Does chocolate alleviate migraine headaches?

From the Guidelines

Chocolate does not remove migraines and may even trigger them in some individuals due to its content of tyramine, phenylethylamine, and caffeine. If you're experiencing a migraine, taking appropriate medication like over-the-counter pain relievers (ibuprofen, aspirin, or acetaminophen) or prescription medications (triptans, gepants, or ditans) would be more effective, as suggested by the American College of Physicians in their clinical guideline for the pharmacologic treatment of acute episodic migraine headache in outpatient settings 1. For acute migraine relief, medications work best when taken early in an attack. Some people find that resting in a dark, quiet room, applying cold compresses, and staying hydrated helps alongside medication.

Key Considerations for Migraine Treatment

• The American College of Physicians recommends considering the use of CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) for the treatment of moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1.
• It is also important to counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy (such as a triptan with an NSAID or acetaminophen) to improve efficacy, and to highlight the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, and managing stress with relaxation techniques or mindfulness practices 1.
• If you suffer from frequent migraines, it's essential to consult with a healthcare provider who can recommend appropriate preventive treatments and help identify your personal triggers, which might include certain foods, stress, sleep disruptions, or hormonal changes, as discussed in the clinical guideline for the prevention of episodic migraine headache using pharmacologic treatments in outpatient settings 1.

From the Research

Relationship Between Chocolate and Migraines

• The relationship between chocolate and migraines is complex and has been studied extensively 2, 3, 4, 5.
• Some studies suggest that chocolate may be a trigger for migraines in a small percentage of participants, ranging from 1.3 to 33% 2, 3.
• However, other studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo 2, 3, 5.
• A double-blind study found that chocolate ingestion was followed by a typical migraine episode in 5 out of 12 patients, while none of the 8 patients challenged with placebo had an attack 4.
• Another study found that chocolate on its own is rarely a precipitant of migraine, with only 13 headaches occurring to chocolate alone in 80 subject sessions 5.

Treatment of Migraines

• Analgesics like aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating migraine attacks 6.
• Serotonin (5-HT)1B/D-agonists, also known as triptans, are highly effective in improving headache, nausea, photo- and phonophobia 6.
• Migraine prophylaxis is recommended when more than 3 attacks occur per month, if attacks do not respond to acute treatment, or if side effects of acute treatment are severe 6.
• Substances with proven efficacy for migraine prophylaxis include beta-blockers, calcium channel blockers, 5-HT antagonists, and amitriptyline 6.

Chocolate as a Migraine Trigger

• The evidence suggests that chocolate is not a significant trigger for migraines in most people 2, 3, 5.
• While some individuals may experience migraines after consuming chocolate, the relationship between the two is not fully understood and may be influenced by other factors 2, 3, 4.