Migraines

Summary
Big meals, especially if they are very sugary or starchy, can trigger a migraine. Skipping meals and not drinking enough can also bring on an attack. So you need to eat regular, healthy, moderate-sized meals and remember to drink frequently, even if you don’t always feel thirsty.

The NHS Eatwell Guide shows that to have a healthy, balanced diet, people should try to:

• eat at least 5 portions of a variety of fruit and vegetables every day (see 5 A Day)
• base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• have some dairy or dairy alternatives (such as soya drinks)
• eat some beans, pulses, fish, eggs, meat and other protein
• choose unsaturated oils and spreads, and eat them in small amounts
• drink plenty of fluids (at least 6 to 8 glasses a day)

If you’re having foods and drinks that are high in fat, salt and sugar, have these less often and in small amounts.

Try to choose a variety of different foods from the 5 main food groups to get a wide range of nutrients.

Summary
There is no special ‘anti-migraine diet’. But avoiding certain foods does help some people prevent attacks. Various surveys have found that the most commonly reported food triggers are cheese, chocolate, alcohol, bananas and citrus fruit.

According to the USA’s National Institute of Neurological Disorders and Strokes, 50% of migraine headaches are triggered by foods or food additives. These triggers include aspartame, caffeine (and caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, monosodium glutamate, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats.

Keeping a diet diary may help you spot your own food triggers. You should list everything you eat every day, the time you ate it and whether you get a migraine within 12 to 24 hours. If you think you have found any trigger foods, avoiding them could reduce the frequency of your migraine attacks

Evidence
There is no single diet that will help. Research into special diets suggests that avoiding particular kinds of foods is not useful for everyone who gets migraine. This is probably because the ‘trigger foods’ vary so much from one person to the next.

Safety
It can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it is a good idea to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.

Cost
Eating a healthy diet and excluding some foods need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP’s practice.

Summary
If you are a big coffee drinker suddenly stopping it can cause a rebound headache for a few days. Caffeine seems to be one of the most common triggers for a migraine. Oddly, some people find their acute migraines are helped by taking caffeine.

Note: A very small amount of caffeine is sometimes included in pain medications such as Panadol Extra and Anadin Extra. The aim of this is to make the painkiller slightly more effective. But if you are taking a lot of them, the caffeine could trigger a migraine.

Evidence
Research has shown that drinking a lot of coffee may make any headache more likely. Reducing caffeine and improving sleep may make migraine less likely.

Safety
Suddenly cutting out caffeine can cause a withdrawal headache for a few days. It is better to reduce it gradually over a few days

Cost
There are no costs. In fact you will save money.

Summary
A few people find that physical exertion triggers a migraine attack. But if you can exercise without it causing a headache, then being more active will do more than just keep you fit. It makes your heart and lungs work better, tones your muscles, and strengthens your bones and joints. It also stimulates blood circulation to your brain and internal organs, boosts your immune system, helps protect against osteoporosis, and triggers brain chemicals that lift your mood and can generate a real sense of well-being. It can also be a very good way of meeting people, and it definitely makes a difference to all sorts of health problems.

Exercise can include aerobics such as cycling, stepping and walking, strengthening exercises such as lifting weights or using resistance machines, and stretching for flexibility.

Evidence
Exercising while you have a migraine may make it worse, although regular exercise might prevent migraines. It is difficult to work out whether exercise generally helps with headaches, as most of the research has looked at exercise along with other things such as relaxation.

Safety
If you are really unfit, start off with walking every day, gradually going further and a bit faster each week. Once you are used to being more active, you can get advice on the best exercises to do from a trainer at your local leisure centre. Supervised exercise programmes are safe for most people. But at first you might feel more tired. If you’re not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. If you feel worse, cut back and build up more slowly. If you think it isn’t helping or that you’re getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and get advice from a healthcare professional.

Cost
You can exercise at home for nothing, remember walking and gardening are both forms of exercise. There will probably be a small cost, if you join an organised programme.

Further information
Natural England is one of several organisations that organise walking schemes designed to help people improve their health. Walk4Life Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.

Summary
Meditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a ‘relaxation response’. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don’t need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.

Evidence
Mindfulness (a particular form of meditation) may improve your health generally and help you to cope with pain. Not enough studies have looked at whether meditation helps with migraine headaches but research is underway.

Safety
There are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.

Cost
Meditation involves certain (simple) techniques that can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially.

Summary
Relaxation techniques such as progressive muscular relaxation (PMR) can be learned from a book, tape or during exercise classes such as yoga classes, and then be easily practised at home.

Evidence
Relaxing after stress seems to help prevent migraine. Relaxation therapy combined with exercise also seems to be helpful. It is not clear whether just using progressive muscular relaxation on its own helps with migraines.

Safety
Relaxation techniques are easily practised at home.

Cost
Once you have learned the relaxation techniques, there are no costs. There are many books and audio aids available and some people find it useful to join a class initially.