1. How Diet Affects HeadacheManagement of Headache TriggersBridgette Linehan, APRNNeurology Nurse PractionerNorton Headache and Concussion Center
2. If I change my diet, will I cure my headaches?• There is no cure for migraine• However, you can potentially reduce someheadache frequency and severity by avoidingheadache triggers• Discovering and eliminating headache triggerscan help adopt a healthy lifestyle with lessburden of headaches
3. Migraine TriggersIf summation of triggers are greater than threshold – a headache happens
4. Migraine Triggers• Most frequently reported triggers– Stress– Menstruation– Changes in sleep– Skipping meals– Changes in weather– Diet• Time from trigger to onset of headache can be up to72 hours - hard to track
5. Migraine Triggers• Can be difficult to track• Sometimes the “perfect storm” of triggers notjust one single item– Explains why sometimes can have a glass of wineand sometimes not– Weather change + menstruation + sleepdeprivation + glass of wine = migraine– Glass of wine alone = no migraine
6. Stress• Stress – When we are stressed, our bodiesreact physically: Muscles tense and hormonesbecome elevated — two physiological changesthat can lead to migraines.• Coming up soon will discuss some strategiesto control stress — and discover other lifestylechanges you can make.
7. Hormones• Hormonal changes. Because estrogen andprogesterone are such potent migrainetriggers, women are nearly three times morelikely than men to experience migraines.• Will be discussed later
8. Physical Exertion or Abrupt Lifestyle Changes• Physical exertion or abrupt lifestyle changes.Jumping into an extreme exercise program cancause migraines, as can changing sleeppatterns, alternating work shifts, or any othersudden deviation from your normal routinethat disrupts or alters your body’s physiology.
9. Intense Sensory Stimuli• Intense sensory stimuli. Bright light, loudnoises, and strong smells — such as cleaningchemicals, cigarette smoke, raw onions,scented candles
10. Environmental Factors• Environmental factors. Some people getmigraines when there are changes in theatmosphere: sudden thunderstorms, abruptchanges in altitude or barometric pressure,windstorms, seasonal changes, even increasedpollen levels. Others are sensitive to theswitch to daylight savings time or travel acrosstime zones.
11. The Top 10 Diet Related Migraine Triggers• 1. Tyramine• 2. Alcohol• 3. Leftovers• 4. Nitrates• 5. Tannins• 6. Sulfates• 7. Common Additives• 8. Artificial Sweeteners• 9. Caffeine• 10. Dehydration & Low Blood Sugar
12. Lower triggers Raise thresholdWays to reduce headache
13. Trigger Modification• Non-modifiable– Genetics– Gender– Weather– Some stressors– Menstruation(somewhat)– Air pollution• Modifiable– Lack of sleep– Missing meals– How stress is handled• Stressors are there, butthe way it is handled canbe modified– Foods
14. Diet and Migraine• Regular meals• Normalize blood sugar• Reduction in Omega-6 fatty acids– Red meats, fast foods• Increase in Omega-3 fatty acids– Fish oil
15. Prehistoric 1900 20001:1 4:1 25:1Omega-6 FAOmega-3 FAChanges in fatty acid intake over time
16. MSG• Flavor enhancer commonly added to Chinese food,canned vegetables, soups and processed meats• MSG occurs naturally in ingredients such as hydrolyzedvegetable protein, autolyzed yeast, hydrolyzed yeast,yeast extract, soy extracts, and protein isolate, as wellas in tomatoes and cheeses• The FDA requires that these products be listed on theingredient panel, the agency does not require the labelto also specify that they naturally contain MSG• Take home message – MSG is hidden in foods
17. Tyramine• Here are examples of tyramine-rich foods:– Aged cheese– Beer on tap– Meats that have been fermented or air-dried, such assummer sausage– Red wine– Sauerkraut– Soy sauce• Other foods that may contain tyramine include:– Sauces containing fish or shrimp– Miso soup– Yeast extract
18. Leftovers• Tyramine content increases over time• Especially if stored improperly• Frequently foods at work / parties• Be careful with airtight containers and properrefrigeration
19. Alcohol• Alone or with congeners (in wine / liquor) caninduce headache in certain individuals• Red wine probably most implicated• Distilled vodka probably least causative• Migraineurs more susceptible to hangoverheadaches• Alcohol leads to dehydration– Can trigger migraine
20. Nitrates and nitrites• Mostly used as a preservative for added flavor• Have vasodilatory effects on the body• Commonly found in– Hot dogs– Deli meats– Pepperoni– Sausage– Cured, smoked, canned meats
21. Sulfites• Sulfites are another type of preservative• Commonly found in most dried fruits(including prunes, figs, and apricots)• Wine (white and red)• Many processed foods• Check labels carefully to avoid this sneakymigraine trigger.
22. Artificial Sweeteners• Inconsistent reports– As with all of this, depends on the individual• Aspartame (NutraSweet)• Sucralose• Various others
23. Caffeine• Overuse of caffeine can lead to more frequentheadaches– Check medicines: Excedrin, Fioricet• Abrupt withdrawal of caffeine often timesleads to more headaches• Some physicians say zero caffeine, probablyaround 100mg/day is ok
24. Caffeine• Soda 12oz (Regular and sugar-free)• 30–50mg• Coffee 6oz• 103mg• Decaffeinated coffee• 6oz=2mg• Tea• 6oz=30mg
25. Caffeine• Starbucks “grande” coffee• 330mg of caffeine
26. Chocolate• Frequently reported migraine trigger• Evidence in inconsistent• Some believe that “craving” chocolate is apremonitory symptom of migraine– ie. headache was inevitable• Some evidence of blood sugar dip afterchocolate causes headache
28. Plan of attack• Frequent, small meals– Normal blood sugar– Avoid dehydration• 2.5 Liters of water per day (about 80oz)– Elimination diet
29. Elimination Diet• Eliminate common triggers from diet– Caffeine, cheese, nuts, chocolate, shellfish,artificial sweeteners, onions, alcohol, dairy,processed meats– After elimination from diet (4+ weeks) begin toreinstate items in to diet one at a time• 4 weeks each item and record headache frequency– If having more headaches, remove this item
30. 7 Healthy Habits to Reduce Migraines• Eat regularly• Maintain a healthy weight• Quit smoking• Exercise gently but regularly• Practice relaxation• Get enough sleep (yet not too much)• Consider physical therapy along withacupuncture, biofeedback, or massage
31. A Quick Eating Out Survival Guide• Avoid buffets: They may leave food sitting toolong or use suspect ingredients.• Chinese food: Possible triggers are MSG andsoy sauce. Japanese food: Possible triggersare soy sauce, tofu, and miso.• Mexican food: Possible triggers are beans(fava, navy, broad), cheese, sour cream,guacamole, and (in rare instances) tomato-based
32. Quick Survival Guide• Restaurants to enjoy include:• High-Quality American: order the chicken (grilled, baked,roasted, steamed, boiled, or broiled -- request no MSG,vinegar, or citrus juice); vegetables (steamed or sautéed inolive oil and garlic); rice or potatoes, plain (baked, boiled,or roasted),• Seafood: have any fish (grilled, baked, roasted, steamed,poached, or broiled — request no MSG, vinegar, or citrusjuice); vegetables (steamed or sautéed in olive oil andgarlic); rice or potatoes, plain (baked, boiled, or roasted),• Italian: order pasta with broccoli and grilled chicken orseafood tossed in an olive oil–based sauce
33. Quick Survival Guide• Desserts:• Treat yourself to strawberries with whippedcream; rice pudding; or herbal tea with plainbiscotti.• Avoid chocolate, unless you have confirmed thatchocolate is not a personal migraine trigger.• Keep in mind these suggested meals are freefrom all of the most common migraine triggers.
34. Quick Survival Guide• After keeping a migraine diary, you’ll probablyfind that you are sensitive to only a handful offoods. Once you’ve identified your personaltriggers, it will be much easier to order a widevariety of dishes in most ethnic cuisines.
36. Coenzyme Q10• Coenzyme Q10 (CoQ10) is a vitamin-likesubstance that helps enzymes create energy atthe cellular level. Without it, cells can’t workproperly.• Daily dose of 300-400milligrams daily.• Few side effects, can be costly
37. Feverfew• Feverfew is a traditional medicinal herb• It relaxing blood vessels and decreasinginflammation to improve circulation in the brain.• Feverfew is also found in combination withriboflavin and magnesium in supplementsformulated specifically for migraine prevention.Women who are pregnant or trying to becomepregnant and individuals taking blood thinnersshould not take feverfew due to undeterminedsafety in these populations.
38. Omega 3 Fatty Acids• Inconsistent reports on effectiveness inmigraine• Natural anti-inflammatory effects• Reduce Omega-6 FA (fast foods, red meat)• Increase Omega-3 FA (fish or fish oilsupplements)
39. Riboflavin (B2)• Mitochondrial defect in migraine leading toimpaired oxygen utilization• Riboflavin used in mitochondria• 200mg twice per day• May take 3 months to see difference• Will turn urine yellow
40. Magnesium• Blood levels do not adequately measuremagnesium stores in the body• Migraine patients often deficient inmagnesium• Lack of magnesium leads to morehyperexcitability of the brain (more migraineattacks)
41. Magnesium• Used IV for severe migraine attacks in hospitalor outpatient infusions• Oral magnesium readily available• At least 400mg per day• Can lead to diarrhea / upset stomach
42. Take Home Message• Trigger awareness to change the balance ofthreshold vs triggers leading to migraineattacks• Foods may play an important role in triggermanagement of migraine• Elimination and slow reintroduction is the beststrategy to really identify triggers• Dietary supplements may improve migrainefrequency and severity
43. Take Home Message• Remember, there is no cure for migraine• Management is the key to success• Reduce triggers• Raise threshold• Do not overuse rescue medications