The Headache Diet

Twice in as many weeks I’ve had patients ask me why I don’t put them on a headache diet.  One of those patients even suggested that maybe I’ve had never even heard of such diets, which they had read about in magazines or from Dr. Oz. This was a discussion point that opens a whole new conversation.

I work in evidence-based medicine, meaning that I feel that I have a moral obligation to only tell patients things that we are quite sure are true and safe.  In all areas of medicine, as in virtually all areas of life in general, there is a cloud of hearsay that surrounds what we know to be true.  Having worked in this field for more than thirty years, I’ve seen scores of ideas about headaches come and go.  Many of those ideas become popular even though most of the time they have no scientific support.

When I started my career the headache research was in its infancy.  We believed a lot of things that have turned out not to be true.  During those early days, we believed firmly that diet played a major role in headache prevention.  We had a dietitian in our inpatient center that spent about an hour with each patient, teaching them how to eat to avoid headaches. The ideas about these diets were based completely on mythology and hearsay.  Once the scientist tried to prove (or disprove) the role of these diets, they found that most were not true.

I know that it would make patients feel more confident in me as a provider if I say with great confidence this or that is the cause of their headaches and I guarantee they will get better if they follow some specific diet.  But morally, I can’t say that because I’ve seen the studies and I know that it is not true.

Even books like, Heal Your Headaches 1, 2, 3, which I often recommend to my patients, is largely based on conjecture and mythology with very little proven science behind it.  Here is what we do know about diets and headaches and the level of certainty that we know it.

Food Supporting Evidence
Caffeine Withdrawal Strong evidence of triggering headaches based on patient experiences.
Missing Meals Moderate evidence of triggering headaches based on patient experiences
MSG Little evidence, mostly based on mythology and old-school (vasodilation) models of headaches
Cheese
Red Wine
Chocolate
Sugar No evidence that it influences headaches. Too much sugary foods adds empty calories which promotes obesity, which can worsen headaches.
Artificial sweeteners Have been studies and have zero evidence of causing headaches.
Gluten Zero. Scientific evidence shows no role in headache

Migraine is an episodic and often a random disease.  For some of us there are specific triggers such as sleep disturbance, stress, weather change or for many women, menstrual cycle. But often the headaches just come without external provocation. They do have causes but those causes are complex and reflect changes within the brain that even the smartest scientists in the world, even those who have spent decades studying headache, poorly understand.

It is a psychological fact that when humans (or any animals) have profound, random events in their lives, they become very superstitious. The people who make slot machines know this very well.  So when a terrible headache comes on, it is human nature to remember what happened hours or a day before.  If they had eaten meatloaf, then they believe that it was the dinner that triggered their headaches.  Then it is hard to convince them otherwise.

The smartest scientists in the world who spend every day studying and working with headache disorders do not know of specific foods that trigger headaches, at least that trigger headaches for everyone. So, if someone tells you, even a health care provider, that they know which foods trigger headaches, they are speaking from mythology and not science.  If a patient really is set on denying themselves culinary pleasures, I won’t stand in their way.  Maybe it is a bit of the Puritan mentality that anything that brings pleasure must be bad for you . . . like wine and chocolate.

The other issue is that patients want to believe it is their diet because they want to take an active role in getting better.  This is highly commendable.  It is essential that the patient takes an active role. We, the headache provider, are really just the sufferer’s coach and support.  There are proven, scientific ways that patients can help their headaches get better.  Here are things that patients can do to take an active role in getting better and each of these things have some science to support it.

1)      Losing weight if they are obese (I know it is easier said than done).

2)      Stop smoking!!!!!!!

3)      Stop taking too many pain medications!!!

4)      Do aerobic exercise.

5)      Go to bed at a decent hour, try to get 7-8 hours of sleep and get up while it is still morning. Practice good sleep hygiene (another topic).

6)      Stay hydrated

7)      Find peace in your life.  Seek counseling for stress management if needed

8)      Recognize the role that anxiety might be playing in your life.  Some headache patients become obsessed with thinking they are sick (they are worried they have tumors, cancer, MS, obscure infections) and such obsessions distracts from getting better.  Including in this, is recognizing if they have an irrational fear of medications.  Sometimes it takes medications to get better.  Irrational fear of medications causes patients not to take them and if they do take them they will get all the bizarre side effects that they fear.  This is called the nocebo effect.

9)      Listen to providers who have spent years studying headaches, going to headache scientific meetings and reading research journals.  Ignore those things said that come from simply mythology, no matter who tells them to you.

10) Consider the supplements that have scientific support. At this time we only know of four a) riboflavin, b) Co Enzyme Q 10, c) Magnesium, d) butterbur.

11) Consider acupuncture.

So, if you really want to help your headaches get better, don’t waste your time on fad diets or other fad treatments, but do the things above which we do know can help, at least to some degree.