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 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 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?

— Bezzy Migraine Member

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.

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Being overly restrictive by combining diets

There are several dietary methods that may help you better control migraine attacks. These include:

• gluten-free diet
• dairy-free diet
• Mediterranean diet
• high fish oil diet
• low-carbohydrate or ketogenic diet
• vegan diet
• a diet made popular 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 trigger migraine attacks.

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.

Getting stuck

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

Unreasonable expectations

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.

Steps you can take today

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 healthy eating tips 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.