headaches among migraine patients. BMC Research Notes (2020) 13:341 https://doi.org/10.1186/s13104-020-05181-4
8. Lea, R., Colson, N., Quinlan, S., MacMillan, J., Griffiths, L. The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability. Pharmacogenetics and Genomics, vol. 19, no. 6, pp. 422–428, (2009)
9. Boehnke, C., Reuter, U., Flach, U., Schuh-Hofer, S., Einha ̈upl, K.M., Arnold, G. High-dose riboflavin treatment is efficacious in migraine prophylaxis; an open study in a tertiary care center. European Journal of Neurology (2004), 11: 475–477 Department of Neurology, Charite ́, Humboldt University of Berlin, Berlin, Germany.
10. Meal Planning Toolkit (2020) The American Migraine Foundation. Retrieved from: https://info.americanmigrainefoundation.com/meal-planning-toolkit-download
References
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