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Eliminating that morning cup of joe, consuming processed foods high in nitrites or monosodium glutamate (MSG), and enjoying too much alcohol are potential headache triggers for individuals battling migraines, said Vincent Martin, M.D., professor in the Department of Internal Medicine at the University of Cincinnati (UC) College of Medicine.

There are two different approaches to preventing headaches with diet. The first approach would be an elimination diet that avoids foods and beverages known to trigger headaches.

The second approach would be follow a comprehensive diet whose very composition may prevent headaches, explained Martin, co-director of the Headache and Facial Pain Center at UC Gardner Neuroscience Institute and an expert in the area of migraine.

His conclusions and others for migraineurs come after performing an exhaustive literature review of more than 180 research studies on the subject of migraine and diet.

Martin’s two-part review, “Diet and Headache” is available online in the scholarly publication Headache: The Journal of Head and Face Pain. It is co-authored by Brinder Vij, M.D., associate professor in the UC Department of Neurology and Rehabilitation Medicine.

Caffeine and MSG

“One of the most important triggers for headache is the withdrawal of caffeine,” said Martin, who also sees patients at UC Health.

“Let’s say you regularly pound down three or four cups of coffee every morning, and you decide to skip your morning routine one day. You will likely have a full-fledged caffeine withdrawal headache that day.”

That said, too much coffee may also present a risk. No more than 400 milligrams daily — one cup typically has 125 milligrams — is probably the maximum for migraine patients, said Martin. “Large amounts of caffeine can bring on anxiety and depressive symptoms as well as headaches,” he explained.

Another trigger for migraine is MSG, which is a flavor enhancer used in a variety of processed foods, including frozen or canned foods, soups, international foods, snack foods, salad dressing, seasoning salts, ketchup, barbecue sauce, and heavily in Chinese cooking, said Martin, also a UC Health physician.

“You eliminate it by eating fewer processed foods,” Martin said. “You eat more natural things such as fresh vegetables, fresh fruits and fresh meats. MSG is most provocative when consumed in liquids such as soups.”

Nitrites are preservatives found in processed meats, such as bacon, sausage, ham and lunch meat, to preserve color and flavor. Martin said a diary study found that 5 percent of individuals with migraine were statistically more likely to have an attack on days when they consume nitrites.

Use of nitrites in foods has declined with stronger government regulation, though checking labels remains a good idea, he said.

Alcohol is one of the most commonly reported dietary trigger factors for migraine. Studies suggest vodka and red wines, especially those with the highest histamine content, are problematic, said Martin.

There is a lot of interest in gluten-free diets, but they are only helpful in lessening headaches if the individuals suffer from celiac disease, which can be established by a positive blood test or intestinal biopsy, he added.

Diets to prevent headaches

There have been three comprehensive diets whose very composition may prevent headaches. These include low fat and low carbohydrate diets, as well as those that increase the amount of omega-3 fatty acids and decrease the amount of omega-6 fatty acids, according to Martin.

Vij, who is also associate director of the Headache and Facial Pain Center at the UC Gardner Neuroscience Institute, said low fat diets restrict the amount of fat in the diet to less than 20 percent of your daily energy requirements.

“The beauty of these diets is that they not only reduce headaches, but may produce weight loss and prevent heart disease,” said Vij ,a UC Health physician.

Low carbohydrate diets such as ketogenic diets can reduce headache frequency, but it’s not something to consider without strict physician supervision. The diet limits carbohydrates more than the well-known Atkins diet, Vij said.

One of the most promising diets for those with more frequent attacks of migraine is one that boosts your omega-3 fats while lessening your omega-6 levels. That means tossing out polyunsaturated vegetable oils (corn, sunflower, safflower, canola and soy) in favor of flaxseed oil, said Martin.

Foods to consume would include flaxseed, salmon, halibut, cod and scallops, while those to avoid would be peanuts and cashews.

“Persons with headache and migraine have more dietary options than ever. Ultimately a healthy headache diet excludes processed foods, minimizes caffeine, and includes a lot of fruits, vegetables, fish and lean meats,” Martin said. He adds, “After all, you are what you eat.”

A Wellness Update is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and healthcare agencies across the U.S. Online at www.awellnessupdate.com.

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