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Headache disorders are among the leading causes of disability worldwide,¹ and migraine and severe headache affect roughly one out of every six US adults (and one in five women).² Migraine and tension-type headaches are the most prevalent headache disorders,³ and migraine, specifically, is associated with other physical and psychiatric comorbidities like anxiety and depression.⁴ Yet despite their prevalence and severity, some studies have found that migraine prevention treatments are underutilized in clinical practice.⁵

Nutritional Strategies: Nutrients and Dietary Approaches

Strategies to reduce migraine occurrence, including nutritional interventions, might greatly increase the quality of life for many patients. Nutrition treatments for migraine may help to reduce allergy-based triggers⁶ and influence systemic inflammation, vasodilation, and cerebral glucose metabolism, as well as attack frequency, duration, and severity.⁷

While the exact pathophysiology of migraine remains unclear, there is evidence that inflammation plays a role, and food has been identified as a triggering factor.⁸ About 25% of patients report that their symptoms can be triggered by certain foods.⁹ In some patients, immune-mediated food sensitivities may be involved, and IgG antibodies may correlate with inflammation.⁸ A 2010 study found preliminary evidence that IgG-based elimination diets successfully controlled migraines without the need for medication,⁹ and a 2011 randomized controlled trial (RCT) of an elimination diet based on IgG antibodies for the prevention of migraine headaches showed a significant reduction in the number of migraines or migraine-like headaches at four weeks.¹⁰

Several RCTs have found that some plants of the genus Petasites (like butterbur), the nutritional supplements coenzyme Q10 (CoQ10) and magnesium citrate, CoQ10 with L-carnitine, and cinnamon may be beneficial in patients with migraine.^11-15 Riboflavin, which is suggested to improve energy metabolism similarly to CoQ10, has also demonstrated some efficacy in reducing migraine frequency.^8,16 In addition, vitamin D deficiency or insufficiency has been reported in some patients with migraine, and a review of 22 observational, case-control, and clinical studies suggested that vitamin D supplementation (1,000-4,000 IU/day) may reduce the frequency of migraine attacks.¹⁷

Other dietary approaches have been shown to be effective for treating migraines. A 2020 study suggests that an adherence to the dietary approaches to stop hypertension (DASH) diet is associated with lower headache severity and duration in migraine patients.¹⁸ In addition, a 2020 cross-sectional study (n=266) found that participants who reported higher adherence to a Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, with an increased consumption of vegetables, legumes, and nuts and decreased intake of refined grains and energy, were up to 36% less likely to have severe headaches.¹⁹

A six-month randomized crossover study suggested that a low-lipid diet may decrease the number and severity of migraine attacks.²⁰ On the other hand, another study suggested that a low glycemic index diet may be an effective and reliable method to reduce migraine attacks.²¹ As well, an exploratory study has found that the administration of alpha-lipoic acid may be associated with a reduction in the number of attacks and the days of treatment in migraineurs with insulin resistance.²²

The Role of Fatty Acids

Studies, based on self-reporting, have shown that a large percentage of US adults are not consuming USDA-recommended amounts of omega-3 fatty acids, particularly women and young adults.²³ For migraine patients, this may be particularly relevant, with some clinical studies suggesting that intake of omega-3 fatty acids may be useful for migraine prophylaxis.^24,25 A 2018 meta-analysis of RCTs aimed at the effectiveness of omega-3 fatty acids on the frequency, severity, and duration of migraine also found that omega-3 intake may lead to a significant reduction in the duration of migraine.²⁶

In addition, a 2018 study provided evidence that supplementation with omega-3 fatty acids plus curcumin may reduce both attack frequency and intercellular adhesion molecule-1 (ICAM-1) serum levels in patients.²⁷ ICAM-1 as an endothelial factor leads to the adhesion of leukocytes to the walls of the cerebral blood vessels, which is an important step in the inflammation process. The authors report that supplementation with these two nutrients may lead to improvements in the function of metabolic pathways and can also be used effectively as a treatment or prevention of migraine complications.²⁷

Recommending appropriate consumption of omega-3 fatty acids may provide an avenue for helping many patients with migraines. While studies substantiate the hypothesized relationship between migraine and nutrition,²⁸ additional research on nutrition’s role in migraine prevention and treatment continues to develop. For example, migraine research continues to explore the efficacy of non-pharmaceutical treatments such as probiotics²⁹ and the impact of other nutritional factors such as adequate water consumption.³⁰ Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

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References

1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 [published correction appears in Lancet. 2020;396(10262):1562]. Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
2. Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: updated age, sex, and socioeconomic-specific estimates from government health surveys. Headache. 2021;61(1):60-68. doi:10.1111/head.14024
3. Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013;53(3):427-436. doi:10.1111/head.12074
4. Green MW. Headaches: psychiatric aspects. Neurol Clin. 2011;29(1):65-80. doi:10.1016/j.ncl.2010.10.004
5. Silberstein SD. Preventive migraine treatment. Continuum. 2015;21(4 Headache):973-989. doi:10.1212/CON.0000000000000199
6. Bektas H, Karabulut H, Doganay B, Acar B. Allergens might trigger migraine attacks. Acta Neurol Belg. 2017;117(1):91-95. doi:10.1007/s13760-016-0645-y
7. Aschermann S, Lux A, Baerenwaldt A, Biburger M, Nimmerjahn F. The other side of immunoglobulin G: suppressor of inflammation. Clin Exp Immunol. 2010;160(2):161-167. doi:10.1111/j.1365-2249.2009.04081.x
8. Sándor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology. 2005;64(4):713-715. doi:10.1212/01.WNL.0000151975.03598.ED
9. Alpay K, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010;30(7):829-837. doi:10.1177/0333102410361404
10.  Mitchell N, Hewitt CE, Jayakody S, et al. Randomized controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutr J. 2011;10:85. doi:10.1186/1475-2891-10-85
11.  Pringsheim T, Davenport W, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 Suppl 2):S1-S59.
12.  Köseoglu E, Talaslioglu A, Gönül AS, Kula M. The effects of magnesium prophylaxis in migraine without aura. Magnes Res. 2008;21(2):101-108.
13.  Hajihashemi P, Askari G, Khorvash F, Reza Maracy M, Nourian M. The effects of concurrent coenzyme Q10, L-carnitine supplementation in migraine prophylaxis: a randomized, placebo-controlled, double-blind trial. Cephalalgia. 2019;39(5):648-654. doi:10.1177/0333102418821661
14.  Zeng Z, Li Y, Lu S, Huang W, Di W. Efficacy of CoQ10 as supplementation for migraine: a meta-analysis. Acta Neurol Scand. 2019;139(3):284-293. doi:10.1111/ane.13051
15.  Zareie A, Sahebkar A, Khorvash F, Bagherniya M, Hasanzadeh A, Askari G. Effect of cinnamon on migraine attacks and inflammatory markers: a randomized double-blind placebo-controlled trial. Phytother Res. 2020;34(11):2945-2952. doi:10.1002/ptr.6721
16.  Thompson DF, Saluja HS. Prophylaxis of migraine headaches with riboflavin: a systematic review. J Clin Pharm Ther. 2017;42(4):394-403. doi:10.1111/jcpt.12548
17.  Ghorbani Z, Togha M, Rafiee P, et al. Vitamin D in migraine headache: a comprehensive review on literature. Neurol Sci. 2019;40(12):2459-2477. doi:10.1007/s10072-019-04021-z
18.  Mirzababaei A, Khorsha F, Togha M, Yekaninejad MS, Okhovat AA, Mirzaei K. Associations between adherence to dietary approaches to stop hypertension (DASH) diet and migraine headache severity and duration among women. Nutr Neurosci. 2020;23(5):335-342. doi:10.1080/1028415X.2018.1503848
19.  Askarpour M, Yarizadeh H, Sheikhi A, Khorsha F, Mirzaei K. Associations between adherence to MIND diet and severity, duration and frequency of migraine headaches among migraine patients. BMC Res Notes. 2020;13(1):341. doi:10.1186/s13104-020-05181-4
20.  Ferrara LA, Pacioni D, DiFronzo V, et al. Low-lipid diet reduces frequency and severity of acute migraine attacks. Nutr Metab Cardiovasc Dis. 2015;25(4):370-375. doi:10.1016/j.numecd.2014.12.006
21.  Evcili G, Utku U, Ögün MN, Özdemir G. Early and long period follow-up results of low glycemic index diet for migraine prophylaxis. Agri. 2018;30(1):8-11. doi:10.5505/agri.2017.62443
22.  Cavestro C, Bedogni G, Molinari F, Mandrino S, Rota E, Frigeri MC. Alpha-lipoic acid shows promise to improve migraine in patients with insulin resistance: a 6-month exploratory study. J Med Food. 2018;21(3):269-273. doi:10.1089/jmf.2017.0068
23.  Papanikolaou Y, Brooks J, Reider C, Fulgoni VL. U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003–2008. Nutr J. 2014;13:31. doi:10.1186/1475-2891-13-31
24.  Sadeghi O, Maghsoudi Z, Khorvash F, Ghiasvand R, Askari G. The relationship between different fatty acids intake and frequency of migraine attacks. Iran J Nurs Midwifery Res. 2015;20(3):334-339.
25.  Soares AA, Louçana PMC, Nasi EP, Sousa KMH, Sá OMS, Silva-Néto RP. A double-blind randomized, and placebo-controlled clinical trial with omega-3 polyunsaturated fatty acids (OPFA Omega-3) for the prevention of migraine in chronic migraine patients using amitriptyline. Nutr Neurosci. 2018;21(3):219-223. doi:10.1080/1028415X.2016.1266133
26.  Maghsoumi-Noroyuzabad L, Mansoori A, Abed R, Shishehbor F. Effects of omega-3 fatty acids on the frequency, severity, and duration of migraine attacks: a systematic review and meta-analysis of randomized controlled trials. Nutr Neurosci. 2018;21(9):614-623. doi:10.1080/1028415X.2017.1344371
27.  Soveyd N, Abdolahi M, Djalali M, et al. The combined effects of Omega-3 fatty acids and nano-curcumin supplementation on intercellular adhesion molecule-1 (ICAM-1) gene expression and serum levels in migraine patients. CNS Neurol Disord Drug Targets. 2018;16(10):1120-1126. doi:10.2174/1871527317666171213154749
28.  Slavin M, Li HA, Frankenfeld C, Cheskin LJ. What is needed for evidence-based dietary recommendations for migraine: a call to action for nutrition and microbiome research. Headache. 2019;59(9):1566-1581. doi:10.1111/head.13658
29.  Martami F, Togha M, Seifishahpar M, et al. The effects of a multispecies probiotic supplement on inflammatory markers and episodic and chronic migraine characteristics: a randomized double-blind controlled trial. Cephalalgia. 2019;39(7):841-853. doi:10.1177/0333102418820102
30.  Khorsha F, Mirzababaei A, Togha M, Mirzaei K. Association of drinking water and migraine headache severity. J Clin Neurosci. 2020;77:81-84. doi:10.1016/j.jocn.2020.05.034