A migraine is much more than a bad headache; unless you suffer from them it is difficult to appreciate just how debilitating a migraine can be. Often people with a migraine can do nothing but lie quietly in a darkened room waiting for the pain to pass. The pain is excruciating, often accompanied by nausea, vomiting and an increased sensitivity to light and sound. A migraine can last for a few hours or a few days. Migraines occur more commonly in women than men (one in four women and one in 12 men) in the UK. and usually affect people in their teenage years up to around 40 years of age, although they do sometimes occur in children. Migraine affects about 15 per cent of adults in the UK (NHS Choices, 2012q).
A range of common factors that can cause migraines in some people have been identified. Some scientists suggest that fluctuating levels of hormones may be linked to the causes of migraines (hence the higher number of women affected). Other factors include: emotional, physical, environmental, medicinal and dietary factors. Foods are frequently identified as triggers and the most common culprits include dairy products (particularly cheese), chocolate, alcohol (particularly red wine), caffeine, citrus fruits, nuts, fried foods and foods containing monosodium glutamate (MSG) such as some Chinese food, processed meats and frozen pizzas. Other triggers include cigarette smoke, bright lights, hunger, certain drugs (such as sleeping tablets, HRT and the combined oral contraceptive pill), loud noises, strong smells, neck and back pain, stress and tiredness. All these factors and others can lead to a migraine, and some people may experience a migraine following any one or a combination of these factors.
One study looked at a range of 36 possible (hormonal, environmental and dietary) triggering factors that may precipitate a migraine in a group of 123 migraine sufferers. The dietary factors included: chocolate, cheese, citrus fruits, alcohol, aspartame, MSG, a fat-rich diet, dairy products and caffeine as well as skipped meals or fasting and deprivation or insufficient intake of water. Out of all the patients tested, only 2.4 per cent did not complain about any dietary factor (Camboim Rockett et al., 2012). The national medical charity Allergy UK lists cheese (particularly Stilton, Brie, Camembert and Emmenthal) as the third commonest cause of food-induced migraine after alcohol and chocolate. They suggest that 29 per cent of food-induced migraines are caused by alcohol, 19 per cent by chocolate, 18 per cent by cheese and 11 per cent by citrus foods. Other foods thought to trigger migraine include fried and fatty foods, onions, pork, pickled herring and yeast extract (Allergy UK, 2005).
In a study at Great Ormond Street Children’s Hospital in London, 88 children with severe and frequent migraines were treated with a diet that eliminated many foods linked to migraine, 93 per cent of the children responded well to the diet and were free of headaches (Egger et al., 1983). Foods were gradually reintroduced to identify those most likely to provoke a migraine. Top of the list was cow’s milk, followed by chocolate (containing cow’s milk), the food preservative benzoic acid, eggs, the synthetic yellow food colouring agent tartrazine, wheat, cheese, citrus, coffee and fish. Interestingly, children who had initially developed a migraine in response to factors other than food (for example flashing lights or exercise) no longer responded to these triggers while on the special elimination diet.
The relationship between food allergy or intolerance and migraine is difficult to prove and, despite the evidence, remains a controversial subject. However, the possibility of cow’s milk allergy or intolerance should be considered in all cases of migraine.