Danielle Aberman, RD, is a registered dietitian and certified health and wellness coach. She holds a bachelor’s degree in clinical nutrition. Since being diagnosed with migraine and finding great relief with diet and lifestyle changes, she has dedicated herself to educating people living with migraine on how to find relief. She also teaches people how to partner with other health professionals to improve their overall migraine treatment plan. Danielle is a partner at 

Danielle Aberman, RDN

I’ve changed my diet to get my migraine attacks under control, but I don’t think it’s helping. I really want dietary changes to help, but I don’t know what to try next. What do you suggest?

Nothing makes me happier as a dietitian than helping people with migraine reduce the frequency and intensity of their attacks. It’s so nice when someone can identify a few foods to avoid and begin to reclaim migraine-free days in their life.

But there isn’t one “migraine diet” that will work for everyone. Migraine is complex and thought to be due to a combination of many genetic factors. This is likely why each of us experiences migraine differently and have different triggers. 

This may also explain why some medications and interventions, including diet, work for some people but not others. Having to try many different approaches is frustrating, but it’s the reality of migraine treatment.

I don’t want to miss an opportunity to acknowledge you for committing to making a significant change to your lifestyle. Good job giving it a try, even if you didn’t get the results you were looking for. You did not fail. Migraine doesn’t play fair, and it doesn’t reward all efforts.

Let’s look at three things to think about when dietary changes aren’t helping.

Sometimes it takes more than one attempt at modifying your diet to find the best way of eating for your overall wellness and migraine control.

Maybe you were trying the popular elimination diet for migraine. The goal of that diet is to identify food triggers by restricting your foods to those commonly considered neutral for most people. If you diligently followed the diet and avoided the lengthy list of restricted foods but haven’t gotten better, there is some good news mixed with some disappointing news. 

The good news is that you may not have food triggers. So, you can continue to enjoy delicious and nutritious foods like guacamole, chocolate, and aged cheeses. 

On the other hand, what didn’t happen was the “Aha!” moment you had hoped for. Identifying a culprit is typically rewarding, and that didn’t happen for you.

If the migraine elimination diet didn’t help you find food triggers, it might be time to move on to an approach to minimize inflammation and help your overall wellness. In my 

 in this series, I discussed the “rules” and general guidelines for healthy eating for migraine control. Just like trialing different medications, sometimes trialing different diets can help.

An evidence-based diet for migraine prevention that focuses on foods to include rather than avoid is the 

. Since most diets focus on what not to eat, this way of eating focuses on what to include. The diet includes fish like salmon and tuna, both high in omega-3 fatty acids. Fish oil may also help 

Before starting a new diet, talk with a doctor to see if it’s a good option.

Talk with your doctor about nutritional supplements you haven’t tried

While your diet attempt may have felt disappointing, adding or changing some nutritional supplements may help you get better control of migraine.

Though more research is necessary, there are several 

 that may be helpful for migraine. This includes:

Additionally, ginger root may be helpful. In a 

, researchers concluded that ginger is safe and effective at reducing pain in people with migraine. Ginger has also been 

 to be helpful for nausea, one of the more debilitating symptoms of migraine.

What is especially nice about ginger is that many people find it helpful in different forms, including the sliced root, crystallized form, and powdered spice. It’s nice to find migraine relief from food rather than another tablet or capsule.

Some supplements and herbs have the potential to interact with certain medications or other supplements. Always talk with your doctor before trying a new supplement or herb.

Migraine is a complex neurological condition that can range from infrequent and easy to treat to chronic and resistant to many medications.

Having an expectation that diet will help may be reasonable for some people. While some may experience significant improvement, others may have only a slight reduction in attacks or no improvement.

At Migraine Strong, we always recommend a multimodality approach, especially for those with more frequent attacks. Attacking migraine with several interventions simultaneously is often more helpful than just one method at a time.

If you implement specific evidence-based lifestyle modifications and find effective medications with your doctor, you may notice gradual but improved success in controlling migraine. Hypothetically, if medication gives someone 40 percent improvement, diet and nutritional supplements help another 25 percent, and cognitive behavioral therapy helps 15 percent, one could say that is a success worth celebrating.

In this Ask the Dietitian, Danielle Aberman, RDN, discusses three aspects to consider when dietary changes aren't improving your migraine symptoms.

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Jillian Kubala, MS, RD

Cardia L, et al. (2020). Clinical use of omega-3 fatty acids in migraine. 

Chen L, et al. (2021). The efficacy of ginger for the treatment of migraine: A meta-analysis of randomized controlled studies. 

Galan-Arriero, et al. (2017). The role of omega-3 and omega-9 fatty acids for the treatment of neuropathic pain after neurotrauma. 

Wolfgang M, et al. (2015). Is ginger beneficial for nausea and vomiting? An update of the literature. 

Ask the Dietitian: 3 Things to Consider When Dietary Changes for Migraine Aren’t Helping

Deena Kuruvilla, MD

When living with migraine, it’s important to know the signs that other medical conditions could be causing your head pain.

At times, it can be hard to distinguish between a true migraine attack and a headache due to a different medical reason.

It can be especially important to know the differences if you experience symptoms such as changes in vision, trouble speaking, or weakness and numbness on either side of your body.

However, there are certain warning signs that can help you decide if you need to proceed to the emergency department for urgent medical attention. As a headache specialist, a mnemonic device that has helped me make this distinction over the years is SNOOP:

If you have headaches associated with systemic symptoms — such as a fever or weight loss — this can be a sign of an active infection such as 

. It’s important to have this assessed by a physician, and especially important if you have a suppressed immune system or a history of cancer.

If you experience abnormal neurological symptoms that you haven’t had before, you should seek immediate medical attention. These might include:

These symptoms can signal a seizure or stroke.

If your headache comes on suddenly and without warning, it may be a sign of bleeding within the brain or a brain tumor. Sudden headaches are typically a reason to seek medical attention or advice.

Headaches that start when someone is older than age 50 may be due to a problem with the blood vessels within the brain or inflammatory diseases such as 

If your headache or migraine attacks suddenly look or feel different, this could indicate another underlying cause of the head pain. 

If your headaches mainly occur when you sit, stand up, or lay down, that could signal low or high pressure in the fluid that cushions the brain, also known as the cerebrospinal fluid.

In most cases, if you have any of the warning signs above, your doctor will order pictures of your brain with a CT scan or MRI, check your vision, and perform a full neurological exam. 

If an infection in the head is being considered, a doctor might also order a 

 is ordered in some cases to look for signs of seizure.

If you already have a migraine diagnosis, have already had some of the above tests done, and are still having frequent or severe attacks, it’s of the utmost importance that you bring this up with your doctor. You’ll want to discuss different steps you can take to prevent attacks from happening and also create a multi-step plan for treatment when these attacks do occur.

It’s important to note that the emergency room can make a person with established migraine disease feel worse because of the loud noise, bright lights, and stressful nature of being in the ER. 

It’s also possible that someone with migraine may be told to have unnecessary testing done or be prescribed inappropriate medications, such as opioids.

It’s important to know the headache signs that may mean more than a migraine attack. You should also alert your primary doctor or neurologist if you see any changes in your regular migraine patterns. 

If you’ve already been diagnosed with migraine and the attacks are not managed, a headache doctor can help you figure out a treatment plan you’re comfortable with. This can help keep you out of the emergency room and reduce disability with the disease.

When living with migraine, it's important to know the signs when other medical conditions could be causing your head pain.

Illustration by Brittany England

Heidi Moawad, M.D.

Ailani J. (2021). Acute migraine treatment. 

Belcastro V, et al. (2013). From migralepsy to ictal epileptic headache: the story so far. 

Do TP, et al. (2019). Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. 

Dodick DW. (2021). Diagnosing secondary and primary headache disorders. 

Hartl E, et al. (2015). Two patients with visual aura — migraine, epilepsy, or migralepsy? 

Kuruvilla DE, et al. (2022). Preventing the progression of episodic migraine to chronic migraine with acute treatment optimization. 

Lamonte M, et al. (1995). Headache associated with aseptic meningitis. 

Riggins N, et al. (2022). Episodic migraine and older adults. 

Ask the Migraine Expert: When Should I Seek Emergency Medical Care for Migraine?

I’ve heard that finding food triggers and changing my diet can help banish debilitating migraine attacks, but there’s so much information to sort through online. What types of diet trends should I avoid?

Diet intervention for migraine relief has been around for decades. Social media has both helped and harmed efforts to leverage our meals and snacks as part of our preventive regimen. 

While there seems to be more positive than negative aspects to the tremendous number of internet resources surrounding food and migraine, there are some pitfalls to be aware of.

Let’s spend some time going over these potential traps so you can avoid delays in finding lasting relief from migraine.

Being overly restrictive by combining diets

 that may help you better control migraine attacks. These include:

 by Dr. David Buccholz that is low in tyramine, glutamate, and caffeine

All of these approaches can be done in a safe, balanced way. But you’ll need to keep realistic expectations, understand your ultimate goal, and know when to stop.

Combining restrictive diets that eliminate too many foods can lead to issues like prolonged, inadequate intake of important nutrients. This is especially problematic for people with certain food preferences that may not eat a wide variety of nutritious foods.

One example of a way of eating that could be too restrictive and lead to significant nutrient deficiencies is combining gluten-free, dairy-free, and low tyramine diets. Another example is low carb combined with vegan restrictions. 

In addition to the potential for a migraine diet to be nutritionally inadequate, restrictive dieting can be too stressful for some people. It can be challenging to figure out what to eat when there are so many foods on the “avoid” list. It can also lead to disordered eating.

Before starting any diet, you should consult with your physician. In the case of combining very restrictive diets, you should only do this with the help of a registered dietitian.

Feelings of stress and anxiety that persist

It’s typical and acceptable to feel nervous or be overly focused on a diet when you first start. Most often, your new way of eating requires planning and preparation that wasn’t part of your established routine. 

But many of us with migraine already have stress in our lives due to this disease. We may feel a sense of overwhelm that doesn’t subside even after a few days of implementing dietary changes.

Although anxiety does not cause migraine disease, it can 

For some people, restrictive diets, like some of the migraine diet approaches, may exacerbate anxiety and defeat the purpose of the changes. It’s likely that most people that have a history of disordered eating have been cautioned to not try restrictive diets.

You may want to consider ending the diet or choosing a less restrictive way of eating if:

You find yourself feeling very stressed or anxious about the migraine diet you’ve chosen.

You feel fearful of foods that you are supposed to avoid.

Your diet is leading to social isolation.

Maintaining social connections is so important to our physical and mental health. If you’re avoiding parties or going out with friends and family and refusing to eat at restaurants, the diet you chose isn’t for you. Perhaps you just need support in figuring out how to eat away from home rather than ditching the diet. 

But if you’re becoming fearful and isolated, it’s time to think about other options. Your doctor or a registered dietitian can help.

Thinking in dietary absolutes or ‘black and white thinking’

The low tyramine diet has a lengthy list of restricted foods and additives. This is the diet that probably causes the most trouble with black and white thinking. 

If you think in absolutes and are following this popular migraine diet, you would probably come away from the bread aisle in the supermarket empty-handed. Rather than comparing ingredient labels and choosing one type of bread, some people will reject all the options — even though the restricted ingredient is likely the equivalent of a “pinch” in a serving or two.

When people have severe food allergies, they truly need to be very careful and “think in absolutes,” especially when they may be at risk for anaphylactic shock. But these stringent rules don’t apply when changing your way of eating to prevent future migraine episodes. 

When following the restrictions to help control migraine, think of the choices in front of you on a scale and make a better selection. Try not to sweat the small stuff and make the best choice you can.

One point that isn’t discussed enough is that migraine elimination diets are meant to be 

 These aren’t lifestyle changes that are going to last for years. 

If you find relief from a migraine-oriented diet, realize that the benefits aren’t because the foods you’ve eliminated are always going to be personal triggers. It’s more because your overly responsive brain needed a temporary break from those foods. 

You’ll be able to add most, if not all, of those restricted foods back to your diet.

It’s empowering to learn your triggers if you have them. It’s equally empowering to eat freely, understanding you don’t have any. This means the period of adding foods back in is every bit as important as the elimination phase. 

Avoid the pitfall of getting stuck in the elimination phase. Instead, embrace the intended purpose of restrictive migraine diets: To identify specific food triggers as well as “safe” or neutral foods. 

It’s certainly possible that changing your diet will decrease the frequency and intensity of your migraine attacks.

But a mistake that some migraine professionals see is an unrealistic view of “food as medicine.” This can sometimes interfere with getting proper medical intervention. Avoid using migraine diets in isolation without also implementing proper medical care alongside it.

It’s important to remember that food may be a trigger for you, but it’s not the cause of migraine. Some people don’t have any food triggers at all. 

Dietary intervention can and does help some people reduce their migraine episodes and overall health. But food is often just one piece of the treatment puzzle.

If any of these pitfalls ring true for you, it likely means that a different, less restrictive approach with specific support would be helpful. These 

 may be the information you’re looking for. 

Perhaps you’d benefit from a more simple approach that minimizes highly processed foods in favor of choosing whole foods and packaged foods with just a few simple ingredients. For example, choosing simple salted popcorn or kettle chips instead of Doritos.

Always consult your doctor before you make changes to your diet. Also, if you feel like you have an unhealthy relationship with food and may have disordered eating, please speak to a doctor. There are many options for assistance and you most certainly aren’t alone.

There's an abundance of information on food and migraine, but it's important to be aware of potential pitfalls. Learn more from registered dietitian Danielle Aberman.

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Katherine Marengo is a clinical registered dietitian. She specialized as a certified nutrition support dietitian (CNSD) in New Orleans at the Medical Center of Louisiana, the No. 2 Level I trauma center in the nation.

Katherine Marengo LDN, R.D.

Karimi L, et al. (2021). The migraine-anxiety comorbidity among migraineurs: A systematic review. 

Ask the Dietitian: What Are Potential Pitfalls to Watch Out for with Migraine Diets?

This is Ask the Dietitian, a series in partnership with our friends at 

Danielle, one of the owners of Migraine Strong, has been living with migraine for 36 years. After her journey uncovering her own migraine food triggers, she became a registered dietitian to help others take control of their wellness and get their lives back.

When I asked my doctor about diet and migraine, he said, “Just eat healthy.”  What does that mean?

While your doctor certainly meant well, it’s understandable that this suggestion may have triggered a swirling cloud of uncertainty for you. 

The idea of “healthy eating” means something different to everyone. For some people, this could be interpreted as drinking smoothies or committing to a vegan, gluten-free, no sugar, raw diet. For others, it may be interpreted as limiting their venti caramel latte to once per week.

While there’s no one-size-fits-all approach to eating well, there are some “rules” and general guidelines for people with frequent or chronic migraine. 

Hopefully, these tips help demystify the vague advice to “just eat healthy.” (And of course, always consult your doctor before changing your eating plan.)

Many people with migraine know that skipping meals or allowing themselves to get too hungry can bring on a dreaded migraine attack. Why? Some experts say people with migraine are more likely to have problems regulating their insulin and 

Short-term ways to address this include not skipping meals, as well as having snacks on hand to avoid feeling hungry for too long.

However, if you notice this pattern, it might suggest that your body has a hard time keeping your blood sugar regulated properly. Drops in blood sugar may be a reason you experience headaches or full-blown migraine episodes. 

While the quick fix is to have food handy, you may find it helpful to avoid sugary foods, including fruit juices and smoothies. It sounds counterintuitive, but sugary foods can cause a surge in blood sugar followed by a subsequent drop after the body processes it. 

For the overly responsive migraine brain, this may be too much change in blood chemistry and result in a painful attack.

Invest time and attention in nourishing your body

You only have one body, so show it some love. Take more time to plan and prepare meals and snacks that include wholesome, nutrient-dense foods. Buy simple foods with fewer ingredients. 

If you don’t enjoy cooking, figure out a few easy meals that you can throw together. You may surprise yourself!

If you usually eat many meals away from home, challenge yourself to come up with a few more options each week that show you are giving yourself the tender loving care you truly deserve. You deserve to be nourished by the foods you eat, so invest in good choices.

You likely know that your doctor’s words of “just eat healthy” mean eating less fast food, highly processed prepared foods, and frozen entrées. This is often easier said than done in our busy world. And for those of us who have a difficult time with our health, the idea of making food after a busy day can be too much. 

But there are good resources for quick, wholesome meals. A quick internet search for “3 ingredient entrées” yields some simple, yummy, wholesome ideas. And if you’re on the go and relying on fast food — a fact of life, sometimes — you can usually make more balanced choices, like salads, grilled options, or fruit.

Additionally, there are services that ship nutritious meals to you with all the ingredients pre-measured. The cost may make these services impractical for some and a good investment for others. 

Many grocery stores and delis also offer prepared meals that are fairly nutritious choices and may be more affordable. 

As much as I wanted to put this as rule number 1, the reality is that this is an annoying rule — even if it’s one of the most important. While I realize many people with migraine are consistently hydrated, others fall short on a typical day. 

It’s worth being mindful of your water intake, as dehydration may make pain response worse or aggravate an underlying condition, 

As said before, having a migraine diagnosis means your brain likes consistency. Embrace some of the extra time it takes to be proactive. 

Try to have wholesome meals in the freezer for days when you’re very busy or when you’re too tired to do more than reheat.

Tracking your symptoms can be a good way to understand how food affects your migraine. For example, maybe you consistently have worsening symptoms after eating common trigger foods, like aged cheeses, raw onions, protein shakes, Asian sauces, and nuts. 

Not everyone has food triggers, but some people can reliably track foods that trigger, especially when their attacks are not frequent.

Caffeine can be a friend or a foe. A daily cup of coffee or soda can be absolutely fine. Headache specialists recommend consuming the same amount of caffeine daily and at the same time. The migraine brain likes consistency and routine. 

Some people with migraine have found that daily caffeine is a trigger, but consuming it at the start of an attack is helpful. It takes a bit of trial and error, but it’s worth it if these adjustments help reduce frequency or severity of attacks.

When eating out (and when cooking for yourself) choose less processed, wholesome foods. Eat at restaurants that are “scratch kitchens” or order simple grilled meats and fish with steamed veggies, or even plain french fries. 

Seasoning with herbs, salt and pepper, butter, and olive oil is usually well tolerated. Even places like Chipotle offer good choices. 

Enjoy restaurants that have nutritional information and allergy guidelines on their websites, and plan before you go so that you know what to order.

This isn’t to say you can never have ice cream. Life without ice cream is hard to imagine! Plan what you are going to eat, and then stick to the plan. If you have it written out, you can see where your sugary foods are coming into your diet and adjust accordingly. 

And remember, even foods like honey, agave nectar, fruit juices, raw sugar, and coconut sugar count as sugar and should be limited.

Would you eat a lot more fish if you could have four fewer migraine days each month and a 30 to 40 percent reduction in migraine headache hours? That’s what a 

Examples of popular fish that are high in omega-3 fatty acids include:

The above guidelines may make a significant difference in your overall wellness, and they may help reduce the frequency and intensity of your migraine attacks. 

The Bezzy Migraine community is a great place to seek support and ideas from others who may also be making similar choices. If you think you would benefit from a more individualized approach, seek the help of a registered dietitian.

Migraine Strong's Danielle Aberman, RDN, shares some tips to help demystify the vague advice to "just eat healthy."

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Kathy W. Warwick, R.D., CDE

Arca KN, et al. (2021). Dehydration and headache. 

Ramsden CE, et al. (2021). Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. 

Siva ZO, et al. (2017). Determinants of glucose metabolism and the role of NPY in the progression of insulin resistance in chronic migraine. 

Ask the Dietitian: 9 Tips for ‘Healthy Eating’ with Migraine

Welcome to Ask the Migraine Expert, a column about managing life with migraine from Deena Kuruvilla, MD. Dr. Kuruvilla is a board certified neurologist and Director of the 

 in Fairfield County, Connecticut. Got a question for the migraine expert? Submit your question via 

I’m seeing a specialist soon. What should I expect and what should I have prepared?

It can feel like you’ve won the lottery when you’ve made an appointment to see a headache or migraine specialist.

 headache specialists across the United States for the 40 million Americans with migraine, finding one and scoring an appointment can be a big challenge.

Once you score one of these golden appointments, how do you make the most of the visit and ensure you have an action plan you’re comfortable with executing and all your concerns are addressed?

It’s important to identify your personal goals for migraine management. Migraine is a disease just like asthma and diabetes, and it must be managed.

If your goal for the visit is to receive a diagnosis and get preliminary information about all the possible treatment options, let your physician know. If your goal is to confirm your diagnosis and start treatment as soon as possible, let them know this.

Highlighting your individual goals before your appointment so that you’re ready to share them with your physician is vital to openly communicating with your physician and setting realistic expectations.

Some common goals reported to me by patients include: 

the exclusion of any dangerous causes for headaches

an overall reduction in monthly migraine days

an effective as-needed treatment, which provides pain freedom and freedom from bothersome symptoms such as nausea, vomiting, sensitivity to light and sound, and disability

In order to identify your personal goals, you can maintain a headache diary using your smartphone or a calendar. It’s helpful for your headache physician to have a realistic view of how many days each month you have no discomfort in the head or neck to obtain an accurate view of your monthly headache days.

You can also keep track of what you are using to treat the headaches, how many of the monthly headache days are disabling and causing interruptions to your daily life, and which associated symptoms you’ve experienced.

So that your physician’s office is prepared for your visit, ensure that all your previous medical records, neuroimaging, and lab studies have been received by your headache specialist’s office prior to your appointment.

In order to formulate an effective treatment plan, it is necessary to bring a list of all the past treatments you have tried, whether they were preventive, abortive, or integrative.

It’s often helpful to communicate with your headache physician about your personal goals for the visit. Share what your past experiences have been with treatments, medical professionals, and integrative medicine treatments such as acupuncture, chiropractic maneuvers, or meditation.

You should share what has worked and has not worked in the past and what side effects you have had with treatments. Understanding  your past experiences can help your physician understand how to proceed with making recommendations that work for you.

So much can be lost in translation during your initial visit with a headache physician due to the volume of information that’s exchanged in a limited time frame.

 from Brown University showed that people forgot half of the information shared by healthcare professionals during their visit. The study went on to show that a quick reminder helped patients recall another 36 percent of the information. Even with prompting, 15 percent of the information was totally forgotten. 

The researchers suggested that shared decision-making and open physician-patient communication can help to combat this issue.

Ask questions and bring up any concerns you have. There are so many times that patient questions have brought up more questions in my mind that really help to pinpoint the diagnosis and treatment plan.

At the end of your visit, ask your physician about the need for a follow-up visit and when the best time would be. Follow-up is especially necessary if a new treatment is started to monitor for side effects and measure the treatment efficacy.

Review the notes you have taken at the appointment and double check the plan.

In addition to ordering diagnostic studies or treatments, your doctor may have referred you to other specialists such as sleep medicine, psychiatry, or psychology. Make sure to schedule those appointments as soon as possible.

 shows that multiple specialists such as a headache physician, psychology, psychiatry, and physical therapy, among others, work better as a team than any individual approach alone.

If a new treatment was started, monitor how you’re feeling and let your doctor know whether you’re experiencing any side effects.

Make sure to review and follow through on the plan that you and your doctor formulated together. For example, if a magnetic resonance imaging (MRI) study of the brain was ordered, confirm that you’re prepared to have this study done as advised by your physician.

The biggest barrier we run into with executing a plan is from insurance companies. Oftentimes, to get a neuroimaging study approved by insurance or to obtain prior authorization for medications, it can take several days to weeks.

It’s helpful to partner with your physician’s ancillary staff to make sure your insurance information is updated in their system and that your pharmacist is also communicating with your physician’s office.

The communication or lack of communication that occurs between insurance companies, pharmacies, and physician offices can be frustrating and confusing, but ultimately, we want you to be able to have your diagnostic studies and treatments in a timely manner.

Different migraine physicians may have different approaches to migraine diagnosis and treatment. If you ever have concerns or doubts about a physician’s approach, just ask!

Open communication is the key to a successful physician-patient partnership.

With migraine specialists in short supply, it can feel like winning the lottery when you've scored an appointment. Here's how to prepare for your first visit.

Illustration by Maya Chastain

So many migraines, so few specialists. (2016). 

Munjal S, et al. (2020). Most bothersome symptom in persons with migraine: Results from the migraine in America symptoms and treatment (MAST) study. 

Ask the Expert