A Natural Approach

to Migraines
PHYSICIANS COMMITTEE FOR RESPONSIBLE MEDICINE
5 1 0 0 W I S C O N S I N A V E., N. W., S U I T E 4 0 0 • W A S H I N G T O N, D C 2 0 0 1 6
PHONE (202) 686-2210 • FAX (202) 686-2216 • PCRM@[Link] • [Link]

R
esearch has shown surprising links between migraines recurrences in all but eight children. In subsequent tests using
and food. Certain foods can cause migraines, while disguised foods, the vast majority of children again became
others can prevent or even treat them. Coffee, for ex- symptom-free when trigger foods were avoided. Migraines
ample, can sometimes knock out a migraine, and foods rich returned when trigger foods were added to the diet.1
in magnesium, calcium, complex carbohydrates, and fiber Since that time, additional research has confirmed that
have been used to cure migraines. Some reports suggest that dietary factors can trigger migraines in children and adoles-
ginger—the ordinary kitchen spice—may help prevent and cents.2
treat migraines with none of the side effects of drugs. The Anywhere between 20 and 50 percent of adults experience
herb feverfew also effectively prevented migraines in placebo- a reduction or elimination of their headaches when common
controlled research studies. trigger foods are avoided.
A migraine is not just a bad headache. It has a character-
istic pattern, usually involving just one side of your head. It Pain-Safe Foods
is a throbbing pain (rather than a dull, constant ache), often
accompanied by nausea, vomiting, and sensitivity to light and
sounds.
See your doctor to evaluate your headache, especially if
P ain-safe foods virtually never contribute to headaches or
other painful conditions. These include:

headaches are new for you, are unusually severe or persistent, • Rice, especially brown rice
or are accompanied by any of these characteristics: • Cooked green vegetables, such as broccoli, spinach, Swiss
chard, or collards
• fever • Cooked orange vegetables, such as carrots or sweet po-
• a change in your strength, coordination, or senses tatoes
• neck or back pain • Cooked yellow vegetables, such as summer squash
• a chronic run-down feeling with pain in your muscles or • Cooked or dried non-citrus fruits, such as cherries, cran-
joints berries, pears, or prunes (but not citrus fruits, apples,
• drowsiness bananas, peaches, or tomatoes)
• difficulty thinking or concentrating • Water: Plain water or carbonated forms, such as Perrier,
• progressive worsening over time are fine. Other beverages—even herbal teas—can be
• the headache awakens you from sleep triggers.
• the headache follows head trauma • Condiments: Modest amounts of salt, maple syrup, and
vanilla extract are usually well-tolerated.
Find Your Migraine Triggers
Common Triggers

I n 1983, researchers at the Hospital for Sick Children in

London reported their results for 88 children with severe,
frequent migraines who began an elimination diet. In this C ommon triggers often cause headaches in susceptible
people. Just as some food sensitivities manifest as a rash
group, 78 children recovered completely and 4 improved on your skin, migraine sufferers have a reaction in the blood
greatly. In addition, some children who also had seizures vessels and nerves. Turn the page for a list of the common
found that their seizures stopped. The researchers then rein- food triggers, also known as the “Dirty Dozen,” in order of
troduced various foods and found that they sparked migraine importance:

1
072903
 food.
1. dairy products* 7. nuts and peanuts Meats, dairy products, and eggs are best left off your plate
2. chocolate 8. tomatoes permanently. Aside from being among the worst migraine
3. eggs 9. onions triggers, they also tend to disturb your natural hormone bal-
4. citrus fruits 10. corn ance, which contributes to migraines, as we will see shortly.
5. meat** 11. apples Their cholesterol, fat, and animal proteins are linked to
6. wheat (bread, pasta, etc.) 12. bananas serious health concerns including heart disease, high blood
pressure, osteoporosis, and cancers of the breast, prostate, and
* Includes skim or whole cow’s milk, goat’s milk, cheese, yogurt, colon, so there is no need to welcome these problem foods
etc. back onto your plate.
** Includes beef, pork, chicken, turkey, fish, etc.
Looking for Other Food Triggers
Certain beverages and additives are also among the worst
triggers, including alcoholic beverages (especially red wine),
caffeinated drinks (coffee, tea, and colas), monosodium glu-
tamate, aspartame (NutraSweet), and nitrites.
I f two weeks on the basic anti-migraine diet does not reduce
your headaches, the next step is to check whether a food
that is not on the list of common migraine triggers may be
Foods that are neither on the pain-safe list nor the com- causing your symptoms. This occasionally happens and, in
mon trigger list should be considered possible but unlikely fact, some people are sensitive to several different foods. An
triggers. Almost any common food, other than those on the elimination diet will help you sort this out.
pain-safe list, has triggered migraines in an isolated individual
in a research study, so these foods cannot be considered com- A Simple Elimination Diet
pletely above suspicion (but they are far from the most likely
culprits).

The Two-Week Test

T he elimination diet is designed to track down any unusual
pain triggers. It is used for many other conditions as well,
particularly arthritis and digestive problems. Start by build-
ing your menu entirely from the pain-safe foods, avoiding all

T he first step in tackling your migraines is to check whether

any of the common triggers are causing them. To do
this, you simply avoid these foods. At the same time, include
others for the moment.
Once your symptoms have gone or diminished, which
may take a week or so, you can add other foods one at a time,
generous amounts of pain-safe foods in your routine and see every other day, to see which ones cause symptoms. Again,
whether migraines occur, and, if so, how often. have a generous amount of each new food so you can see
Here is how to start with anti-migraine foods. For two weeks: whether it causes symptoms. If not, you can keep it in your
diet. Hold off adding any foods on the “Dirty Dozen” list and
1. Have an abundance of foods from the pain-safe list. any of the beverage and additive triggers until last.
2. Avoid the common triggers completely. Here are some tips to help you identify triggers:
3. Foods that are not on either list can be eaten freely.
• Foods that have caused headaches were usually eaten
The key is to be very careful in avoiding the common within three to six hours of the attack.
triggers. See Foods That Fight Pain by PCRM president Neal • The offending foods can be ones you are very fond of,
Barnard, M.D., for trigger-free recipes. perhaps even foods for which you have cravings. They
may be the ones you might least suspect.
Confirm Your Food Triggers • Sometimes the headache will not show up until a large
amount of the culprit is eaten, perhaps over a few days.

I f your diet change makes your headaches disappear or be-

come much less frequent, the next step is to confirm which
foods are your triggers. To do this, simply reintroduce the
• If you are affected by several foods, eliminating only one
may make no difference at all. This sometimes leads
people to believe that foods are not the problem.
eliminated foods one at a time, every two days, to see whether • You might find that you can have a small amount of a
any symptoms result. Start at the bottom of the list (bananas), trigger food without getting a headache, while a larger
and work your way up to the riskier foods, skipping any that amount brings on the headache.
you do not care for. If you wish, you can then check the bev- • Your tolerance might be different at different times. For
erages and additives on the common triggers list. example, a woman might normally be able to eat half a
As you do this, have a generous amount of each new food, box of chocolates with no problem, but, as she approaches
so you will know whether or not it causes symptoms. If it causes her period, a single piece might trigger the migraine. The
no problem, you can keep it in your diet. Anything that causes reason, presumably, is that the natural changes in hor-
a headache should be eliminated again. Then, after a week or mones that occur over the month affect her sensitivity.
two, try the suspect food once again for confirmation. Keep • Your triggers can change over time.
your diet simple so you can detect the effect of each newly added • Your doctor can arrange special blood tests to detect

2
072903
 food sensitivities. They can be rather expensive but are tor:
faster than elimination diets. Information is available a. Feverfew: 250 milligrams per day or two to three
from Serammune Physicians Lab, 1890 Preston White fresh leaves.
Dr., Reston, VA 22091, 800-553-5472. Typical skin-patch b. Ginger: 1⁄2 to 1 teaspoon (1 to 2 grams) of fresh
tests are of little use for migraine triggers, since they detect powdered ginger per day.
only certain kinds of allergies. c. Magnesium: 400 to 700 milligrams per day total
(foods plus supplements, if used) or 200 milligrams
Feverfew: The Anti-Migraine Herb per day as elemental supplement alone.
d. Calcium: Reduce calcium losses by avoiding animal
F everfew is an herb whose name comes from the fact that the
ancient Greeks and many later societies used it as a
treatment for fever. A recent review of six clinical research
protein, caffeine, tobacco, and excess sodium and
sugar. If you wish, you can take 1,000 to 2,000 mil-
ligrams per day of elemental calcium, with 200 IU (5
trials concluded that feverfew is likely to be effective in the micrograms) of vitamin D. Regular physical activity
prevention of migraines.3 Researchers at the City of London will keep calcium in your bones where it belongs.
Migraine Clinic found that feverfew eliminated about two-
thirds of migraines in a selected group of headache patients, If a Migraine Hits
which is similar to the effectiveness of most migraine drugs.4
However, while some people get a pronounced effect, others If a migraine occurs, try the following:
get none at all. Averaging everyone together, it eliminates
about one-fourth of all headaches.5 This does not mean that • Although caffeine can be a migraine trigger for some
it will eliminate precisely one-fourth of your headaches. It people, for others it works as a treatment. The dose is
will more likely either have a very noticeable effect or no ef- one to two cups of strong coffee at the first sign of an
fect at all. attack.
Feverfew is sold at all health food stores. The amount • Have a starchy food, such as rice, potatoes, crackers, or
that has been shown to prevent migraines in research studies bread. Yes, wheat products are migraine triggers for some
ranges from 50 to 114 milligrams per day. However, most people, but if you can tolerate them, they might actually
practitioners use capsules containing about 250 milligrams of help. Some people find that they actually crave starchy
a standardized-potency feverfew, recommending one capsule foods during migraines and that digging into toast,
per day taken on an empty stomach. If you find fresh leaves, crackers, pasta, potatoes, or other starchy foods reduces
the usual dose is two to three leaves per day. the headache or nausea, and can even shorten the attack.
Thousands of people have used feverfew over long pe- Experience will tell you whether these foods help.
riods with no apparent ill effects, and research studies have • Fresh powdered ginger, 500 to 600 milligrams (about 1⁄4
shown no serious risks. However, there has been little effort teaspoon), in a glass of water has been helpful in anecdotal
to systematically look for side-effects over prolonged periods. reports. It can be repeated every few hours, up to about
I would encourage you to avoid it if you are (or might be) 2 grams per day.
pregnant; there is no indication that it causes birth defects, but • Calcium might be able to treat migraines as well as pre-
not enough data are in to be sure. Also, people with clotting vent them. Researchers reported a case of a woman who
disorders or who are taking anticoagulant medicines should was able to stop an early migraine by chewing 1,200 to
consult with their doctors about taking feverfew. Otherwise, 1,600 milligrams of elemental calcium.6,7 Again, avoid
our best information suggests that you can stay on it indefi- the temptation to get calcium from milk, yogurt, or any
nitely. other animal source. They cause much more trouble than
they are worth.
Using Foods to Fight Migraines • Lie down in a quiet, dark room, and sleep if you can. Use
hot or cold compresses, and massage the blood vessels at
1. Emphasize pain-safe foods: brown rice; cooked vegetables, the temples.
such as broccoli, collards, spinach, and chard; and cooked • Biofeedback and acupuncture have been helpful for many
or dried non-citrus fruits. people as well.
2. Avoid the common trigger foods completely. If your mi-
graines have diminished or ceased, you can reintroduce References
1. Egger J, Carter CM, Wilson J, Turner MW. Is migraine a food allergy?
the trigger foods one at a time to assess their effect. A double-blind controlled trial of oligoantigenic diet treatment. Lancet
3. If steps one and two did not diminish your migraines, an 1983;2:865-9.
elimination diet can help you identify whether an unusual 2. Millichap JG, Yee MM. The diet factor in pediatric and adolescent migraine.
trigger is causing your problem. Pediatr Neurol. 2003 Jan;28(1):9-15.
4. Minimize hormone shifts by avoiding animal products, 3. Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum
parthenium L.): an update of a systematic review. Public Health Nutr.
keeping vegetable oils minimal, and having plenty of
2000 Dec;3(4A):509-14.
high-fiber whole grains, beans, vegetables, and fruits. 4. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as
5. Try these supplements, in consultation with your doc- prophylactic treatment of migraine. Br Med J 1985;291:569-73.

3
072903
5. Murphy JJ, Heptinstall S, Mitchell JRA. Randomised double-blind pla-
cebo-controlled trial of feverfew in migraine prevention. Lancet 1988;2:
189-92.
6. Thys-Jacobs S. Vitamin D and calcium in menstrual migraine. Headache
1994;34:544-6.
7. Thys-Jacobs S. Alleviation of migraines with therapeutic vitamin D and
calcium. Headache 1994;34:590-2.

4
072903