Headache Medicine 2020, 11(2):51-53 ISSN 2178-7468, e-ISSN 2763-6178
51
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DOI: 10.48208/HeadacheMed.2020.15
Headache Medicine
© Copyright 2020
Original
Food avoidance among patients with headache
Stella Boreggio Machado
1
Nayara Cavalcanti Ares
2
Claudio Scorcine
3
Yara Dadalti Fragoso
4
1
Universidade Metropolitana de Santos, Nutrition, Santos, São Paulo, Brazil.
2
Universidade Metropolitana de Santos, Physical Education, Santos, São Paulo, Brazil.
3
Universidade Metropolitana de Santos, Post Graduate Studies, Santos, São Paulo, Brazil.
4
MS & Headache Research, Research, Santos, São Paulo, Brazil.
Abstract
Objective
To assess food and drink avoidance among patients with headache by means of an online
survey.
Methods
Individuals with frequent headaches were invited to answer a Google Form questionnaire
[https://form.jotformz.com/200233754863656]. The survey included sex, age and cha-
racteristics of headache. Dietary habits were assessed as the number of times the individual
consumed certain foods, on a daily, weekly, or monthly basis. The participants could state up
to three foods that they avoided for fear of headache attacks.
Results
120 complete forms were received. Alcoholic beverages were the most frequent trigger fac-
tor, reported by 26.7% of the patients. 95.5% of the participants did not consume alcohol
regularly. Cheese, caffeine and fat were also recognized as potential triggers of headaches.
There was no standard prole of dietary triggers and, therefore, everyone has to be personally
approached in this subject.
Conclusion
The online survey conrmed that individual characteristics of headache were dietary triggers in
half the participants. Alcohol was the most frequently mentioned trigger, followed by cheese,
fat and caffeine.
Yara Dadalti Fragoso
yara@bsnet.com.br
Received: April 24, 2020.
Accepted: April 27, 2020.
Edited by
Marcelo Moraes Valença
Keywords:
Diet
Headache
Carbohydrates
52
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Machado SB, Ares- NC, Scorcine C, Fragoso YD.
Food avoidance among patients with headache
Introduction
T
he association of dietary factors and primary headaches is
controversial.
1
Certain foods can trigger headache in up to 64%
of patients, but not all the attacks and not all the time.
2
The literature
on this subject is conicting since no mechanism for supporting the
existence of a food-headache association has yet been established
with adequate evidence.
3
Among the proposed mechanisms for the
onset of headache attacks through dietary triggers are the “amine
hypothesis”, “allergy vasodilation”, “dysregulation of neurotransmit-
ters involved in appetite” and “inammatory diet”.
3
Perhaps one of the best examples of the conicting evidence on
triggering foods relates to chocolate. Although eating chocolate
is widely believed to trigger migraine attacks, the risk of having
a migraine after doing this is as likely as after eating placebo.
4
Another confounding factor may be the masticatory trigger for
headache attacks: this could be misinterpreted as the food itself (for
example, chewing red meat).
5
Anxiety and anticipatory behavior
can also play a role among patients who believe a certain food
will trigger an attack.
6
The objective of the present study was to assess headache patients’
food avoidance and consumption using an online survey.
Methods
This study was approved by the Ethics Committee at Univer-This study was approved by the Ethics Committee at Univer-
sidade Metropolitana de Santos, SP, Brazil, under CAAE sidade Metropolitana de Santos, SP, Brazil, under CAAE
17241719.1.0000.5509. Individuals with headache at least once 17241719.1.0000.5509. Individuals with headache at least once
a month over the last three months were invited to answer a Google a month over the last three months were invited to answer a Google
Forms survey [https://form.jotformz. com/200233754863656].Forms survey [https://form.jotformz. com/200233754863656].
This study was approved by the Ethics Committee at Univer-
sidade Metropolitana de Santos, SP, Brazil, under CAAE
17241719.1.0000.5509. Individuals with headache at least once
a month over the last three months were invited to answer a Google
Forms survey [https://form.jotformz.com/200233754863656].
The Kolmogorov-Smirnov test assessed the sample normality, Stu-
dent’s t test was used for parametric variables and Pearson’s cor-
relation and the chi-square test were used for comparisons.
Results
A total of 120 individuals answered the survey (95 women). Their
average age was 36 years and 65.8% of them had presented head-
aches for four or more years. Migraine or probable migraine was
identied in 104 subjects. The remaining 16 patients presented the
characteristics of tension-type headache. Table 1 presents the list of
foods that the patients avoided because they believed that these foods
could induce headache attacks. Alcohol, greasy food, cheese and
caffeine were the most cited triggers of headaches. Figure 1 presents
Table 1. Number (and percentage from n=120) of participants who sponta-
neously referred specic dietary components that could trigger headaches.
Food/drink Number of patients (n) %
Triggers?
Yes 63 52.5%
Alcohol 32 26.6%
Bread 1 0.8%
Caffeine 9 7.5 %
Cheese 9 7.5 %
Chocolate 7 5.8%
Cured meats 4 3.3%
Egg 1 0.8%
Fat 15 12.5%
Nuts 3 2.5%
Red meat 2 1.6%
Salt 3 2.5%
Soda 3 2.5%
Spicy food 4 3.3%
Sweets 9 7.5 %
the frequencies of food consumption. In summary, alcoholic beverag-
es, zzy drinks, fruits, processed fruit juices, sh, prawns, soya prod-
ucts and cured meats were often avoided by these patients. Bread,
cheese, natural fruit juices, beans, eggs, read meats, chocolates and
coffee were frequently consumed by these patients. Only 13 patients
(10.8%) reported ve or more dietary triggers for their headaches
that they never consumed.
There were no differences in food preference and/or avoidance
regarding sex, age, frequency or type of headache. Caffeine and
cheese, which were spontaneously cited as headache triggers by
10% of the patients, were among the ve items most consumed by
them. Cheese was consumed by 73% of the patients while black
coffee was consumed by 77% of them. Canned sh and prawns
were consumed by less than 10% of the patients, although none of
them regarded these items as potential triggers.
Discussion
The association between headaches (particularly migraine) and
dietary components is complex and often misunderstood. Physicians
frequently tell patients to avoid a list of standard foods and drinks that
are not triggers for all headache sufferers. In addition, it is important
to acknowledge that, beyond diet, other lifestyle changes may have
a role in the therapeutic success of these patients.
7
Rather than im-
plementing a standard list of foods and drinks that are “forbidden”,
identication of dietary triggers for each patient is ideal. This can be
done with the help of food diaries, which are an inexpensive way to
understand which foods and drinks may trigger headache attacks in
that individual.
8
It was interesting to observe that half the patients considered that at
least one dietary component was a headache trigger. While alcohol
53
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Machado SB, Ares- NC, Scorcine C, Fragoso YD.
Food avoidance among patients with headache
was believed to trigger headache attacks by over a quarter of our
patients, other dietary factors were remarkably different among the
patients. For example, some participants could not tolerate cheese,
while other ate it regularly without problems. This reinforces the idea
that, like the pharmacological approach to headaches, a tailor-made
dietary recommendation for each patient is necessary. While patients
may give us details of their food avoidance, the biological mechanism
through which dietary triggers precipitate headache attacks remains
obscure.
9
Our study had limitations. It used a small sample of individuals who
answering an online survey. The diagnosing their headache was not
ideal, and the sample comprised a mixture of cases of migraine, prob-
able migraine, and tension-type headache. However, the aim of this
study was not to study any specic primary headache. There were no
evaluations for micronutrients or the percentage of proteins, car-
bohydrates, and fat in the patients’ diet. All of these factors will be
addressed in future studies in our group.
Concl usion
The online survey used in this study conrmed the individual charac-
teristics of headache dietary triggers. Alcohol, the most frequently
reported trigger, affected 26% of the participants. Overall, half the
patients had at least one food or drink that was associated with
headaches.
Acknowledgement:
SB Machado received a Scientic Initiation
Grant from the Brazilian National Council for Scientic and
Technological Development (CNPq) for which the authors are
grateful.
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Figure 1. Percentage of individuals with headache (n=120) who avoided consuming each of these foods or drinks. Note that avoidance of dietary factors
is higher than that spontaneously cited by patients.
