What diet is recommended for migraine prevention?

Diet Recommendations for Migraine Prevention

There is insufficient evidence to recommend any specific dietary approach for the prevention of migraine headaches. 1

Current Evidence on Dietary Interventions

• The 2023 U.S. Department of Veterans Affairs and Department of Defense Clinical Practice Guidelines explicitly state there is insufficient evidence to recommend for or against dietary trigger avoidance for the prevention of headache 1
• The 2023 guidelines specifically eliminated a previous 2020 recommendation that had suggested education regarding dietary trigger avoidance for migraine prevention 1
• IgG antibody testing for dietary trigger avoidance is specifically recommended against (weak against recommendation) in the management of headache 1

Potential Dietary Approaches with Limited Evidence

Despite insufficient evidence for formal recommendations, some dietary interventions have shown promise in small studies:

• Ketogenic diet and DASH (Dietary Approaches to Stop Hypertension) diet have shown some evidence for reducing migraine frequency, duration, and severity in adults, though the quality of evidence is moderate at best 2, 3
• Elimination diets may help some patients but must be personalized and carefully monitored to maintain nutritional balance 2, 3, 4
• Some patients report sensitivity to specific dietary triggers such as:
  • Alcohol (particularly red wine and beer) 5, 2, 4
  • Caffeine (both consumption and withdrawal) 5, 4, 6
  • Certain foods containing tyramine, phenylethylamine, histamine, nitrites, and sulfites 5, 6
  • Monosodium glutamate (MSG) and aspartame 5, 6

Practical Approach to Dietary Management

Given the limited evidence, a pragmatic approach may include:

• Maintaining a headache diary to track potential food triggers alongside other factors (stress, sleep, hormonal changes) 7
• Avoiding fasting or skipped meals, as these can precipitate migraine attacks 6
• Considering a trial of eliminating suspected trigger foods based on individual patterns observed in the headache diary 4, 6
• Avoiding a universal elimination diet that restricts multiple food groups simultaneously, as this may lead to nutritional deficiencies 6

Supplements with Some Evidence for Migraine Prevention

Some supplements have shown limited evidence for migraine prevention:

• Magnesium supplementation has the strongest evidence among nutritional supplements for migraine prevention 5
• Other supplements with some supporting evidence include riboflavin (vitamin B2), coenzyme Q10, and feverfew 5

Important Caveats and Considerations

• Dietary interventions should be considered as part of a comprehensive approach that includes appropriate pharmacologic treatment when indicated 1
• Patients who experience two or more migraine attacks per month with significant disability should be evaluated for preventive pharmacologic therapy, regardless of dietary modifications 1, 8
• The complex interaction between diet and migraine is bidirectional and may be influenced by other factors such as age, sex, and comorbidities 2
• The gut microbiome may play a role in migraine pathophysiology, though research on pre/probiotics for migraine is still emerging 2

Conclusion

While some patients may benefit from identifying and avoiding personal dietary triggers, current clinical guidelines do not support any specific dietary approach for migraine prevention due to insufficient evidence. Patients should focus on maintaining regular, balanced meals while working with healthcare providers to optimize pharmacologic treatment when indicated.