The relation of adherence to the DASH diet with migraine attack frequency and pain intensity in Iranian women: a cross-sectional study

The Evidence for Diet as a Treatment in Migraine-A Review

Background/objectives: The connection between diet and migraine has gained increasing attention in migraine research due to its potential relevance as part of migraine treatment. This study reviewed the current evidence on the use of diets or specific foods in the prevention of migraine. Methods: A PubMed search was performed with the keywords "diet and migraine" OR "brain-gut-axis and migraine". One author (KVN) screened titles, abstracts, and full-text articles and excluded or included them based on eligibility criteria. Results: A ketogenic diet and a "Dietary Approaches to Stop Hypertension" diet reduced attack duration (p < 0.002), frequency (p < 0.05), and severity (p < 0.01). The ketogenic diet also reduced monthly medication intake (p ≤ 0.05). A low-fat vegan diet mixed with an elimination diet reduced the attack duration (p < 0.01), frequency (p < 0.05), severity (p < 0.0001), and percentage of medicated headaches (p < 0.001). Elimination diet reduced attack duration (p < 0.05), frequency (p < 0.02), severity (p < 0.01), and medication intake (p < 0.002). Elimination diet with IgG-positive foods reduced attack frequency (p < 0.001), and total medication intake (p < 0.01). Gluten-free diet reduced frequency (p = 0.02) and severity (p = 0.013). Conclusions: Certain diets and food items may trigger attacks in some migraine patients, though the overall evidence supporting this is limited. Modifying a diet may reduce symptoms such as attack duration, frequency, severity, and medication intake. However, the included studies' small populations and diverse study designs make the results difficult to apply in clinical practise. Further high-quality, double-blinded, randomised controlled trials are necessary to confirm the association between diet and migraine.

Association of dietary and lifestyle inflammation score (DLIS) with chronic migraine in women: a cross-sectional study

Due to more frequent and intense attacks, chronic migraine (CM) sufferers usually report more disability compared to patients with episodic migraine (EM). There is increasing evidence that points to inflammatory diet and lifestyle as a probable underlying cause of migraine. The present study investigated the association of dietary and lifestyle inflammation scores (DLIS) with the odds of CM in Iranian women. In the current study, 285 women with migraine enrolled. Migraine was diagnosed by a single neurologist based on the third edition of the International Classification of Headache Disorders (ICHD-III). The women were categorized into CM and EM groups based on their attack frequency per month. Adherence to the dietary inflammation score (DIS), Lifestyle Inflammatory Score (LIS), and DLIS (DIS + LIS) was assessed based on last year's dietary intakes collected using a semi-quantitative food frequency questionnaire (FFQ). The Odds Ratio (OR) for CM across the DIS, LIS, and DLIS tertiles were assessed through logistic regression. Most of the participants were overweight or obese (74.4%). The percentage of women with CM was 40.7%. Women with CM had significantly higher DIS (P = 0.002) and DLIS (P = 0.04) than women with EM. There was a significant positive association between CM and DIS. Those in the third tertile of the DIS had almost two times higher chance of experiencing chronic migraine compared with those in the first tertile [OR = 2.02; 95% CI 1.06-3.82; P = 0.03]. the P-value for the trend also was significant (0.03). In terms of LIS and DLIS tertiles, no significant association was observed. Adherence to the more inflammatory diets was associated with higher chances of experiencing CM in women.

The predictive role of the dietary phytochemical index in relation to the clinical and psychological traits of migraine headaches

We investigated the relationship between dietary phytochemical index (DPI) and migraine headaches in Iranian patients, analyzing both clinical and psychological traits. A cross-sectional study was conducted using non-obese adults aged 20-50 years who were diagnosed with migraine. The study used a validated 168-item food frequency questionnaire to assess the usual dietary intake of participants. The DPI was calculated using the following formula: [daily energy derived from phytochemical-rich foods (in kJ)/total daily energy intake (in kJ)] × 100. Clinical outcomes of migraine including frequency, duration, and severity of headaches, as well as migraine-related disability were obtained using relevant questionnaires. Moreover, the mental health profile of patients including depression, anxiety, and stress, as well as serum levels of nitric oxide (NO) were measured. A Poisson regression was used for headache frequency. Linear regression analyzed migraine-related outcomes including duration, severity, migraine-related disability, and serum NO levels. In addition, psychological traits were analyzed via logistic regression. A total of 262 individuals (85.5% females) with a mean age of 36.1 years were included in the analysis. The frequency of migraine attacks was lower in patients in the last DPI tertile compared to those in the first DPI tertile both in the crude [incidence rate ratio (IRR) = 0.70, 95% confidence interval (CI) 0.63, 0.78, Ptrend < 0.001] and fully-adjusted models (IRR = 0.84, 95% CI 0.74, 0.96, Ptrend = 0.009). After controlling for potential confounders, an inverse relationship was observed between higher adherence to DPI and migraine-related disability (β = - 2.48, 95% CI - 4.86, - 0.10, P trend = 0.046). After controlling for potential confounders, no significant relationship was observed between DPI and depression (OR = 0.79, 95% CI 0.42, 1.47, Ptrend = 0.480), anxiety (OR = 1.14, 95% CI 0.61, 2.14, Ptrend = 0.655), and stress (OR = 1.04, 95% CI 0.57, 1.90, Ptrend = 0.876). Higher intakes of phytochemical-rich foods may be associated with lower migraine frequency and improved daily activities among patients. Further studies should confirm our observations and delineate the biological pathways linking phytochemicals and migraine headaches.

Associations of combined lifestyle index with migraine prevalence and headache frequency: a cross-sectional study from the MECH-HK study

BACKGROUND

Prior research has shown that individual lifestyles were associated with migraine. Yet, few studies focused on combined lifestyles, particularly in Chinese populations. This cross-sectional study aimed to investigate the relationships of a combined lifestyle index with migraine in Hong Kong Chinese women.

METHODS

Baseline data from a cohort study named Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK) were used for analysis. In total 3510 women aged 55.2 ± 9.1 years were included. The combined lifestyle index comprised eight lifestyle factors: smoking, physical activity, sleep, stress, fatigue, diet, body mass index, and alcohol. Each component was attributed a point of 0 (unhealthy) or 1 (healthy). The overall index was the sum of these points, ranging from 0 (the least healthy) to 8 points (the healthiest). Migraine was diagnosed by the International Classification of Headache Disorders 3rd edition. Additionally, for women with migraine, the data on migraine attack frequency (attacks/month) was collected.

RESULTS

A total of 357 women with migraine (10.2%) were identified. The prevalence of migraine for the 0-3-point, 4-point, 5-point, 6-point, and 7-8-point groups were 18.0% (162/899), 10.9% (86/788), 6.6% (51/776), 6.0% (38/636), and 4.9% (20/411), respectively. In the most-adjusted model, compared to the 0-3-point group, the odds ratios and 95% confidence intervals for the 4-point, 5-point, 6-point, and 7-8-point groups were 0.57 (0.43-0.75), 0.33 (0.24-0.46), 0.30 (0.21-0.44), and 0.25 (0.15-0.41), respectively (all p < 0.001). For each component, migraine was significantly associated with sleep, stress, fatigue, and diet; but was unrelated to smoking, physical activity, body mass index, and alcohol. Among women with migraine, per point increase in the combined lifestyle index was associated with a reduced migraine attack frequency (β = - 0.55; 95% confidence interval = - 0.82, - 0.28; p < 0.001).

CONCLUSIONS

A combined lifestyle index was inversely associated with migraine and migraine attack frequency in Hong Kong Chinese women. Adhering to a healthy lifestyle pattern might be beneficial to the prevention of migraine attacks. Conversely, it is also plausible that women with migraine might have a less healthy lifestyle pattern compared to those without headaches.

CGRP Antagonism and Ketogenic Diet in the Treatment of Migraine

The study of migraine is based on the complexity of the pathology, both at the pathophysiological and epidemiological levels. Although it affects more than a billion people worldwide, it is often underestimated and underreported by patients. Migraine must not be confused with a simple headache; it is a serious and disabling disease that causes considerable limitations in the daily life of afflicted people, including social, work, and emotional effects. Therefore, it causes a daily state of suffering and discomfort. It is important to point out that this pathology not only has a decisive impact on the quality of life of those who suffer from it but also on their families and, more generally, on society as a whole. The clinical picture of migraine is complex, with debilitating unilateral or bilateral head pain, and is often associated with characteristic symptoms such as nausea, vomiting, photophobia, and phonophobia. Hormonal, environmental, psychological, dietary, or other factors can trigger it. The present review focuses on the analysis of the physiopathological and pharmacological aspects of migraine, up to the correct dietary approach, with specific nutritional interventions aimed at modulating the symptoms. Based on the symptoms that the patient experiences, targeted and specific therapy is chosen to reduce the frequency and severity of migraine attacks. Specifically, the role of calcitonin gene-related peptide (CGRP) in the pathogenesis of migraine is analyzed, along with the drugs that effectively target the corresponding receptor. Particularly, CGRP receptor antagonists (gepants) are very effective drugs in the treatment of migraine, given their high diffusion in the brain. Moreover, following a ketogenic diet for only one or two months has been demonstrated to reduce migraine attacks. In this review, we highlight the diverse facets of migraine, from its physiopathological and pharmacological aspects to prevention and therapy.