One out five people (most of them women) get migraine headaches. A single attack can last a few hours to a few days, and attacks can strike three times a year – or three time a week. All too often, nausea accompanies a migraine, earning it the nickname ”sick headache.”

If you’re a person whose life has been hexed by migraine, you’ve probably been searching for a solution. And you may have suspected that a food or beverage is somehow responsible for those painful episodes. You could be on the right track. The notion that a food in the stomach causes a pain in the head isn’t new.

Hippocrates, the Greek ”father of medicine,” noted a connection between food and migraine. And modern research confirms his observation: a survey of 1,883 migraine sufferers in Great Britain found that 95 percent of the attacks suffered over a three month period were caused by diet (Headache, October, 1975).

Acting on this and others findings, the link between food allergy and migraine was investigated in a two year study of 33 migraine sufferers by Jonathan Brostoff and co-researchers at the Department of Immunology, Middlesex Hospital Medical School in London.

Both RAST tests and follow up food tests strongly suggested that many of these people had food allergies. They were then treated with elimination diets and food rotation – and responded well. ”In the 23 patients who were sensitive to certain foods, elimination of those foods from the diet resulted in relief (complete in most cases) from migraine,” report the researchers.

The most common migraine triggers in this study were milk, eggs, wheat, chocolate, oranges and tea. ”We have shown that food allergy is important in some (migraine sufferers),” conclude the authors. ”Patients were allergic to more than one food – usually three – and on elimination of these foods from the diet many patients became symptom free for the first time in several years.” (Lancet, July 5, 1980).

Ellen C. G. Grant, a neurologist at Charing Cross Hospital in London, also investigated the dietary factor in headaches in 60 migraine sufferers. The people studied has reactions to an average of ten foods each, the most common offenders being wheat, oranges, eggs, tea, coffee, chocolate, milk, beef, corn, cane sugar and yeast (much as in Dr. Brostoff’s study).

When those foods were avoided, all the patients improved, with a dramatic drop in number of headaches per-month. Dr. Grant speculates that the few patients who continued to have occasional migraines were sensitive to tobacco smoke, gas or other environmental factors (Lancet, May 5, 1979).

Yet another researchers, Edda Hanington, M.D., of the City of London Migraine Clinic, has noted that certain foods seem to have a distinct knack for triggering migraine. In addition to the foods noted by Drs. Brostoff and Grant, Dr. Hanington lists alcoholic beverages; fried, fatty food; onions; meat, especially pork; and seafood as prime offenders.

Many of those foods contain tyramines and other histaminelike substances. Some migraine researchers theorize that these substances cause the blood vessels in your head to swell, triggering a migraine (tyramines are also found in aged, fermented or pickled foods, such as strong cheese, red wine and pickled herring).

Dr. Hanington has also found that tartrazine (FD&C Yellow No. 5), a common additive in foods, beverages and medicines, can provoke migraine. So can sodium nitrite and monosodium glutamate, found in cured meats and some processed food respectively.

Despite the work of Drs. Brostoff, Grant, Hanington and others, the role of allergy in migraine remains controversial – there’s some disagreement as to whether theses reactions can be considered allergic in the strict sense. Regardless of the mechanism involved, however, food induced migraine should be handled like any other food induced reaction: by careful observation and avoidance.

To root out the cause of the migraine, Dr. Hanington recommends you note everything you’ve eaten in the 24 hours prior to each attack. Or you can start by simply eliminating the most common migraine triggers. ”Without going to any extremes, every migraine sufferer should be aware of the foods which might possibly be involved.

Is simple to have a trial period of, say, six weeks and exclude chocolate, cheese and alcohol, which are the most common precipitants, from the diet. ”Excluding citrus fruits and coffee may also be rewarding,” continues Dr. Hanington. She adds that dietary trials are particular value to people who suffer frequent, severe attacks but who have no inkling that the cause could be their daily cheese sandwich, candy bar or other customary food (Journal of Human Nutrition, vol 34, no. 3, 1980).

Surprisingly enough, going without food can trigger migraine. In the survey of 1,883 migraine sufferers mentioned earlier, fasting for longer than 5 hours during the day or longer than 13 hours overnight triggered migraine 67 percent of the same time (Headache, October, 1975).

Presumably, that’s caused by the dip in blood sugar that some people experience when they go without food (see the entry on Blood Sugar Problems (Diabetes and Hypoglycemia), for more information on diet related low blood sugar). Donald J. Dalessio, M.D., of the Scripps Clinic and Research Foundation in La Jolla, California, offers the following guidelines for migraine sufferers.

1. No alcohol, particularly red wines and champagne.
2. No aged or strong cheese, particularly cheddar cheese.
3. Avoid livers, pickled herring, canned figs, broad beans and chocolate.
4. Use monosodium glutamate sparingly (if at all, we might add).
5. Avoid cured meats such as hot dogs, bacon, ham and salami (which all contain sodium nitrite).

In addition, Dr. Dalessio warns against skipping meals or over-consumption of carbohydrates (sugar, fruit, pasta, desserts) at any single sitting, to control blood sugar related headache. You may find it helpful to know that food induced migraine tends to be dose related: some people can get away with a nibble or two of cheese, but not an entire cheese sandwich.

Or they can eat one piece or chocolate, but not a handful. Or they can drink a glass of orange juice – if they skip their coffee or tea. Coffee and tea, particularly in large amounts, seem to be especially bad for migraine sufferers. Researchers at the Royal Southern Hospital in Liverpool, Great Britain, tell of 26 year old man with a long history of migraine that did not respond to drugs.

Neurological tests were normal. Yet the pain grew so severe and frequent that he had to quit his job. Further quizzing revealed that the man drank more than 20 cups of coffee a day. He was advised to give it up. ”His headaches and other symptoms promptly (disappeared),” say the researchers. ”He has remained symptom-less for six months, and he has been able to set up business again” (Lancet, February 25, 1978).

While you may not be drowning 20 cups of coffee a day, a cup or two in the morning, combined with cola drinks later on and an occasional headache tablet (many of which contain caffeine), could add up to enough caffeine to trigger a migraine. If you can't attribute your pain to any particular food or beverage, you could be allergic to exhaust, household cleaning fumes, tobacco smoke, perfume, paint, dust and mold.

Investigating allergy to inhalants is more complicated than tracking down allergy to foods, but the guidelines in Clearing The Air, should help considerably. In addition to allergy, it also appears that migraine is more likely to strike if you are under stress, having a menstrual period or taking birth control pills.

Obviously a woman can't do anything about her menstrual cycle, but controlling other factors will help to ward off stubborn cases of migraine. Non migraine headaches may also be allergy related, in which case the approach we’ve described should work just as well.

When a group of 30 headache patients at the Charing Cross Hospital in London were placed on a food allergy elimination diet, their total number of migraine attacks dropped from 187 a month to zero – and the number of regular headaches dropped from 284 to 14 (Lancet, September 9, 1978).