Diet and migraine: what is proven?

Fasting and Headache

PURPOSE OF REVIEW

This review synthesizes the latest updates in the literature on the connection between fasting and migraine, examining both clinical outcomes and underlying pathophysiological mechanisms.

RECENT FINDINGS

Although no studies have specifically explored fasting as a therapeutic intervention for migraine, various retrospective analyses suggest that fasting might worsen migraine symptoms in the short term. On the other hand, recent investigations, including several randomized controlled trials, have shown that ketogenic diets significantly reduce the number of migraine days and decrease inflammation markers. Additional research has shown improvements in disability assessments, as indicated by VAS, MIDAS, and HIT-6 scores. These benefits are not replicated by merely administering ketone bodies. Furthermore, genetic studies have found a link between glycemic processing and the occurrence of migraine. There is accumulating evidence that ketogenesis can reduce both the frequency and disability associated with migraine, likely through the reduction of systemic inflammatory markers and diminished cortical excitability. However, the potential benefits of intermittent fasting on migraine prevention remain underexplored and warrant further investigation.

An Assessment of the Dietary Habits of Individuals with Migraine Living in Spain: An Exploratory Observational Cross-Sectional Pilot Study

BACKGROUND/OBJECTIVES

Eating habits have been proposed as a potential therapeutic approach for migraines; nevertheless, scientific evidence to support firm recommendations is lacking. Specifically, dietary habits in migraineurs living in Spain have not been investigated. Therefore, this study aimed to evaluate their dietary patterns and examine how these habits vary based on the frequency of migraine attacks or the degree of migraine-related disability.

METHODS

An exploratory, observational, cross-sectional pilot study was conducted on 260 individuals (18-64 years old) diagnosed with migraine in Spain. Data on diet, lifestyle, and migraine characteristics were collected with an online questionnaire consisting of a food frequency questionnaire and enquires about perceptions about diet, lifestyle, and different aspects related to migraines. Statistical differences were analyzed with the Kruskal-Wallis test, followed by Dunn's post-hoc test, using JASP.

RESULTS

The consumption of plant-based foods was below the AESAN recommendations. No differences were observed in terms of food servings consumption across different migraine attack frequencies or levels of migraine-related disability. Both the chronic migraine group and the severe disability group showed differences in the consumption of some foods considered as migraine triggers (such as chocolate, cured cheese, cured meats, and alcoholic beverages). Moreover, people who suffered from infrequent migraine consumed significantly more caffeine than those who had chronic migraine.

CONCLUSION

It remains unclear whether avoiding dietary migraine triggers is driven by the biological effects of certain food compounds or influenced by dietary perceptions and unfounded beliefs. Thus, further research on the role of diet in migraine management is necessary.

Exploring the associations of sleep bruxism and obstructive sleep apnea with migraine among patients with temporomandibular disorder: A polysomnographic study

BACKGROUND

Migraine is the most common disabling headache disorder in the world. Temporomandibular disorders (TMDs) are a group of conditions characterized by pain/dysfunction of masticatory muscles or their associated structures. There is a lack of studies concerning the association between sleep disorders such as sleep bruxism (SB), obstructive sleep apnea (OSA), migraine, and TMD, despite the increased prevalence of these conditions in TMD patients.

OBJECTIVE

Our case-control study assesses the potential relationship among SB, OSA, and migraine using polysomnography (PSG) among the group with TMD.

METHODS

One hundred nineteen patients with TMD were recruited and hospitalized in the Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension, and Clinical Oncology at Wroclaw Medical University. Their sleep parameters were assessed by PSG according to American Academy of Sleep Medicine guidelines. Migraine diagnosis was based on the third edition of the International Classification of Headache Disorders. The group of 30 patients with median age 35.0 years (interquartile range [IQR]: 26.0, 41.0) were diagnosed with migraine and this group consisted of 17 without aura (MwoA) and 13 with aura (MwA). Thirty patients with migraine were compared to 89 patients with TMD without migraine (controls) with median age 37.0 years (IQR: 26.0, 44.0).

RESULTS

Sleep bruxism was detected in 86% of the migraine group and 71.9% of control participants. The median bruxism episode index (BEI) among patients with migraine was 3.8 n/h (IQR: 2.7, 5.8) and 3.5 n/h (IQR: 1.8, 6.0) in the control group. SB and severe SB (respectively, BEI > 2 and BEI > 4) were not associated with migraine (odds ratio [OR] = 2.68, 95% confidence interval [CI]: 0.84-8.55, p = 0.095; OR = 0.98, 95% CI: 0.42-2.32, p = 0.966). However, mixed bruxism episodes were more frequent in the migraine group compared to study participants not experiencing migraine (median 0.7 n/h [IQR: 0.4, 1.6] vs. median 0.5 n/h [IQR: 0.2, 0.9], p = 0.044; OR = 1.96 with 95% CI: 1.16-3.32, p = 0.013). The median average duration of SB episodes in the migraine group was longer than in the controls (7.0 s [IQR: 5.5, 8.4] vs. 5.9 s [IQR: 5.1, 6.6], p = 0.005). The apnea-hypopnea index (AHI) value was not associated with migraine compared to controls (OR = 1.01, 95% CI: 0.96-1.06, p = 0.605), but MwoA had significantly increased AHI values compared to MwA (mean AHI = -0.1, standard deviation [SD] = 1.5 for MwA vs. mean AHI = 0.9 with SD = 1.3 for MwoA, p = 0.049).

CONCLUSION

Sleep bruxism may not be associated with migraine among patients with TMD; however, mixed bruxism episodes were more frequent in the migraine group. The increased duration of SB episodes in patients with migraine may suggest the common background of these conditions. OSA is also not associated with migraine; however, MwoA might increase the odds of OSA. There is a need to further explore sleep disturbances and migraine, especially in groups with their increased prevalence, such as patients with TMD.

The Interplay Between Gut Microbiota, Adipose Tissue, and Migraine: A Narrative Review

BACKGROUND

Migraine, a prevalent neurovascular disorder, affects millions globally and is associated with significant morbidity. Emerging evidence suggests a crucial role of the gut microbiota and adipose tissue in the modulation of migraine pathophysiology, particularly through mechanisms involving neuroinflammation and metabolic regulation.

MATERIAL AND METHODS

A narrative review of the literature from 2000 to 2024 was conducted using the PubMed database. Studies addressing the relationships between microbiota, adipose tissue, and migraine-including dietary interventions and their impact-were analyzed.

RESULTS

The findings highlight a bidirectional gut-brain axis, with gut microbiota influencing neuroinflammation via metabolites such as short-chain fatty acids (SCFAs). Obesity exacerbates migraine severity through chronic inflammation and the dysregulation of adipocytokines like leptin and adiponectin. Dietary patterns, such as low glycemic index diets and Mediterranean diets, and the use of prebiotics, probiotics, and postbiotics show potential in migraine management.

CONCLUSIONS

This review underscores the need for integrative approaches targeting the microbiota-gut-brain axis and adipose tissue in migraine therapy. Future studies should explore longitudinal effects and personalized interventions to optimize outcomes.

Hallmarks of primary headache: part 1 - migraine

BACKGROUND AND AIM

Migraine is a common disabling conditions which, globally, affects 15.2% of the population. It is the second cause of health loss in terms of years lived with disability, the first among women. Despite being so common, it is poorly recognised and too often undertreated. Specialty centres and neurologists with specific expertise on headache disorders have the knowledge to provide specific care: however, those who do not regularly treat patients with migraine will benefit from a synopsis on the most relevant and updated information about this condition. This paper presents a comprehensive view on the hallmarks of migraine, from genetics and diagnostic markers, up to treatments and societal impact, and reports the elements that identify migraine specific features.

MAIN RESULTS

The most relevant hallmark of migraine is that it has common and individual features together. Besides the known clinical manifestations, migraine presentation is heterogeneous with regard to frequency of attacks, presence of aura, response to therapy, associated comorbidities or other symptoms, which likely reflect migraine heterogeneous genetic and molecular basis. The amount of therapies for acute and for prophylactic treatment is really wide, and one of the difficulties is with finding the best treatment for the single patient. In addition to this, patients carry out different daily life activities, and might show lifestyle habits which are not entirely adequate to manage migraine day by day. Education will be more and more important as a strategy of brain health promotion, because this will enable reducing the amount of subjects needing specialty care, thus leaving it to those who require it in reason of refractory condition or presence of comorbidities.

CONCLUSIONS

Recognizing the hallmarks of migraine and the features of single patients enables prescribing specific pharmacological and non-pharmacological treatments. Medical research on headaches today particularly suffers from the syndrome of single-disease approach, but it is important to have a cross-sectional and joint vision with other close specialties, in order to treat our patients with a comprehensive approach that a heterogeneous condition like migraine requires.

The Brain, the Eating Plate, and the Gut Microbiome: Partners in Migraine Pathogenesis

This review summarizes the relationship between diet, the gut microbiome, and migraine. Key findings reveal that certain dietary factors, such as caffeine and alcohol, can trigger migraine, while nutrients like magnesium and riboflavin may help alleviate migraine symptoms. The gut microbiome, through its influence on neuroinflammation (e.g., vagus nerve and cytokines), gut-brain signaling (e.g., gamma-aminobutyric acid), and metabolic function (e.g., short-chain fatty acids), plays a crucial role in migraine susceptibility. Migraine can also alter eating behaviors, leading to poor nutritional choices and further exacerbating the condition. Individual variability in diet and microbiome composition highlights the need for personalized dietary and prebiotic interventions. Epidemiological and clinical data support the effectiveness of tailored nutritional approaches, such as elimination diets and the inclusion of beneficial nutrients, in managing migraine. More work is needed to confirm the role of prebiotics, probiotics, and potentially fecal microbiome translation in the management of migraine. Future research should focus on large-scale studies to elucidate the underlying mechanisms of bidirectional interaction between diet and migraine and develop evidence-based clinical guidelines. Integrating dietary management, gut health optimization, and lifestyle modifications can potentially offer a holistic approach to reducing migraine frequency and severity, ultimately improving patient outcomes and quality of life.

CGRP Antagonism and Ketogenic Diet in the Treatment of Migraine

The study of migraine is based on the complexity of the pathology, both at the pathophysiological and epidemiological levels. Although it affects more than a billion people worldwide, it is often underestimated and underreported by patients. Migraine must not be confused with a simple headache; it is a serious and disabling disease that causes considerable limitations in the daily life of afflicted people, including social, work, and emotional effects. Therefore, it causes a daily state of suffering and discomfort. It is important to point out that this pathology not only has a decisive impact on the quality of life of those who suffer from it but also on their families and, more generally, on society as a whole. The clinical picture of migraine is complex, with debilitating unilateral or bilateral head pain, and is often associated with characteristic symptoms such as nausea, vomiting, photophobia, and phonophobia. Hormonal, environmental, psychological, dietary, or other factors can trigger it. The present review focuses on the analysis of the physiopathological and pharmacological aspects of migraine, up to the correct dietary approach, with specific nutritional interventions aimed at modulating the symptoms. Based on the symptoms that the patient experiences, targeted and specific therapy is chosen to reduce the frequency and severity of migraine attacks. Specifically, the role of calcitonin gene-related peptide (CGRP) in the pathogenesis of migraine is analyzed, along with the drugs that effectively target the corresponding receptor. Particularly, CGRP receptor antagonists (gepants) are very effective drugs in the treatment of migraine, given their high diffusion in the brain. Moreover, following a ketogenic diet for only one or two months has been demonstrated to reduce migraine attacks. In this review, we highlight the diverse facets of migraine, from its physiopathological and pharmacological aspects to prevention and therapy.