Higher consumption of simple carbohydrates and caffeine was associated with an increased risk for migraine and headache, whereas foods rich in fiber—especially those high in folate, thiamine and vitamin C—were linked with a decreased risk for migraine and headache in a new cross- sectional survey.

“With the exception of caffeine and alcohol—which have a clear association with migraine and headache—nutritional factors related to migraine and headache risk have not been well studied or proven; yet, some patients are put on highly restrictive diets without an evidence base,” stated Catherine Buettner, MD, Division of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, both in Boston. “We know very little about nutrition and migraine, and this cross-sectional study attempts to begin to fill that gap. Prospective studies in this area are needed.”

The study was based on 13,673 people over 20 years old who participated in the National Health and Nutrition Examination Survey (NHANES), an ongoing, cross-sectional survey of the civilian, non-institutionalized population. Of these participants, 2,880 (21%) reported severe headaches or migraine within the past 30 days. Diet was determined using the 24-hour recall, a U.S. Department of Agriculture instrument. Home interview, physical examination and laboratory testing were also performed on all persons with migraine or other headache.

Among those who reported severe migraine or other headache within the past 30 days, only 16% had excellent/very good health status; 24% had good health status; and 37% had fair/poor health status. Twenty-six percent were morbidly obese, 20% were overweight, and 54% were in a normal weight range for their height. Thirty-four percent were taking six or more medications, 26% were taking three to seven medications, and 31% were taking zero to two medications.

Among all patients with headache, fiber intake was substantially less than the recommended levels, Dr. Buettner said. For both men and women, dietary carbohydrates, caffeine, fiber and folate were significantly different between headache patients and other participants. Intakes of vitamins B₁ and C were significantly different only among women, she said.

“These data raise the question of whether we can change a person’s headache pattern by improving nutrition,” said Steven Baskin, PhD, director of New England Institute for Behavioral Medicine in Stamford, Conn. “We can’t make too much of the odds ratios in this cross-sectional, population-based study. The pathophysiology of headache involves much more than food intake. But these data do argue against a restrictive diet. I believe the best advice is to recommend a heart-healthy nutritious diet for patients who have migraine or other headaches. This diet is good advice in general, and might lessen the frequency and severity of headache,” said Dr. Buettner.

“The population–based, cross-sectional study by Dr. Buettner and colleagues helps shed some light on an extremely important and under-researched area. The relationship between diet and migraine has a long controversial history,” said Dr. Baskin. “When I first started practicing, we put everyone on a migraine diet with restricted intake of certain foods based more on clinical lore than research evidence, and we offered little advice as to what constitutes an appropriate diet for migraine sufferers.”

Research shows an association between obesity and high-frequency migraine and chronic daily headache, Dr.Baskin continued (Headache 2010;50:631-648). Many overlapping pathways are implicated in both migraine pathophysiology as well as feeding regulation. These pathways are modulated, in part, by diet, Dr. Baskin noted.

“Dr. Buettner’s study is an important early step in looking at nutritional relationships and migraine/headache,” Dr. Baskin said. “Future prospective research, as Dr. Buettner points out, should isolate specific dietary factors that increase or decrease migraine risk—caffeine usage, alcohol ingestion.”

The study was presented in a poster session at the 2010 annual meeting of the American Academy of Neurology (P06.275).