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You can manage the pain of migraine

By Diana Cullum-Dugan

Environmental nutrition newsletter

Migraines can be so debilitating that, at their worst, they can keep you in bed for days, with the blinds closed and your head stashed under a pillow.

An estimated 10 percent of Americans suffer from them, but there are plenty of ways to deal with the pain – including before it starts.

Most involve addressing the three things that tend to play a role in what causes them: diet, lifestyle and stress.

“Migraines now have become one of the most treatable conditions,” says Dr. Eugene Gosy, a neurologist and pain management specialist in Amherst.

Migraines involve a disorder in which the brain is highly sensitive to a variety of stimuli, producing pounding headaches so severe that they may prompt nausea and vomiting.

Migraineurs – those who suffer from migraines – are genetically prone. Up to 90 percent have a strong family history, and women experience them more often than men. The first migraine typically occurs during childhood, adolescence, or early adulthood, usually increasing to an average of one per month. Most who have suffered with them for years tend to get a sense they’re coming on several hours before the pain becomes severe.


There is no solid scientific understanding of how and why migraines occur. Triggers can include:

• Changes in the body’s normal production of chemicals in the central nervous system.

• Electrolyte-based shifts during stressful events, exercise or fasting.

• Sensory changes, including bright lights and strong odors.

• Hormonal transitions, such as variations during the menstrual cycle.

• Intake of certain foods and beverages.

Lifestyle also may play a role.

“There is a tendency for Type A individuals to get them,” Gosy said. “People who are hypo-manic multitaskers, very highly functioning individuals, are more often affected than other personality types. Generally speaking, migraineurs need to stay on an even keel. If they sleep in longer, they’ll trigger migraines. If they shorten the sleep cycle, it triggers migraines, so literally, if they balance lifestyle, that’d be important.”

Migraine and pain management specialist Dr. Brian McGeeney, assistant professor of Neurology at Boston University School of Medicine, explains that the underlying problem for migraineurs is a super sensitive pain system: they have a greater tendency to experience a cascade of reactions in the brain which can trigger a migraine.


“Dietary triggers won’t do that in most people, because it takes a trigger to pull the trigger,” McGeeney says. “That is, the ‘gun’ has to be loaded with genetics and a super sensitivity to pain. Then, a variety of sensory input and diet might finally pull the trigger.” These triggers include:

1. Fasting: Such as skipping breakfast or going five or more hours without eating, has been reported as the most frequent food trigger, according to a 2012 study in Neurology Science.

2. Alcohol: Especially red wine, and beer runs a close second. One or two drinks may set off the pain cascade immediately or the following day, also according to a study last year in Neurology Science.

3. Tyramine: An amine compound found naturally in some foods can cause blood vessels to dilate, which can begin the cascade toward a migraine. These foods include red wine, beer, chocolate, avocados, nuts, overripe bananas, soy sauce, aged cheese (such as brie, blue, and Swiss) and dairy foods including milk, yogurt and ice cream.

4. Pork and processed meats: Including hot dogs, deli meat, bacon and ham.

5. MSG (monosodium glutamate): A flavor enhancer used in many Asian dishes. It’s not known why, but one theory is that glutamate is a neurotransmitter that relays signals in the brain.

6. Nitrates and nitrites: Compounds found naturally in vegetables and often added to processed meats, like deli meat and hot dogs. Usually the nitrates we consume in vegetables, such as spinach, beets, radishes, celery and cabbage, are not a problem.

7. Aspartame: The non-nutritive sweetener in NutraSweet and Equal has been linked with trigger headaches in some people, possibly because the body breaks down the sweetener into formaldehyde (Dermatitis, 2008).

To find effective relief, migraineurs should identify their own unique triggers. Keep a log with all foods eaten, along with symptoms experienced. Most often, just reducing the amount or frequency of food triggers may leave you migraine-free. It’s important to work with your health care team, including doctors, neurologists, dietitians and integrative specialists.


During the last 20 years, more than a half dozen prescription medications have been created to prevent and treat migraines and their more severe cousins, cluster headaches, Gosy says. They include the antihistamine cyproheptadine (periactin), which can be used for children, as well as a variety of beta-blockers and calcium channel blockers for adults.

While no foods have been proven to prevent migraines, some show promise. Magnesium and riboflavin supplements were found effective in some studies. Increasing your intake of magnesium-rich foods (halibut, almonds, soybeans, spinach, potatoes with skin, peanut butter, yogurt and brown rice) and riboflavin-rich foods (almonds, kale, legumes, mushrooms, spinach, tomatoes) may prove helpful.

Vitamin E-rich foods, including wheat germ oil, almonds, and vegetable oils, show a reduction in pain severity and nausea and an increased ability to function during a migraine, according to some research. Omega-3 fatty acids, found in salmon, tuna, mackerel, halibut, sardines, flaxseed, and walnuts, have been linked with a reduction in headache duration, severity and frequency.

Refresh Editor Scott Scanlon contributed to this story.