There is no special migraine diet. Nevertheless, the way you eat can help to reduce the number of migraine attacks. Does a change in diet make sense, and what do people with migraine need to bear in mind?
What is migraine?
According to the World Health Organization, migraine ranks 7th among the twenty diseases that most severely impair our quality of life and ability to work. It is a serious disease of the nervous system. Between 10 and 15% of the population are affected. Migraine is understood to mean severe headaches that occur in attacks. The pain has a pulsating, throbbing character, is stabbing or pulling and is usually localised on one side at a temple or behind one eye. The side can change during an attack and radiate to other areas, such as the neck. The scalp is usually painful as well. The pain gets worse with movement. This distinguishes migraine from tension-type headache, where those affected sometimes find movement a relief.
Symptoms of migraine
It is often accompanied by symptoms – mostly of a neurological nature – such as sensitivity to light, noise and smells, nausea, vomiting, pale facial skin and sensitivity to cold; increased urination can also occur. Those affected then have to withdraw to darkened rooms and are bedridden. Work or even everyday family life is out of the question. Heat or cold, in the form of a hot-water bottle or cooling pads on the head, can relieve the pain. A migraine attack can last from 4 hours to a maximum of 72 hours. In some people, migraine is accompanied by an aura. These are mostly visual disturbances – for example flashes of light – that occur about an hour before the headache begins. Anyone who suffers from migraine on more than 15 days a month has chronic migraine. Here, migraine attacks merge into one another almost without a break. The disease becomes a burden in private and professional life, as those affected are completely “out of action” on migraine days. In the worst case, it can cost them their career, relationship and plans for the future.
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Migraine without aura is by far the most common diagnosis. It typically occurs in the morning. Some people with migraine are woken by the violent attacks between 3 and 5 a.m. A migraine attack can announce itself days before the headache phase. Warning signs include mood swings, nervousness, euphoria, loss of appetite, cravings for sweet foods and increased sensitivity to cold. Migraine occurs most frequently between the ages of 25 and 45. Children can also be affected; as many as 10 per cent of schoolchildren are affected today.
Most common causes or triggers
There are numerous factors that favour migraine. These include stress, physical and mental exhaustion (especially overtiredness), eye strain, loud noise, bright or flickering light, carrying heavy weights (such as heavy shopping bags), menstruation, depression and fluctuations in blood pressure. Intense smells, diets, skipping meals, certain foods, spices, alcohol and medicines can also be triggers. Sudden changes (moving house, a death), weekends, going to bed late, travel, the start or end of holidays, strong emotions such as fear, worry, sadness, being moved, shock, excitement or a fit of crying, but also the weather with a change in the weather, a change of climate or föhn winds can trigger a migraine. Usually it is an interplay of several factors. Women are about three times more likely to suffer from migraine than men, as they have to contend with monthly hormonal fluctuations. Women also link experiences with emotional sensations more strongly because their nervous system is more active than that of men. One in 7 women in Germany suffers from this condition at least occasionally.
Acute treatment
When the pain occurs, action must be taken as quickly as possible. In migraine in particular, the absorptive capacity of the stomach and intestines is very often disturbed during the attack. The active substances cannot take effect, and the pain therefore lasts a very long time. Taking medication early prevents worse. The drugs of first choice are triptans, which act specifically against migraine. Other painkillers that are available over the counter at the pharmacy and help with mild to moderate pain are ibuprofen, aspirin and naproxen. A dose of 500 mg is usually sufficient. These medicines must not be taken more than 10 times a month, otherwise this can in turn lead to migraine. It is also helpful to take a medicine against nausea. Preventive drug therapies, which must be agreed with a doctor, are usually based on taking beta-blockers. The latest research is testing a new antibody-based migraine drug for the treatment of chronic migraine.
The migraine brain: what happens in the head?
The exact cause has still not been fully clarified. However, the theory of a circulatory disorder is considered outdated. It is assumed that nerve fibres running to the brain are activated by stress and cause inflammation of the nerves. The nervous system of people with migraine is constantly under high tension. Many scientists assume that the brain of migraine patientsreacts more sensitively than the brain of healthy people because of their predisposition. It is fundamentally more active and more efficient and therefore has a constantly high energy consumption. If this energy is not continuously supplied in sufficient quantities and additional triggering stimuli (“triggers”) come into play, the brain is quickly flooded with excitatory neurotransmitters. They irritate the trigeminal facial nerve, and the blood vessels surrounding it react with inflammation. This dilates the vessels, so that the pulse on one side of the head is felt as violently throbbing pain.
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Whether someone suffers from migraine can be recognised from their brain, even when no acute migraine attack is occurring. This is because the brain of migraine patients – compared with healthy people – shows a thinner cerebral cortex in some areas, while other areas are slightly thickened. The shape of the cerebral convolutions is also different. What is interesting is this: the thickness of the cerebral cortex changes over the course of life – but where the furrows and bulges lie in our thinking organ is already laid down in the womb. It is known that migraine is inherited. So far, 44 gene variants on 38 risk genes have been decoded.
There is no migraine diet
There is no specific migraine diet that helps all those affected equally. However, a change in diet accompanied by a change in lifestyle can have a positive effect on quality of life and reduce the number of attacks per month. There are some special points that a migraine patient should bear in mind in their diet.
Foods: trigger or symptom?
A craving for sweet foods is considered a so-called warning sign of a migraine attack, so it is more a symptom of a beginning migraine attack than a trigger. Frequently mentioned food triggers are citrus fruits, alcohol (especially red wine), salami, strawberries, ready meals, crisps, long-matured cheeses, tinned sardines… The list is long, but can be reduced to certain constituents that can make people “ill”. A lot of salt, nitrate and nitrite, glutamate as a flavour enhancer and histamine-rich foods are suspected of being triggering irritants for migraine. In principle, however, you should not do without them. Everyone reacts differently to these foods. In addition, scientists today believe that the role of food tends to be overestimated rather than underestimated. Much more important are regular daily routines and habits, which should always be maintained. In this context, weekend migraine has become famous. When the stress of the week falls away, migraine attacks often occur – caffeine withdrawal (if a lot of coffee is consumed in the office during the week) also makes itself felt.
A carbohydrate-rich diet
Thinking uses a lot of energy. The brain uses ⅕ of the energy we burn in the body, even though it makes up only 2% of our body weight. The brain needs sugar or glucose to function properly. However, this does not mean pure table sugar. The rapidly rising and falling insulin levels it causes mean stress for the body. Since the brain of migraine patients is much more active – always on alert, so to speak – people with migraine should eat a diet rich in carbohydrates, namely long-chain carbohydrates from wholegrain products, potatoes, muesli, vegetables and pulses. These are broken down more slowly, keep you full for longer and also supply plenty of vitamins, minerals and fibre. According to the general recommendation of the German Nutrition Society, carbohydrates should make up at least 50% of the diet. Migraine patients should take in significantly more. For some of those affected, a low-fat and reduced-protein diet has also proved successful. A low-carb diet, on the other hand, is not sensible and should be avoided.
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Healthy fats are good for the brain
The human brain consists of 60% fat. A third of this consists of so-called omega-3 fats. The brain needs these to function properly. They must be supplied regularly with food, so they are essential nutrients, and are found in linseed oil, olive oil, oily fish, walnuts and eggs.
Ensure an adequate magnesium intake
Studies show that thirty per cent less magnesium is measured in the brains of migraine patients. Magnesium deficiency causes the vessels to narrow and muscles and nerve cells to be overexcited. It is often not enough to take in magnesium through food (with wholegrain, soya products, oat flakes, nuts and vegetables). It is therefore recommended that migraine patients take 2 × 300 mg of magnesium citrate daily. Attention must also be paid to an adequate intake of vitamin B2. Riboflavin supports the brain in building nerve pathways.
Identifying individual triggers
It is useful to keep a migraine diary, at least for a certain period, in order to find out your individual trigger factors and so learn to understand better what triggers your own migraine. Every migraine is individually different, from attack to attack but also from person to person. The same factors are not always involved in an attack and do not always have to trigger one. Migraine is a complex disease. The time of day at which a particular food is eaten can also matter. Some people with migraine have no problems with alcohol if it is drunk after 8 p.m. It can also make a difference whether something is eaten at home or when out and about.
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Ideally, the diary is a headache and food diary at the same time. Even though foods are normally not the trigger but a symptom of migraine, there are food intolerances and allergies that cause stress in the body and lead to (head)aches. All foods and drinks consumed must be listed in detail, with the time, special features and any pain that occurs. But the diary should also include the migraine attacks suffered, their duration, pain intensity, the impairment experienced and accompanying symptoms.
Regularity is the key
Routine is the magic word. People with migraine must maintain a certain routine in all areas of life in order to keep the number of attacks per month as low as possible. Unforeseen, sudden changes in the daily routine can lead to disturbances of brain activity. Not only the daily rhythm gets out of step, but also the brain. People with migraine should take the following points particularly to heart:
Eat regularly: keep to set times of day. Never skip a meal! Eat breakfast!
Drink plenty: at least 2 litres a day. The fluid taken in ensures that the head and body are adequately supplied with oxygen and have good blood flow.
Sleep rhythm: keep to fixed times. A regular sleep–wake rhythm is particularly important and should be maintained at weekends too. You should always get up at the same time, even if you go to bed later. Get your metabolism going, eat something – only then lie down again.
Avoid unnecessary stress and physical overexertion where possible
Do endurance sport regularly, such as jogging, swimming or cycling.
Practise relaxation: learn yoga, autogenic training or muscle relaxation techniques. This lowers stress hormone levels.
