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How supplements and watching what you eat could help ward off migraines

Can food choices really help to ease attacks? Dietician Orla Walsh looks at the evidence

Migraine is the third most common disease in the world, with an estimated global prevalence of 14.7% - and it's the most prevalent neurological condition worldwide.

Research suggests that 3,000 migraine attacks occur every day for each million of the general population, the equivalent of more than 190,000 attacks every day in the UK.

The impact of migraines on a person's quality of life can be quite profound. In fact, the World Health Organisation classifies migraine as the seventh most disabling disease worldwide.

For those that suffer from the neurological condition, this won't come as a shock.

What is migraine?

Migraine often begins during puberty. However, research suggests that migraines more often affect those aged between 35 and 45 years.

Twice as many women suffer from migraine than men, which is often blamed on hormones. Sadly, migraines are recurrent and often chronic.

Attacks typically include a headache that may be one-sided and pulsating. For some, they last for a couple of days. Often people feel nauseous when a migraine hits and need to take to bed, in a cool dark room, in a bid to sleep it off.

One person's experience is very different to the next person's. Some people experience an attack a few times each year while others suffer them on a weekly basis.

Fortunately, diet can play a role in reducing the severity and intensity of migraine attacks.

Riboflavin, aka vitamin B2

Riboflavin is a water-soluble B vitamin, which means as it isn't stored in the body, you need to eat it daily. Riboflavin helps the body cells use fat, protein and carbohydrates, and helps produce other B vitamins such as vitamin B3 and vitamin B6.

With regard to migraines, the evidence for riboflavin is convincing. Consistent results from good-quality research called randomised controlled trials (RCTs) and several lower-quality pieces of research suggest a supplement containing 400 mg of riboflavin can reduce the frequency of migraine.

Food sources include milk, liver, cuttlefish and yeast extract.

Magnesium

Magnesium is a mineral that helps you take energy from food and make new proteins. It's also important for bones, muscles and nerves.

Results from reviews suggest that an oral magnesium supplementation may help prevent migraines. Studies have shown that 600mg of trimagnesium dicitrate or 3mg of magnesium oxide each day for every kilogram that a person weighs helped to prevent migraines.

This doesn't often result in side-effects, but if it does, it's more commonly gut upset such as diarrhoea.

Food sources of magnesium include pumpkin seeds, green leafy vegetables such as spinach, black-eyed peas, sunflower seeds and soya beans.

Coenzyme Q10

Coenzyme Q10 is a substance that is naturally present in the body. It is sold as a supplement, as CoQ10 has important functions in the body and because people with some diseases have reduced levels of it.

A small RCT and a lower-quality trial found that supplementation with 300mg of CoQ10 each day decreased the frequency of migraine attacks.

More research is needed. No serious side-effects of CoQ10 have been reported, but it may affect digestion and sleep. It may also interact with certain medications, such as warfarin and insulin. Food sources of CoQ10 include meat, fish and nuts.

Menstrual migraines

For some women, migraines increase around the time of their period. A small RCT and another pilot study suggest that a supplement of phytoestrogen may decrease the frequency of migraines.

Food sources include soy milk, soya yoghurt, tofu, edamame beans and tempeh.

A different, small RCT showed that a supplement containing 400 IU of vitamin E taken daily around the time of menstruation significantly reduced migraine pain severity and duration, light and sound sensitivity and nausea.

Food sources of vitamin E include eggs, spinach, almonds and sunflower seeds.

Feverfew

Feverfew grows naturally throughout Europe. Historically, people have used feverfew for headaches.

The dried leaves, and sometimes the flowers and stems of the plant, are made into capsules, teas, tablets and liquid extracts.

Multiple RCTs have concluded that feverfew is not associated with significant adverse effects, and is safe for use in most populations.

If a side-effect is experienced, the most common is gut upset.

A systematic review of RCTs, which is considered to be the gold standard of evidence, showed that daily doses of feverfew (Tanacetum parthenium L.) were mildly effective in preventing migraines.

They were shown to decrease migraines by 0.6 each month.

Butterbur

Butterbur is a shrub that grows in Europe, typically in wet, marshy ground. Although traditionally used for a multitude of reasons, it's only in more recent years that it has been used for headaches. 'Raw' or unprocessed butterbur products should be avoided, because they may contain harmful substances.

Small studies suggest that Butterbur (Petasites hybridus), in the form of Petadolex®, is well tolerated. Two RCTs suggest that 75mg of Petadolex® is effective at reducing migraine frequency.

Triggers

Everyone's different. It's possible that something may be a trigger for one person and not a trigger for most other people. There are a number of triggers that keep cropping up in conversations with those who have migraines and have been brought to light in research. For example:

1. Aspartame was reported by 8 to 9% of participants in a small RCT and two case-reports;

2. A sudden reduction in caffeine was reported by 22% of participants in a retrospective cohort study;

3. Fasting or long gaps between meals was reported by 40 to 82% of people in an RCT, prospective cohort study and a case-control study.

There are a lot of myths out there, and for this reason certain some foods are associated with migraines despite a lack of evidence.

For example, experimental studies have failed to report an association with tyramine, chocolate, dairy, vegetables, eggs and monosodium glutamate (MSG).

There are some triggers that research both supports and refutes. More research is needed before stronger evidence can be created.

One of the best things a migraine sufferer can do is to keep a diary of attacks. They may be able to find triggers that are unique to them. Trying to find a solution or trigger that fits everyone is unrealistic.

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