Food and diet
Does gluten sensitivity cause migraine? Is there a migraine diet? Frequently asked questions about what we eat and migraine
The Migraine Trust is often asked about the relationship between what we eat and how this might affect migraine. Here we have an example of such an enquiry, with an answer kindly provided by Dr Shazia Afridi, a Trustee of The Migraine Trust and Consultant Neurologist at Guy’s and St Thomas’ NHS Trust, London.
I’ve come across a number of sites online that suggest gluten sensitivity causes migraine – is this true? I’ve also read about avoiding various foods and additives to help migraine. Is there any evidence for this and is there a migraine diet?
Celiac disease is an autoimmune disease where the body produces an immune response to gluten resulting in gastrointestinal and other symptoms. It can be tested for by detection of various antibodies in the blood e.g. Anti-gliadin antibodies (AGA). Non-celiac gluten sensitivity is a more controversial diagnosis. Antibodies in the blood are often negative but up to 50% of such patients presenting to gastroenterologists have detectable AGA circulating levels in one study. There is evidence that it is a separate disorder but it is often over-diagnosed and there is likely to be an overlap with irritable bowel syndrome.
Headaches may be part of a large number of symptoms which are listed as being associated with gluten-sensitivity but there is no evidence that gluten-sensitivity causes migraine. Two published studies investigating the prevalence of headache in adults with celiac disease from Italy showed different results: Cicarelli et al reported 32% prevalence of migraine in celiac disease compared with only 5.6% reported by Briani et al. Another study found headaches were more prevalent in celiac patients from a celiac clinic compared to controls although they had fewer females in their control group and migraine is more common in females. Interestingly, they also reported a similar prevalence amongst the irritable bowel group who did not have celiac disease.
There is no good evidence to suggest a gluten-free diet has an effect on migraine. In the aforementioned study only eight of the 188 celiac patients reported an improvement although the study wasn’t specifically looking at this. It also showed that the duration of gluten-free diet did not correlate with migraine severity. There was a paper in 2001 of ten celiac disease patients with migraine, most with other neurological problems as well. It was stated that a gluten-free diet resolved the migraine in seven of these but it does not state for how long and no details of the migraine history or treatment were given in the report.
Other diets have been tried but the studies are usually open-label so the participants know what they are eating which may mean the results could be influenced by the placebo effect. Also they often involve only a small number of participants or a short duration. There have been two such studies suggesting the benefits of a ketogenic diet over a four week period but better studies are needed to validate these findings.
There have also been some small studies suggesting eliminating individualised food allergens. One study involving thirty migraineurs looked at headache days over a six week diet period and had positive results but a larger randomised, controlled study of 167 participants where half were given a sham diet for twelve weeks was negative. It may be the case that in a small number of people allergens may be a trigger but there is no evidence to suggest that this is the case in the majority of migraine sufferers.
Another popular myth suggests that chocolate can trigger migraine. The evidence does not support this. The myth may have arisen because of cravings which can form part of the prodrome or premonitory phase of migraine, so when the chocolate is eaten during this phase the migraine has actually already begun.
In conclusion, there is no migraine diet but it is clear that missing meals is a well established migraine trigger so eating a healthy diet at regular mealtimes is advisable. If you are concerned about gluten sensitivity or a specific food allergy it is advisable to consult with your GP.
- Cicarelli et al. Neurol Sci, 2003; 24:311-17
- Briani et al. J Neuroimmunol, 2008; 195(1-2):171
- Dimitrova et al. Prevalence of Migraine in Patients with Celiac Disease and Inflammatory Bowel Disease. Headache 2013; 53:2 (344-55)
- Orr S. Cephalalgia, 2015
- Hadjivassiliou et al. Neurology, 2001; 56:385-388
- Alpay K et al. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia 2010 Jul; 30(7):829-37
Information taken from Migraine News journal, Issue 113, September 2016.
In September 2016 our trustee Professor Peter Goadsby contributed to a piece on the BBC Good Food website about food and migraine. Read ‘How does food affect migraines?’ on bbcgoodfood.com >