Associations between lifestyle intervention-related changes in dietary targets and migraine headaches among women in the Women's Health and Migraine (WHAM) randomized controlled trial

Associations between diet quality and migraine headaches: a cross-sectional study

AIMS

We evaluated associations between diet quality and migraine outcomes.

METHODS

The current work represented a cross-sectional study on 262 patients with migraine (20-50 y). Diet quality was assessed using the standard healthy eating index 2015 (HEI-2015) and alternative healthy eating index 2010 (AHEI-2010). A validated 168-item food frequency questionnaire was used to assess dietary intake. Migraine outcomes included clinical factors (severity, duration, frequency, and disability related to migraine) and serum nitric oxide (NO). Associations between diet quality indices and migraine outcomes were evaluated using linear regressions, and β and 95% corresponding confidence interval (CI) were reported.

RESULTS

HEI-2015 was inversely associated with migraine frequency (β = -4.75, 95% CI: -6.73, -2.76) in patients with the highest HEI scores (third tertile) vs. those with the lowest scores (first tertile) after adjusting for relevant confounders. AHEI-2010 was inversely associated with migraine frequency (β = -3.67, 95% CI: -5.65, -1.69) and migraine-related disability (β = -2.74, 95% CI: -4.79, -0.68) in adjusted models. Also, AHEI-2010 was inversely associated with migraine severity in patients in the second vs. first tertile (β = -0.56; 95% CI: -1.08, -0.05). We detected no associations between diet quality and NO levels (All P > 0.14).

CONCLUSIONS

Improved diet quality may be associated with favorable migraine outcomes (lower headache frequency, severity, and migraine-related disability). Future studies are required to confirm and delineate the causal mechanisms of our observations.

Interrelationships of Sleep Quality, Obesity Severity, and Clinical Headache Features among Women with Comorbid Migraine and Obesity

Obesity and migraine are often comorbid. Poor sleep quality is also common among individuals with migraine and may be influenced by comorbidities such as obesity. However, understanding of migraine's relationship with sleep and the potential exacerbating effect of obesity remains limited. This study evaluated the associations of migraine characteristics and clinical features with sleep quality among women with comorbid migraine and overweight/obesity and assessed the interplay between obesity severity and migraine characteristics/clinical features in relation to sleep quality. Women seeking treatment for migraine and obesity (n = 127; NCT01197196) completed a validated questionnaire assessing sleep quality (Pittsburgh Sleep Quality Index-PSQI). Migraine headache characteristics and clinical features were assessed using smartphone-based daily diaries. Weight was measured in-clinic, and several potential confounders were assessed using rigorous methods. Nearly 70% of participants endorsed poor sleep quality. Greater monthly migraine days and the presence of phonophobia related to poorer sleep quality, and specifically poorer sleep efficiency, controlling for confounders. Obesity severity was neither independently associated nor interacted with migraine characteristics/features to predict sleep quality. Poor sleep quality is common among women with comorbid migraine and overweight/obesity, although obesity severity does not appear to uniquely relate to or exacerbate the association between migraine and sleep in this population. Results can guide research on mechanisms of the migraine-sleep link and inform clinical care.

Healthy Eating Index Diet Quality in Randomized Weight Loss Trials: A Systematic Review

BACKGROUND

Weight loss interventions focus on dietary and physical activity changes to induce weight loss. Both through weight loss and independent of it, diet quality is important for reducing chronic disease risk. However, whether and how diet quality changes over the course of a behavioral intervention is unclear.

OBJECTIVE

To systematically review the evidence from randomized controlled trials on the effect of behavioral interventions on diet quality as defined by the Healthy Eating Index (HEI) among adults with overweight and obesity.

METHODS

PubMed, Ebscohost CINAHL, Embase, OVID APA PsycInfo, Scopus, and Web of Science were searched through May 2021. Inclusion criteria comprised randomized controlled trial design, a primary or secondary aim of weight loss, a sample of US adults with overweight or obesity, measurement using the HEI-2005, 2010, or 2015, and assessment of the time by treatment effect. Interventions must have included behavioral components and lasted at least 3 months. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The systematic review protocol was published on Open Science Framework.

RESULTS

Of 3,707 citations retrieved, 18 studies met inclusion criteria. A wide array of behavioral interventions were assessed, including in-person and mobile health interventions as well as those prescribing intake of specific foods. Risk of bias in the included studies primarily arose from the measurement of the outcome variable. Sample sizes ranged from 34 to 413 participants. Nine studies used multiple dietary recalls, with few using the recommended method of Healthy Eating Index calculation. Changes in diet quality ranged from no improvement to a 20-point improvement. More often, improvement was in the 4- to 7-point range.

CONCLUSIONS

The evidence for the efficacy of behavioral weight loss interventions for improving diet quality among adults with overweight and obesity is limited. Modest improvements in HEI scores were observed in the reviewed studies.

Triggering and relieving factors of migraine among university students: A cross-sectional study in Lebanon

Introduction Migraine is common among university students and can directly affect their daily activities and learning since students with migraine have difficulties attending classes and missed more school days than other students. Objectives This study aimed to identify triggering factors of migraine along with factors that relieve headaches associated with migraine episodes among university students. Methods An observational cross-sectional study targeted students from different faculties of the public university campus in Lebanon using a survey for data collection. Results Feeling hungry (65.9%), fasting (50.7%), and coffee deprivation (22.7%) were the most commonly reported dietary factors inducing headaches among university students. In comparison, climate changes (77.1%), noise and high volumes (73.9%), and hot weather (60.2%) were the most common environmental triggers. Among the psychological factors, anxiety (53.4%) and crying (47.3%) were highly reported and were significantly higher among women. Fatigue (63.2%), studying for exams (59.5%), and neck pain (46.8%) were the most common physical activity-reported factors. Lack of sleep (72%) and changes in sleeping hours (42.7%) were the primarily reported sleeping habits that can trigger headaches, with no statistically significant differences between men and women.  Sleeping (66.3%), relaxing (53.4%), avoiding migraine’s trigger factors (42.9%), and having a warm bath (38.5%) were the most reported relieving factors of headache among students. No statistically significant association was noted between any of the factors and the sex of the participants. Conclusion The triggering and relieving factors of migraine were comparable between men and women. Some triggering factors such as crying, anxiety, and fatigue were found significant among women, while driving was a higher migraine trigger among men. Lifestyle interventions may provide clues on effective relieving strategies and yield the establishment of different medical services and university programs.

Lifestyle factors and migraine

Migraine, a common and disabling neurological disorder, is among the top reasons for outpatient visits to general neurologists. In addition to pharmacotherapy, lifestyle interventions are a mainstay of treatment. High-quality daily diary studies and intervention studies indicate intraindividual variations in the associations between lifestyle factors (such as stress, sleep, diet, and physical activity) and migraine attack occurrence. Behaviour change interventions can directly address overlapping lifestyle factors; combination approaches could capitalise on multiple mechanisms. These findings provide useful directions for integration of lifestyle management into routine clinical care and for future research.

Migraine and Diet: Updates in Understanding

PURPOSE OF REVIEW

We explore recent developments in the prevention and treatment of migraine through dietary interventions.

RECENT FINDINGS

Healthier diets (defined in multiple ways), meal regularity, and weight loss are associated with decreased headache burden. Specific diets including the ketogenic diet, the low-glycemic index diet, and the DASH diet are supported by modest evidence for the prevention of migraine. Neither a gluten-free diet, in patients without celiac disease, nor elimination diets have sufficient evidence for their routine consideration. Diet remains a crucial, but underexplored, component of comprehensive migraine management. Multiple interventions exist for providers and patients to consider integrating into their treatment plan. Larger studies are needed to support stronger recommendations for utilization of specific dietary interventions for the prevention and treatment of migraine.

Migraine and Diet

Migraine is characterized by recurrent attacks of disabling headaches, often accompanied by sensory and motor disturbances. Clinical manifestations of migraine are influenced by dietary behaviors and dietary elements. Several dietary triggers for migraine have been identified, leading to the definition of strategies such as elimination diets, ketogenic diets, and comprehensive diets, mainly to help prevent migraine. Although inconsistency is present in the literature and no consensus exists, the available data are promising in supporting beneficial dietary interventions for some migraine patients. Several factors influence the net outcome, including age, sex, genetics, and environmental factors. Advancement in understanding the underlying mechanisms of migraine pathogenesis and how dietary factors can interfere with those mechanisms has encouraged investigators to consider diet as a disease-modifying agent, which may also interfere with the gut–brain axis or the epigenetics of migraine. Future work holds potential for phenotyping migraine patients and offering personalized recommendations in line with biopsychosocial models for the management of migraine. Diet, as an important element of lifestyle, is a modifiable aspect that needs further attention. Well-designed, systematic, and mechanism-driven dietary research is needed to provide evidence-based dietary recommendations specific to migraine. This narrative review aims to present the current status and future perspective on diet and migraine, in order to stimulate further research and awareness.