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Does Diet Affect Migraines?

Migraines have been a fact of life for me since childhood. One of my first memories is of my mother snapping an Excedrin in half so I could take a pill and get relief from a headache.

I popped Advil like candy in high school, then graduated to prescription drugs at college in the late ‘80s. I thought true bliss was upon me when my neurologist introduced me to Imitrex in the mid-1990s. One little pink pill, and my pain stopped within the hour.

But Imitrex doesn’t reduce the number of migraines—it only relieves them once they arrive. And they kept arriving. I tried chiropractors. I tried acupuncture. I tried bargaining with my migraines: I promise to hydrate more, exercise more, sleep more and stress less. But by the end of 2011, at age 44, I found myself taking medication up to five days a week to relieve the pain, the nausea. The blinding pounding at my temples.

“Why don’t you try cutting out gluten?” my Los Angeles-based acupuncturist, Cindy Rosenberg, suggested. But I already avoided wine, beer and MSG. Wasn’t that enough?

Then, in early January, I got what I called The Migraine Virus. It was 10 days of fatigue and headaches that felt as if someone was slamming an ax into my skull.

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Hydrating didn’t help. Ibuprofen didn’t help. And the Imitrex? No better than a sugar pill. When it was finally over, I went online and searched “gluten free.” I made a list of forbidden foods, and then started paring away at my diet.

Did it work? Well, it relieved about 30 to 40 percent of my migraines. I lost eight pounds, had more energy and, for the first time, escaped most of the colds and flus my three kids brought home from school.

Since then, I’ve cut a large number of other possible triggers from my diet, including most sugars, caffeine, dairy and peanuts. For the first time in my life, I’m migraine-free. My next job is to find a balance between what I eat and how my head feels.

In the meantime, here is a list of common triggers:

1. Gluten

Scientists at the University of Maryland recently announced a scientific basis for gluten sensitivity—a condition related to but distinct from celiac disease, which is an autoimmune reaction to the gluten protein that attacks the small intestine.

“Migraine headaches are not unusual symptoms related to celiac disease and other gluten-related disorders,” says Dr. Alessio Fasano, director of the Center for Celiac Disease Research and professor of pediatrics, medicine and physiology at the University of Maryland School of Medicine in Baltimore.

Why can eating a slice of bread trigger a migraine in some people? There isn't universal agreement on this, Fasano says. But one theory is gaining in popularity among researchers: gluten triggers inflammation.

“When gluten is ingested, it’s perceived as an enemy by the immune system,” he said. “Some people will get rid of this enemy by cleaning up the mess. Other people … react by developing weapons that are meant to get rid of this enemy, but cause collateral damage called inflammation. Sometimes, the inflammation stays in the intestine and creates indigestion. Sometimes it goes to the brain and causes a migraine.

Strictly speaking, gluten is a protein found in foods processed from wheat and related grains, including barley and rye. So that means it’s found in breads, cereals, cookies, cakes, pies and many other foods.

As far as replacing it, rice, corn, potatoes, quinoa and buckwheat, none of which have gluten, are several alternatives. But check your local market for gluten-free products, including bread, pasta, baking flour, cereals and bagels.

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2. Dairy

“For some people, dairy is a trigger,” says Dr. Alexander Mauskop, director and founder of the New York Headache Center in Manhattan, “but that’s a small percentage of patients.”

However, like gluten, dairy can be an inflammatory agent, and any inflammatory agent can trigger migraines in sensitive individuals, says Rosenberg, who sees many migraine sufferers at her practice.

But this seems crazy, right? People have eaten bread and milk for thousands of years while managing quite nicely.

“What seems to be clear—in my work anyway—is our immune systems are really, really overtaxed,” Rosenberg says. “They’re reacting to things all over the place that they shouldn’t be, things they weren’t reacting to 30 years ago.”

Replace dairy products with alternatives, such as almond milk, rice milk and coconut milk.

3. Sugar

“Three out of four migraine sufferers have reactive hypoglycemia,” says Mauskop. “When they eat something too rich in simple carbohydrates, like sugar and white flour, their blood sugar levels go up and then drop. They get a sugar crash, and then a migraine.”

“We develop a true addiction to sugar,” Rosenberg says. “The brain responds to sugar in the same way it responds to nicotine or other addictive agents.”

It's best, she advises, to cut out as much as you can—or even all of it. “The real key to getting over the sugar addiction,” she says, “is learning to recognize naturally sweet foods as sweet.”

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4. Caffeine

“Caffeine is a big trigger,” Mauskop says. “In small amounts, taken once a week, it’s effective. But you get to two or more cups a week, and it starts to become a problem.”

Excedrin, an over-the-counter headache medication, works in part because it has caffeine. But taken more than once a week, Mauskop says, or in conjunction with coffee, it gets progressively less effective.

Caffeine regulates the blood flowing to your brain, Rosenberg says. “If the blood vessels are continually being controlled by caffeine, then they are tightening up each day in expectation of caffeine. So, the body expects its coffee. The coffee ends up working just like a medication, but one your body doesn’t need.”

What should you drink instead? Water, water and more water. Hydration will open those blood vessels better than the strongest cup of Joe.

What You Can Do

If you're thinking of changing up your menu or learning about other food triggers, start with gluten. In fact, you should take a test.

There’s no reliable test for gluten sensitivity yet, but there is one for celiac disease, and it’s important to know where you fall before you start eliminating gluten from your diet, Fasano says. People with gluten sensitivities can cheat every now and then, with only minor repercussions. Celiacs cannot, or their health will suffer. So if you’re thinking about eliminating gluten, ask your doctor to first do a blood test to screen for celiac disease.

As for other triggers, “I always tell people to eliminate something for a month,” Rosenberg says. “Sometimes people will notice the difference by limiting it, but usually you have to remove it completely.”

If you later want to try, say, cow’s milk, reintroduce just that one new element for one day, then wait three days. “If you have any reaction,” Rosenberg says, “you probably can’t eat it.”

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