Migraine is a multidimensional and complex disorder, influenced by genetic and environmental factors. It is a relatively common neurological disorder characterized by intense headaches and other somatosensory and transient motor disturbances. It appears in episodic or chronic forms, with or without aura.

Many triggering factors may exist in a patient, and identifying just one can be difficult. Additionally, some factors may reinforce each other.

The most likely triggering factors apart from diet are:

• Fatigue or excessive effort.
• Depression, anxiety.
• High blood pressure.
• Menstruation.
• Loud noises, bright lights, e.g., spending long periods on a computer or gaming console.
• Oral contraceptives.

Scientifically, it is accepted that migraines are sensitive to diet, meaning certain dietary components may trigger attacks,

such as chocolate, citrus fruits, nuts, ice cream, tomatoes, onions, dairy products, processed meats, alcoholic beverages, coffee, caffeine, monosodium glutamate (MSG), histamine, tyramine, phenylethylamine, nitrates, aspartame, sucralose, and gluten.

Interestingly, some foods may cause headaches, while others may cause headaches during withdrawal (e.g., caffeine), and the amount of food or exposure time can greatly influence the outcome.

Note that this list does not apply to everyone, and for most of these, the scientific evidence is insufficient.

Caution—DO NOT restrict all foods that may lead to migraines from your diet for a long time. This may not be helpful, and excessive worry about avoiding foods can be another source of stress and reduce the enjoyment of meals. Also, such diets, especially without supervision, can prevent adequate nutritional intake.

• Try to avoid long periods of fasting, skipping or delaying meals, or not eating enough.
• Avoid fried or very fatty foods.
• Make sure you have a starchy snack before doing sports or intense activity.
• Make sure you drink enough fluids.
• “Healthier” diets, regular meals, and weight loss are associated with reduced headaches. Diets that include the ketogenic diet, low glycemic index diet, and DASH diet are supported for migraine prevention but with moderate evidence. For other diets, such as a gluten-free diet (in patients without celiac disease), or elimination diets, there is not enough evidence.

Elimination diets
This diet requires the individual to identify dietary components that may trigger migraines and eliminate them. This approach should be personalized for each person who observes a high frequency of headaches or migraines when exposed to a dietary trigger. A food diary is helpful.

Folic acid
Folic acid is essential for DNA methylation and it has been suggested that folic acid supplementation is beneficial for migraine. Its presence in the diet has been reported to have a beneficial effect on migraines.

Magnesium
Magnesium deficiencies are associated with migraine pathogenesis, therefore magnesium has been widely used in the prevention and treatment of migraines. Magnesium has been categorized as a recommended macronutrient for migraine prevention by the United States Headache Consortium (USHC) with rare side effects (abdominal pain, nausea, and diarrhea). According to reports from the Canadian Ministry of Health, the maximum oral dose of magnesium should not exceed 350 mg/day. However, clinical trials have reported controversial results regarding the possible effectiveness of oral magnesium intake in migraine prevention.

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