It can feel like your skull is shattering — the pain so intense, you become nauseous. A migraine is more than a severe headache. It’s a common neurological condition with a variety of symptoms that can last for different amounts of time, depending on the individual. One-third of people who get migraines experience “visual disturbances” before the migraine strikes.
Migraines also “account for more years lived in disability worldwide than any neurological disease,” Elizabeth Seng tells me. Seng is an assistant professor at Yeshiva University and a research assistant professor at Albert Einstein College of Medicine in New York. She studies the psychosocial factors associated with migraines and works to develop behavioral treatments for the condition.
“People with migraine are extremely resilient in the face of a misunderstood, disabling disease,” Seng says.
Mental health and migraines — Many people hide their migraines from their employers and families because they’ve been told it’s “just a headache,” Seng explains. One of the reasons for this enduring stigma is that migraines are more common in women and “women’s pain is more frequently dismissed than men’s pain,” she says. In fact, migraines are three times more common in females than males.
Another contributor to the stigma is the fact that because migraine frequency can vary with life stress, this sometimes leads to a harmful assumption that people who experience migraines can’t cope with life stressors.
Subsequently, there’s a complicated and concrete relationship between migraines and mental health. For example, some studies suggest a bidirectional relationship between migraines and depression, with both conditions increasing the risk of the other. Migraines can also co-occur with generalized anxiety disorder, panic disorder, and bipolar disorder. Scientists say this co-occurrence may have multiple causes depending on the person, including environmental and genetic risk factors.
Jessica Ailani, a clinical professor of neurology at MedStar's Georgetown University Hospital and director of the MedStar Georgetown Headache Center in Washington D.C., describes people who experience migraines as a “community that feels both unheard and unseen.”
She explains that while our understanding of migraines is progressing, “we still have a long way to go.”
“It is what makes the field exciting to scientists, but frustrating if you are someone who has migraines,” Ailani tells me.
While there’s no cure for migraines, there are various treatments to alleviate the symptoms. These include pain-relieving and preventive medications, for example. But clinicians are interested in other treatments that don’t depend on a pill — some of which, at this point, are better validated than others.
This article focuses on one of those interventions: Diet.
What to eat when you have migraines
When it comes to reducing migraines, Seng says cutting down on alcohol and caffeine use is “a good start,” as well as avoiding large variations in how much of each you take in — for example, avoiding a night of binge drinking or a day when you drink five cups of coffee rather than your usual one cup.
Some migraine mitigation diet plans also recommend limiting how often you eat cheese, chocolate, processed meats, citrus fruits, and certain dairy products. But overall, the number of high-quality studies on diet-related triggers is limited.
A 2021 study published in the journal BMJ also suggests it might be wise for people who suffer from migraines to increase their consumption of omega-3 fatty acids. These polyunsaturated fats are necessary for human health and can only enter our systems via what we eat. Omega-3 fatty acids are found in foods like flaxseed and fish, and in supplements like fish oil.
Christopher Ramsden is the first author of this study and a clinical investigator at the National Institutes of Health. Around 2007, during his medical residency, he became struck by the number of people who continued to experience migraine pain despite taking multiple medications.
“I wondered if the foods that we eat could impact chronic pain by altering our biochemistry,” he tells me.
This line of inquiry led to a number of studies, including in animals and in a small clinical trial involving people with severe chronic headaches. The 2021 BMJ study “provides the first solid evidence that diet alterations could help manage migraine headaches,” Ramsden says.
Ramsden and colleagues assigned migraine-suffering study participants to one of three diet plans to be followed over 16 weeks. Previous research suggests modern diets are low in omega-3 fatty acids and high in omega-6 fatty acids — fats found typically in vegetable oils. These fatty acids are precursors for several families of bioactive lipid mediators which regulate physical pain in preclinical models, explains Ramsden. The mediators derived from omega-6 fatty acids can worsen pain, while the mediators derived from omega-3 fatty acids can lessen pain.
“It is likely that the pain relief is due to alterations in one or more families of these pain mediators,” he explains. “However, the specific mediators and molecular mechanisms are not yet known.”
Subsequently, the three groups received meal kits that would give them either:
- Typical levels of omega-3 and omega-6 acids
- High levels of omega-3 and high levels of omega-6
- High levels of omega-3 and low levels of omega-6
Ultimately, the diet low in omega-6 fatty acids (vegetable oil) and high in omega-3 fatty acids (fatty fish) resulted in 30 to 40 percent reductions in total headache hours per day. They also experienced fewer severe headaches and fewer headaches overall per month. Blood samples also revealed this group had lower levels of pain-related lipids.
Foods that contain omega-3s include:
- Fish and other seafood, including salmon, mackerel, tuna, herring, and sardines
- Nuts and seeds, including flaxseed, chia seeds, and walnuts
- Fortified eggs, yogurt, milk, and soy beverages
Omega-3 supplements include cod liver oil, fish oil, algal oil, and krill oil.
What comes next — Exactly why these results emerged needs to be studied further, as well as why the participants reported fewer headaches but not a change in their quality of life (this may have to do with how “quality of life” was measured in the study, explains Ramsden).
“Because diets can alter the amounts of omega-3 and omega-6 fatty acids in the nervous system, immune system, and other tissues implicated in chronic pain, the biochemical hypotheses that underpin these studies could potentially be relevant for other types of chronic pain,” Ramsden says.
His team is currently testing a similar, controlled diet intervention in people with chronic headaches following traumatic brain injury in collaboration with Kimbra Kenney, while a team at UNC-Chapel Hill is testing similar diet interventions in other chronic pain conditions.
“The long-term goal of these trials is to improve the lives of patients with chronic pain by allowing them to integrate targeted dietary changes alongside medications,” Ramsden says.