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

This is Ask the Dietitian, a series in partnership with our friends at Migraine Strong, featuring Danielle Aberman, RDN. Danielle, one of the owners of Migraine Strong, has been living with migraine for 36 years. After her journey in uncovering her own migraine food triggers, she became a registered dietitian to help others take control of their wellness and get their lives back.

Dear Danielle,

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?

— Bezzy Migraine Member

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.

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Consider changing your dietary approach

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 first article 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 high fish oil diet. 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 reduce neuroinflammation.

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 nutritional supplements that may be helpful for migraine. This includes:

• magnesium
• riboflavin
• coenzyme Q10
• butterbur
• feverfew
• omega-3 fatty acids
• vitamin D
• melatonin

Additionally, ginger root may be helpful. In a meta-analysis, researchers concluded that ginger is safe and effective at reducing pain in people with migraine. Ginger has also been shown 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.

Check in with your expectations

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.