- Monosodium glutamate (MSG) is a flavour enhancer widely used in fast foods. It is also used in meat tenderiser as well as many canned, prepared and packaged foods under the guise of various descriptions including ‘hydrolysed vegetable protein’, ‘yeast extract’ and ‘hydrolysed oat flour’. MSG may trigger headaches through direct vasoconstrictor effect at high doses.
Identifying the causal agent in adverse reactions to food, alcohol and drugs can be a difficult challenge. It is therefore essential to keep a food diary, as removal of foods to which the patient is allergic/intolerant can greatly reduce symptoms. The importance of eating regularly also cannot be overemphasised, as skipping meals can trigger headaches. This is not only to do with hypoglycaemia but also fluctuating levels of stress hormones.
Some supplements may be able to decrease the severity of symptoms and reduce the frequency of headaches, depending on the type of headache.
Magnesium may be beneficial because it counteracts vasospasm and inhibits platelet aggregation, both involved in the pathogenesis of vascular-type headaches. Its concentration also influences serotonin receptors, nitric oxide synthesis and release, inflammatory mediators and various other migraine-related receptors and neurotransmitters.3
Vitamin B2 (riboflavin)
Vitamin B2 is involved in the Krebs cycle, an intrinsic part of energy production. In migraines specifically, trials using vitamin B2 over a period of three months resulted in a 50% reduction in attacks.4 However, side-effects such as diarrhoea and polyuria (passing large volumes of urine) may result.
Co-enzyme Q10 (CoQ10)
CoQ10 is an endogenous enzyme cofactor made by all cells in the body. Supplementation with CoQ10 has been found to be effective in treating migraine within one month. It may work particularly well in the treatment of paediatric migraine.
Eicosapentaenoic acid (EPA)
EPA is one of the body’s natural omega-3 fatty acids. Some small studies have shown that it may be useful in reducing headache severity and frequency, possibly by lowering prostaglandin levels (thereby modulating inflammation) and normalising serotonin activity.
HEADACHES IN PREGNANCY AND LACTATION
Although migraines usually improve during pregnancy, some women find that their headaches worsen or remain the same. An increase in headaches during the first trimester, caused by fluctuating oestrogen levels, is not uncommon. However, acute and preventive migraine medications can have teratogenic effects, which means they may interfere with normal embryonic development. These include some herbal remedies such as feverfew and butterbur. For this reason, non- drug approaches are essential. Food triggers should be identified through the use of food diaries and elimination diets, preferably before pregnancy. Magnesium supplementation is an option for both acute and preventative treatment but must be done under the guidance of a qualified health professional.
Nutritional guidance plays an integral part in headache management. Food diaries are essential in determining the relationship between certain foods and headaches. Although changing one’s diet may require a great deal of motivation, the results are likely to be lasting and rewarding.
- Keith SW, et al. BMI and headache among women: results from 11 epidemiologic datasets. Obesity 2008; 16(2): 377-383.
- Wöber C, et al.; PAMINA Study Group. Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia 2007; 27(4): 304-314.
- Sun-Edelstein C, Mauskop A. Food and supplements in the management of migraine headaches. Clin J Pain 2009; 25(5): 446-452.
- Schoenen J, Jacquy J, Lanaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. Neurology 1998; 50: 466-470.