Q I didn’t catch the whole news story but heard scientists found something good in food for migraine sufferers. Can you fill me in? GH, Greenville
A It sound like you heard a news blurb about a new study that has been called the first moderate-sized controlled trial that showed changes in diet — specifically the kind of fat in the diet — can decrease chronic physical pain. Experts say the study is clinically meaningful. Until now, most of the information about food, diet and migraine headaches has been anecdotal or from small studies.
For example, The Mayo Clinic website states that constipation, food cravings and fluid retention are among the warning signs that a migraine may be coming on. Many of my patients who suffer from migraine headaches tell me they know what their food triggers are: alcohol (especially red wine and beer), chocolate, aged cheese, cured meats, smoked fish, yeast extract, food preservatives that contain nitrates and nitrites, artificial sweeteners and monosodium glutamate (MSG). Since none of the items listed are critical to a healthy diet, I encourage them to avoid their triggers.
I ask them to keep a food and headache diary for several weeks to identify foods they ate before a migraine attack. Of course, a food or beverage might not trigger a migraine each time it is consumed. They are more likely to contribute to an attack if a person is not sleeping well, not being physically active, not eating a generally healthy diet and skipping meals.
The American Migraine Foundation, in essence, suggests migraine sufferers follow the Dietary Guidelines for Americans by making half of their grains whole — in part to help prevent constipation — fill half the plate with fruits and vegetables and, importantly, to limit sodium to less than 2,300 milligrams per day. If you eat processed and fast foods, and salty snacks you are likely to be getting 6,000 mg.
Caffeine from coffee or soda is reported by some to reduce the headache pain, but at the same time getting too much caffeine daily from all sources — food, drinks, medicine — increases the risk of a headache. Many experts recommend limiting caffeine to less than 200 milligrams a day.
The study you asked about was conducted down the road in Chapel Hill. It focused on swapping EPA and DHA for linoleic acid to reduce the number and the severity of the headaches. The people in the study had on average more than 16 headache days per month and about five hours of headache hours per day.
Participants received meal kits that included fish, vegetables, hummus, salads and breakfast items. The control group’s diet was like most American’s diets — high linoleic acid levels and low levels of EPA and DHA. In general, those on the intervention diets had fewer headache hours and days.
Participants followed the diet high in omega 3 fatty acids or 1.5 g/day of EPA and DHA. Some also lowered their intake of linoleic acid. The paper published in The British Medical Journal includes the dietary guidelines and lists of food provided to the participants. In addition to using special cooking oils, salad dressings and mayonnaise, they ate at least 4 ounces of fish each day, incorporated 1½ teaspoons of ground flaxseed into breakfast foods, ate lots of fruits and vegetables and avoided processed food, fast food and fried food.
It’s not a typical eastern North Carolina diet but the menus sounded pretty good and if I had regular severe migraines, I would be willing to try it and see if it made a difference. As always, additional study is needed before this would become a recommended intervention to help prevent migraine headaches.