As a Registered Dietitian Nutritionist that specializes in migraine, I often get this question:
What am I supposed to eat?!
There are so many popular diets today to choose from. They all come with their own set of guidelines and they all have a list of alleged benefits.
Today I’ll dive into every diet I’ve been asked about and answer the question: does it help migraine?
Elimination Diets
Elimination diets are very popular for migraine. The goal of these diets is to eliminate your potential food triggers and discover relief from not consuming those “harmful” foods.
I guide many of my clients through elimination diets for migraine, and find it to be a very effective and helpful tool. HOWEVER, proceed with caution if you choose to go down this path.
- These diets may be very difficult to plan and follow without some guidance.
- “Eliminating” many foods from your diet, even for a short period of time, can be dangerous and triggering, particularly for those with a history of disordered eating.
- Even when following a popular migraine-specific elimination diet, it’s important to keep in mind that we are all unique. Every person with migraine has their own set of triggers! There’s a lot of opportunity to miss YOUR triggers when following these elimination diets.
- No elimination diet is meant to last forever! After symptoms have improved, it is necessary to re-introduce the eliminated foods to see which are actually triggers. I see many people fall into the elimination diet trap, afraid to return towards a “normal” diet.
The bottom line? I like elimination diets, but they aren’t for everyone, and they aren’t a final destination since you may miss triggering foods.
If you’re interested in doing an elimination diet, work with me! I’m a Registered Dietitian specializing in migraine and can help guide you through it.
Common Diets for Migraine
There are many types of diets suggested for people with migraine. I’ll briefly go through what each diet entails and whether I would recommend following it for migraine relief.
Anti-Inflammatory
This diet pattern focuses on lowering inflammation through food. There’s a focus on boosting heart-healthy omega 3 fatty acids (seen in fatty fish, flaxseeds, and walnuts) and antioxidants (seen in many plant foods). Popular iterations of this diet include DASH and Mediterranean.
DASH
DASH, or “Dietary Approaches to Stop Hypertension”, was created to fight high blood pressure. It focuses on balancing food group portions, rather than providing a list of foods to consume from.
- Whole grains: 6-8 servings per day
- Vegetables: 4-5 servings per day
- Fruit: 4-5 servings per day
- Dairy: 2-3 servings per day
- Lean Chicken, Meat, & Fish: 6 or fewer servings per day
- Nuts, Seeds, & Legumes: 4-5 servings per week
- Fats & Oils: 2-3 servings per day
- Added Sugars: 5 or fewer servings per week
Sodium may be restricted when following the DASH diet between 1500-2300 mg per day, depending on your health needs.
Mediterranean
The Mediterranean diet is styled after the eating patterns of countries bordering the Mediterranean Sea, like Greece or Italy. Its main purpose is to protect against heart disease.
The American Heart Association defines the Mediterranean diet as:
- emphasizes vegetables, fruits, whole grains, beans and legumes;
- includes low-fat or fat-free dairy products, fish, poultry, non-tropical vegetable oils and nuts; and
- limits added sugars, sugary beverages, sodium, highly processed foods, refined carbohydrates, saturated fats, and fatty or processed meats.
Does it help migraine?
Anti-inflammatory diets are some of the best-researched and highly-loved diets out there! They prevent and treat many chronic diseases.
Specifically in migraine, a boost of omega-3 fatty acids with a reduction in omega-6 fatty acids has been shown to be helpful as it impacts our inflammatory response. This eating style is also balanced, nutrient-dense, and very accessible, making it a good fit for just about anyone.
Gluten-free
A gluten-free diet recently saw a rise in popularity. Gluten is a protein found in wheat, barley, and rye grains.
For those with celiac disease, a gluten-free diet is necessary. In these people, exposure to gluten will create an autoimmune response, causing damage to the small intestine and causing uncomfortable symptoms throughout the body.
Some people do not have celiac disease, but still are reactive to gluten. This is known as non-celiac gluten sensitivity.
Gluten can be “hiding” in many processed foods, making this diet very difficult to navigate without guidance. Some things to watch out for include (but aren’t limited to):
- Beer
- Candy
- Chips
- Cereal
- Deli meat
- Gravy
- Malt flavoring
- Sauces and salad dressings
- Seasoning blends
- Soup
- Medications, both over-the-counter and prescription
- Cross-contamination with gluten-containing products
Does it help migraine?
A decision to follow a gluten-free diet should not be taken lightly. It is a difficult-to-navigate diet, typically comes with a higher cost, and will not benefit someone that can easily digest gluten.
There is a correlation between celiac disease or gluten sensitivity and migraine. They seem to coexist in individuals and share very similar symptoms: head pain, brain fog, fatigue, and nausea. For people with celiac disease or gluten sensitivity and migraine, eliminating gluten can significantly help alleviate migraine attacks.
If you suspect gluten is playing a role in your migraine disease, it’s certainly worth getting tested or eliminating gluten for a period of time to see if your symptoms improve.
Fasting
Fasting is a diet pattern that specifies when to eat, not what to eat. It has been popularized for its potential benefits in managing/preventing diabetes, heart disease, neurodegenerative diseases, cancer, and in aiding weight loss efforts.
Intermittent fasting comes in many different forms.
- In the 5:2 diet, you eat freely for 5 days and limit to (usually) 500 calories for the final 2 days each week.
- Alternate day fasting involves limiting one day to (usually) 500 calories, consuming your regular intake the next day, and repeating.
- Time-restricted, such as 16/8 fasting, requires you to limit your eating window (8 hours a day while fasting for 16 hours).
- Eat: Stop: Eat, or the 24-hour fast, includes a complete fast for a 24-hour period, then returning to your typical diet.
Many people will also fast for religious reasons, such as Ramadan. For a month each year, Muslims celebrating Ramadan fast from sunrise to sunset.
Does it help migraine?
This is a diet that can be risky, particularly with migraine. It is important to be aware of your migraine triggers. Fasting leaves you susceptible to hunger, dropping blood sugar levels, and dehydration.
If you want to proceed with a fasting diet, I would recommend starting “small” with a time-restricted fast. This isn’t too extreme and can easily be manipulated to suit your needs.
Although fasting is mandatory in religious events like Ramadan, people with illnesses may be exempt from participating if there is a health concern. I encourage you to explore this option or discuss preventive options with your physician that align with you.
Low carbohydrate
“Low-carb” diets restrict carbohydrate foods, while increasing fat and protein foods.
- Carbohydrate foods: bread, rice, pasta, fruit, vegetables
- Fat foods: plant oils, nuts, seeds, fish, cheese
- Protein foods: meat, seafood, eggs, tofu, nuts, seeds
Adkins
This low-carb diet focuses on a restriction of “simple” carbohydrate foods, like white rice, fruit juice, and chips. It is primarily used as a weight loss tool.
- Simple carbohydrates: white rice or bread, cereals, sugar-sweetened beverages, fruit juice
- Complex carbohydrates: whole grains, legumes, fiber-rich fruits and vegetables
Many grocery stores carry “Adkins” branded products, including bars, shakes, frozen meals, and treats.
Keto
The ketogenic diet is structured as a low-carbohydrate, high-fat, and moderate-protein diet with the goal of entering ketosis. This is a metabolic state where your body burns fat for energy, making ketones for fuel.
Ketones seem to be neuroprotective, as this diet helps refractory epilepsy in children. Epilepsy is a neurological disease related to migraine.
Does it help migraine?
While they don’t fit the traditional version of a “balanced” diet, low-carb diets may suit some individuals and help them to reach their health goals. What I like about these diets is the focus on lean proteins, healthy fats, and complex carbohydrates.
This diet may be helpful for migraine, and there is exciting research happening to link the ketogenic diet to migraine relief. If you are curious to try going keto, I urge you to work with a dietitian, as it is a difficult and restrictive diet.
Low fat
The low-fat diet focuses on lowering your daily intake of calories from fat, especially saturated fats.
- Saturated fat: present in animal-based foods and oils that are solid at room temperature, like coconut oil and palm oil
- Polyunsaturated fat: include two major fatty acids:
- Omega-3: fatty fish, walnuts, flaxseeds
- Omega-6: plant oils
- Monounsaturated fat: plant oils, avocado, and nuts
Trans fat: naturally exists in some animal-based foods, but is banned from other food products due to their health risks
This can be helpful for heart health and weight loss. Fat is the most calorie-dense macronutrient, producing 9 calories per gram (compared to protein and carbohydrates, which both contain 4 calories per gram).
Does it help migraine?
Similar to low-carb diets… While they don’t fit the traditional version of a “balanced” diet, low-fat diets may suit some individuals and help them to reach their health goals. What I like about this diet is opting for healthy unsaturated fats.
This can be a beneficial diet, and has shown some promise in helping alleviate migraine. Two things to keep in mind when following this diet:
- Fat is flavor. Processed foods that remove fat to suit this diet usually need to add in a bunch of sugar or other ingredients to boost the flavor. This may not suit your health goals.
- Fat is satiating. You may find yourself getting hungry more quickly after meals and snacks. I’d recommend boosting your protein and fiber intake (both other satiating nutrients) if you don’t want to add any more fat.
Low FODMAP
A low-FODMAP diet is geared towards people with IBS and other digestive complaints. “FODMAP” stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. which are short-chain carbohydrates (sugars) that may be difficult to digest.
This is an elimination diet, aiming to determine which foods cause your digestive symptoms. Like all elimination diets, the low-FODMAP diet begins by following a very restrictive eating pattern for a period of time, then reintroducing potentially triggering foods to “test” them.
Does it help migraine?
Migraine and digestive complaints certainly coexist often. While this diet isn’t specifically designed for people with migraine, you may discover relief in other areas. You may even be able to pinpoint some migraine food triggers, since this is an elimination diet.
This diet, like all elimination diets, can be very difficult to navigate on your own. I’d highly recommend working with a dietitian if you plan to follow this diet. One of the primary challenges is that there is no intuitive way to know which foods are high or low in FODMAPs – each food group contains options both high AND low.
Low glycemic index
To better understand this diet, we need a deeper understanding of carbohydrates and glycemic index.
Carbohydrates usually consist of about half of our dietary intake each day, and include foods like grains, dairy, fruits, and vegetables. There are two main types of carbohydrates:
- Simple (fast-digesting) carbohydrates: white rice or bread, cereals, sugar-sweetened beverages, fruit juice
- Complex (slow-digesting) carbohydrates: whole grains, legumes, fiber-rich fruits and vegetables
When we eat carbohydrate foods, our body breaks them down into glucose for energy. Some of these foods break down more easily, and more quickly allows glucose to enter the bloodstream. The level at which a carbohydrate food raises our blood glucose levels gives a glycemic index value.
This diet focuses on making carbohydrate choices that have a lower glycemic index, which keeps blood glucose levels stable.
Does it help migraine?
This diet is beneficial for people with diabetes, but can be helpful in preventing migraine attacks. A shift in blood sugar levels is a potential trigger for migraine. Following this diet certainly has promise in alleviating migraine.
Paleo
Also known as the “Stone Age” diet or “caveman” diet, the paleo diet limits foods to what would have been available through hunting and gathering about 2.5 million to 10,000 years ago.
The paleo diet excludes dairy products, legumes, and grains, while putting a focus on lean meats, fish, nuts, seeds, fruits, and vegetables.
Does it help migraine?
This diet is focused on unprocessed, nutrient-dense foods, which can be excellent for migraine. Dairy, legumes, and grains aren’t inherently bad for us, but in some people, could potentially include some potential food triggers.
Plant based
This diet pattern contrasts the Standard American Diet (SAD) because there is a focus on plant foods instead of processed foods or animal products. There are a few variations of this diet, including plant based, vegetarian, and vegan.
Plant based
There are no strict guidelines for this diet, but a good example of this plan is the “MyPlate”. Meals should have a strong emphasis on plants, with half of our plate including fruits and vegetables, a quarter including starchy vegetables or grains, and a quarter including protein foods.
In this diet, animal products are still permitted, but minimized.
Vegetarian
A vegetarian diet excludes meat and seafood. People may choose to follow a vegetarian diet for health, ethics, religious, or sustainability reasons.
Vegan
A vegan, or “strict vegetarian” diet not only excludes meat and seafood, but other animal products as well. This diet typically excludes dairy, eggs, honey, and animal byproducts (like carmine, a red coloring typically seen in candies).
This decision may also be made for health, ethics, religious, or sustainability reasons. However, it often extends past a diet. Veganism is often described as a lifestyle. People choosing to be vegan avoid any animal harm caused by food, fashion, beauty, entertainment, and more.
Does it help migraine?
Plant based diets are often balanced and nutrient-dense. For people with animal-based migraine food triggers, avoiding those foods can bring migraine relief.
Many people are concerned with potential nutrient deficiencies when cutting out animal products, including protein, B12, calcium, iron, and zinc. Being mindful of those risks, choosing fortified foods, considering supplementation, and incorporating a variety of foods each day can easily avoid these deficiencies.
The Migraine Nutritionist’s Advice
If any of the diet plans listed above are particularly speaking to you, that’s great! Everyone’s body works differently, we all have different health goals, and each person’s migraine disease will respond differently.
However, there’s no need for strict diet guidelines to eat optimally for migraine.
Personally, I have always been an “intuitive eater”, meaning I tend to “go with the flow” with my diet. With my knowledge of nutrition, I put a focus on balanced meals and snacks, and fill my kitchen with nutritious options. However, I tend to reach for whatever food sounds best in the moment, and try to listen to what my body tells me. (This is way easier said than done, so don’t panic if you aren’t “there”.)
My advice is to look at how you currently eat, reflect on how that feels for you, and make small adjustments as needed. If you don’t feel that you have a good grasp on nutrition and desire some extra support, I’d love to work with you and guide you through your diet. Together we can discover what eating style works best for you, your health goals, and your migraine disease.
