Migraine diet: which foods to avoid and which not to

Which foods should I avoid if I have migraine?

There is no one rule that applies to everyone, and it is worth knowing that before clearing out your fridge. Lists do exist, but they do not agree with one another.

One review compared ten low-histamine diets [2]. In most cases, the foods excluded differed. Fermented foods were the only group that appeared in all ten. And only some exclusions could be explained by the food’s actual histamine content [2]. Of the rest, some were excluded because of other amines, while others contained neither.

The evidence on food triggers is not strong either. A review of 43 studies rates its quality as low [1]. Two out of three were surveys or cross-sectional studies, and no randomised trial tested a food as a trigger [1]. The factors most often associated with more attacks were alcohol and caffeine [1].

That is why we look first at alcohol and meal timing. No amount of alcohol is safe for health (WHO): the less, the better. Avoid it during pregnancy and breastfeeding, in childhood, while driving, or if your medication does not allow it. Low-histamine diets were studied for a different clinical suspicion [2]. They do not justify removing fermented foods from everyone with migraine.
Dehydration has been reported alongside attacks in observational studies [1]. That does not prove that drinking more water prevents them. Caffeine withdrawal can also cause headaches [3].

Is migraine caused by histamine and DAO deficiency?

DAO, or diamine oxidase, is the intestinal enzyme that breaks down histamine from food. The hypothesis is that people with low DAO build up histamine and have more attacks. It has been studied as a hypothesis, but has not been shown to explain all migraine.

The most frequently cited study measured DAO in 137 people with migraine and 61 without migraine [4]. DAO was low in 87 % of the first group and also in 44 % of the second [4]. The review discussing this study also notes that there is still no consensus or validated tool for diagnosing histamine intolerance [4].

In practice, a low DAO test result does not mean that migraine is a histamine problem. Commercial serum DAO tests cannot diagnose the cause of your attacks.

If you also have digestive symptoms such as bloating, gas, or indigestion, see our guide to bloating and abdominal distension.

Do tomatoes, avocados, milk, or chocolate cause migraine?

These are among the questions we hear most often in consultations. None of the four has the evidence behind it that its reputation might suggest.

• Chocolate. Placebo-controlled studies found no differences. There is no basis for routinely excluding it [5].
• Tomatoes and avocados. Some lists exclude them, but the proposed mechanism has not yet been clarified [2].
• Citrus fruits and bananas. Some lists exclude them because of putrescine; its clinical importance remains unclear [2].
• Milk. Some lists exclude it, but its histamine content is not equivalent to that of mature cheeses [2]. It is advisable not to remove it just because of a list and to discuss it in consultation.

If you have confirmed that one of them makes you feel unwell, simply avoid it. If not, the next step is to check.

Removing a food because it is on a list costs you one food and does not take away an attack.

How to find out whether a food triggers your migraine, step by step

Use a diary and check one food at a time. Intolerance tests sold online cannot answer this question.

1. Keep a diary for several weeks. Record meals, drinks, sleep, attacks, medication and, where relevant, your menstrual cycle.
2. Look for repeated patterns. One coincidence does not prove that a food is the trigger [3].
3. Change just one thing at a time. Avoid removing several foods at once.

If you try excluding a food, do so for no more than two to four weeks and then review it with your dietitian-nutritionist. The same review warns that looking for a simple cause-and-effect relationship can be misleading [3]. Stress, sleep, your period and the weather act at the same time. Chocolate raises one more question. If a craving for something sweet is part of the hours before an attack, it could be the first symptom rather than the cause [5].

How can I prevent migraine through diet?

Start by looking at your meal times, caffeine intake, and how much you drink.

Eat without long gaps. According to a review drawing on other studies, skipping meals is reported as a trigger by 44 % of people with migraine, and alcohol by 27 % [1]. Try a meal schedule you can stick to even during a working week.

Keep your caffeine intake steady. Coffee is among the factors most often associated with more attacks [1]. But stopping suddenly can also cause headaches [3]. If you drink coffee, keep the amount steady. If you want to cut down, talk to your healthcare professional about how to do so. As a general reference, EFSA sets 400 mg of caffeine per day for adults, 200 mg during pregnancy, and up to 200 mg per day while breastfeeding. For children and adolescents, the amount is 3 mg per kilogram of body weight per day.

Drink throughout the day. A small trial compared drinking more water with maintaining usual intake. It found no statistically significant reduction in pain [1]. Drink according to your thirst and circumstances; water is not a substitute for medical treatment.

Underneath all of this is your overall eating pattern, which has its own guide: the anti-inflammatory diet. It is based on vegetables, pulses, fish, nuts, and extra virgin olive oil, with few ultra-processed foods.

What mistakes do we see in consultations?

• Following a low-histamine diet without review. It may reduce variety without clarifying the trigger [2].
• Cutting back until you skip dinner. Fasting is a commonly reported trigger [1].
• Judging a food based on just one day. Review several entries and other possible factors [3].

Can diet get rid of migraine?

No. Migraine is a chronic neurological disease that can be treated and managed. Food choices can help you avoid things that trigger attacks and maintain a routine. Your doctor or neurologist will prescribe acute and preventive treatment.

There are treatments available. In addition to medication, the American Headache Society consensus includes behavioural therapies [6]. These include cognitive behavioural therapy, biofeedback, relaxation techniques, and mindfulness [6]. If you have spent years coping with whatever you have in the medicine cabinet, it is worth discussing this with your doctor.

There is also a pitfall unrelated to food. Taking medication for attacks on many days of the month can contribute to another type of headache. Medication-overuse headache refers to headache on fifteen or more days a month in someone who already had a headache disorder [7]. In addition, the medication must have been taken for ten or fifteen days a month, depending on the drug, for more than three months [7]. If this sounds familiar, discuss it with your doctor.

If you also live with fibromyalgia, your dietary approach should take that into account. See our fibromyalgia nutrition guide.

What types of migraine are there, and when should I see a neurologist?

Migraine can occur with or without aura. Aura involves reversible neurological symptoms, often visual, that usually develop gradually [7]. Chronic migraine involves headache on at least fifteen days a month for more than three months, with migraine features on eight or more days [7]. If you have not yet been diagnosed, your attacks are becoming more frequent, or the pattern of your pain changes, make an appointment with your doctor. They will assess whether you need to see a neurologist [8]. Dietary care can support that assessment.