What nitrates should be avoided to prevent migraine triggers?

Nitrates to Avoid for Migraine Prevention

Foods containing nitrates should be completely avoided by migraine sufferers as they are established migraine triggers that can precipitate attacks through nitric oxide-mediated mechanisms. 1

Types of Nitrates to Avoid

• Processed/Cured Meats: Hot dogs, bacon, ham, salami, pepperoni, and other processed meats containing sodium nitrate as a preservative 2
• Food Additives: Specifically sodium nitrate and monosodium glutamate (MSG), which are common in processed and packaged foods 2
• Medications: Nitrate-based medications used for cardiovascular conditions (nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) can trigger severe migraine attacks 3
• "Chinese Restaurant Food": Often contains high levels of MSG and sodium nitrate that can trigger migraines 2
• Cured Meats: Products specifically labeled as containing nitrates or nitrites as preservatives 1

Mechanism of Nitrate-Induced Migraines

Nitrates trigger migraines through multiple pathways:

• Vasodilation: Nitrates convert to nitric oxide (NO) in the body, causing blood vessel dilation that can trigger headache 3
• Oral Microbiome Involvement: People with migraines have significantly higher levels of nitrate-reducing bacteria in their oral microbiome, which may convert dietary nitrates to nitric oxide more efficiently 4
• Two Types of Nitrate Headaches:
  • Immediate headaches (within 1 hour) - mild to moderate severity
  • Delayed migraine-type headaches (3-6 hours after nitrate consumption) - more severe and debilitating 3

Identification of Nitrate-Containing Foods

• Read Food Labels: Look specifically for "sodium nitrate," "sodium nitrite," "potassium nitrate," or "potassium nitrite" in ingredient lists 2
• Common Sources: Preserved meats, certain cheeses, processed foods 1
• Restaurant Foods: Ask about food additives when dining out, particularly at establishments serving cured meats or using MSG 2

Patient Monitoring and Management

• Headache Diary: Patients should maintain a detailed diary tracking food consumption and headache patterns to identify personal triggers 1
• Elimination Diet: Consider a systematic elimination of suspected trigger foods followed by careful reintroduction to confirm nitrate sensitivity 2
• Medication Awareness: Patients with both cardiovascular disease and migraines should be aware that nitrate medications may trigger severe migraine attacks 3

Special Considerations

• Individual Variation: Sensitivity to nitrates varies among migraine sufferers, with those having a personal or family history of migraines being more susceptible 3
• Cumulative Effect: The triggering effect of nitrates may be dose-dependent and cumulative with other triggers 5
• Medication Contraindications: Triptans (common migraine medications) are contraindicated in many cardiovascular conditions that are treated with nitrates, creating a therapeutic challenge 3

Common Pitfalls

• Hidden Sources: Nitrates may be present in foods not commonly associated with them, such as certain vegetable products or wine 2
• Multiple Triggers: Patients may have multiple migraine triggers beyond nitrates, making identification challenging without systematic tracking 1
• Delayed Reaction: The migraine-triggering effect of nitrates can be delayed by several hours, making it difficult to associate with the causative food 3, 5

By avoiding nitrate-containing foods and medications when possible, migraine sufferers may significantly reduce the frequency and severity of their attacks.