Breakfast consumption is inversely associated with primary headaches in university students: The MEPHASOUS study

Irregular meal and migraine headache: a scoping review

INTRODUCTION

Migraines are a type of headache, with certain types being more severe than others. The aim of this scoping review is to map the association between migraine headache and irregular meals, including skipping meals or missed diets and fasting.

METHODS

The six-stages methodological framework of Arksey & O'Malley for scoping reviews was used. A protocol was registered on OSF on November 17, 2024 ( https://doi.org/10.17605/OSF.IO/Z8C7M ) as OSF preregistration for Generalized Systematic Review Registration. Searches were made from the Cochrane Library, Research for Life, PQD Evidence, Global Index Medicus, Scopus, and MEDLINE databases. To make comprehensive searches, Google Scholar, Google, and grey literature sources, including databases of relevant organizations, were searched. Only studies published in English without a date limit were considered. Screening and data extraction were conducted by two groups of reviewers independently.

RESULT

Thirty-six studies were included in this review. It includes systematic reviews, randomized placebo-control trials, cohort studies, literature reviews, chart reviews, case control studies, case studies, and cross-sectional studies. Some studies found no clear link between meal omission and migraines, with mixed evidence on the role of dietary factors as triggers. But the majority of studies suggest that fasting and skipping meals, especially breakfast, can trigger migraines by reducing brain glucose levels and causing hypoglycemia, a known trigger. The timing of meals is crucial, as missed meals can provoke different types of migraines, including retinal and abdominal migraines. Moreover, irregular meal patterns, particularly in those with chronic migraines, are strong predictors of attacks. Consistent and balanced meals help to prevent migraines and manage symptoms.

CONCLUSION

While few studies show mixed evidence, the majority indicate that fasting or skipping meals can trigger migraines. Regular, balanced meals benefit preventing and managing migraines, as irregular meal patterns are predictors of migraine attacks. Moreover, some studies have low to moderate methodological quality, often lacking rigorous control groups and randomization. Thus, it is recommended to draw conclusions from interventional research having longitudinal research with better sample sizes.

Changes in gamma-aminobutyric acid and glutamate/glutamine levels in the right thalamus of patients with episodic and chronic migraine: A proton magnetic resonance spectroscopy study

OBJECTIVE

To explore gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels in the right thalamus of patients with episodic migraine (EM) and chronic migraine (CM) and their effects on the chronification of migraine.

BACKGROUND

Migraine affects approximately 1 billion people worldwide, with 2.5%-3% of people with EM progressing to CM each year. Magnetic resonance spectroscopy studies have revealed altered GABA and Glx levels in the thalamus of patients with migraine without aura, but these neurometabolic concentrations are underexplored in the thalamus of patients with CM.

METHODS

In this cross-sectional study, patients with EM and CM were recruited. Mescher-Garwood point resolved spectroscopy sequence was used to acquire neurotransmitter concentrations in the right thalamus of patients with EM and CM and matched healthy controls (HCs).

RESULTS

A total of 26 patients (EM, n = 11; CM, n = 15) and 16 age- and sex-matched HCs were included in the analysis. There were significantly lower GABA+/Water levels in the right thalamus of the CM group (mean ± standard deviation: 2.27 ± 0.4 [institutional units]) than that of the HC group (2.74 ± 0.4) (p = 0.026; mean difference [MD] = -0.5 [i.u.]), and lower Glx/Cr levels in the EM group (mean ± SD: 0.11 ± < 0.1) than in the HCs (0.13 ± < 0.1) and CM group (0.13 ± < 0.1) (p = 0.023, MD < -0.1, and p = 0.034, MD < -0.1, respectively). The GABA+/Glx ratio was lower in the CM group (mean ± SD: 0.38 ± 0.1) compared to the EM group (0.47 ± 0.1) (p = 0.024; MD = -0.1). The area under the curve for GABA+/Water levels in differentiating patients with CM from HCs was 0.83 (95% confidence interval 0.68, 0.98; p = 0.004). Correlation analyses within the migraine group revealed no significant correlation between metabolite concentration levels and headache characteristics after Bonferroni correction.

CONCLUSION

Reduced GABA+/Water levels and imbalance of excitation/inhibition in the right thalamus may contribute to migraine chronification.

Migraine and Diet: Updates in Understanding

PURPOSE OF REVIEW

We explore recent developments in the prevention and treatment of migraine through dietary interventions.

RECENT FINDINGS

Healthier diets (defined in multiple ways), meal regularity, and weight loss are associated with decreased headache burden. Specific diets including the ketogenic diet, the low-glycemic index diet, and the DASH diet are supported by modest evidence for the prevention of migraine. Neither a gluten-free diet, in patients without celiac disease, nor elimination diets have sufficient evidence for their routine consideration. Diet remains a crucial, but underexplored, component of comprehensive migraine management. Multiple interventions exist for providers and patients to consider integrating into their treatment plan. Larger studies are needed to support stronger recommendations for utilization of specific dietary interventions for the prevention and treatment of migraine.

Sleep disturbance and quality of life among university freshmen in Qinghai-Tibet Plateau of China

PURPOSE

University freshmen are particularly vulnerable as they are undergoing the transition from high school to university with a range of changes. Sleep problems among this group in the Qinghai-Tibet Plateau of China were barely studied. This study aimed to explore sleep disturbance, and its association with quality of life (QoL) and demographic and clinical characteristics among university freshmen in Qinghai-Tibet Plateau, China.

METHODS

A multistage stratified cluster random sampling method was performed to recruit student participants with a structured questionnaire to collect sociodemographic and clinical characteristics, and lifestyle behaviors. Sleep disturbance including three aspects of sleep disturbance (i.e., difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA)) was assessed using standardized measurement. Multiple logistic regression models were applied to analyze the data.

RESULTS

Among included 2,769 freshmen, the prevalence of sleep disturbance was 14.8% (95% CI: 14.2-15.5%), and corresponding prevalence of DIS, DMS, and EMA was 8.2% (95% CI: 7.7-8.7%), 8.3% (95% CI: 7.8-8.8%), and 4.2% (95% CI: 3.8-4.6%), respectively. Freshmen with sleeping disturbance had significantly lower QoL in physical [F _{(1, 2769)} = 60.23, p < 0.001], psychological [F _{(1, 2769)} = 46.18, p < 0.001], social [F _{(1, 2769)} = 23.04, p < 0.001], and environment [F _{(1, 2769)} = 6.07, p = 0.01] domains. Multiple logistic regression analyses revealed that having breakfast five times a week or less (less than three times, OR = 1.79, 95% CI: 1.34-2.40; 3-5 times, OR = 1.40, 95% CI: 1.09-1.79), self-perceived severe Internet dependence (OR = 1.71, 95% CI: 1.11-2.65), self-perceived poor health status (OR = 3.44, 95% CI: 2.06-5.74), high academic stress (OR = 1.42, 95% CI: 1.13-1.78), poor relationship with classmates (OR = 3.44, 95% CI: 1.53-7.71), and severe ADHD symptoms (OR = 1.08, 95% CI: 1.05-1.12) were positively associated with sleeping disturbance.

CONCLUSION

Sleep disturbance was common among freshmen and is associated with poorer QoL. Prevention and intervention strategies should be developed and implemented, especially among the vulnerable university freshman groups.