Can a plant-based diet improve your migraines?

The plant-based diet, migraines, and other chronic diseases

Affecting over 1 billion people worldwide, migraine is a major public health concern. A new case report brings renewed hope for all those in need of alternative or additional treatment options for chronic migraine headaches.

"The LIFE (low inflammatory foods everyday) diet that is rich in dark green leafy vegetables, and is a nutrient-dense, whole-food, plant-based diet, succeeded in reversing chronic migraine, when other interventions had failed. The response was quick and long-lasting," says Dr David Dunaief, case report author and internist specialising in dietary intervention for chronic diseases.

Eric Adams, a patient of Dr Dunaief's and New York City Mayor-elect, highlights the significant impact the plant-based diet could have on migraines as well as other chronic diseases:

"My own personal health journey of overcoming type 2 diabetes is a testament to the curative powers of a whole-food, plant-based diet. Now, exciting new research by Dr. David Dunaief is showing that the plant-based diet could be effective in treating chronic migraine.

"Studies like these show that we need to change the paradigm when it comes to treatment of chronic diseases, and understand that often it's not our DNA making us sick, it's our dinner."

What are migraine symptoms and how are they treated?

Migraine is a condition that causes episodes of severe, pulsating headaches that are typically on one side of the head and that can last 4-72 hours. They can also cause people to feel/be sick and are often accompanied by noise and light sensitivity.

Episodic migraines involve intermittent headaches, whereas people with chronic migraines have headaches on at least half of days, of which at least half are migraines. Both types can severely disrupt a person's life.

They are further distinguished into 'migraine without aura' and 'migraine with aura'. The former is the most common type and can include the above symptoms: the latter involves all combinations of the symptoms above, but is also preceded by any of the following migraine auras (warning signs):

• Visual impairment - in the form of temporary partial vision loss, a bright light, or objects appearing to move/shake.

• Numbness/pins and needles - typically starting in the hand and travelling up the arm to the face.

• Speech impairment.

• Smell impairment.

• Food cravings.

• A feeling of well-being.

• Other unusual sensations

Migraine treatments

Current treatment options include over-the-counter and prescription medications in the form of anti-pain, anti-sickness, and anti-migraine drugs. These are divided into 'as needed' medicines to treat migraine symptoms and preventative medication, taken regularly. However, there are side-effects, and some medicines aren't suitable to be used by children and pregnant/breastfeeding women.

Alternative natural treatment options, such as yoga, meditation, and elimination diets, are not very effective in relieving migraine symptoms. With limited preventative and reactive treatment options, migraines continue to have a significant impact on many people's lives.

Patient picks for Migraine

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Is your period causing your migraines?

Headaches and migraines are a common problem that affect both sexes. But women tend to be more frequently affected. This is thought to be due to the influence of hormones. Interestingly, most women who experience migraines remember their first attack occurring around the time they started their period. So what can you do if menstrual migraines are affecting your quality of life?

by Dr Jennifer Kelly, MRCGP

Brain and nerves

Migraine and combined hormonal contraception

If you have migraine with aura, you should not use combined hormonal contraceptives - which means the combined oral contraceptive (COC) pill ('the pill'), the contraceptive vaginal ring ("the ring") or the contraceptive patch ('the patch'). This is because of a small but significant increased risk of having a stroke. If you have migraine without aura you should not take combined hormonal contraceptives if you are aged 35 or older. If you previously never had migraine, and then develop any type of migraine (with or without aura) after starting combined hormonal contraceptives, you should stop using them. Some women aged under 35 who have migraine without aura are prescribed combined hormonal contraceptives. They then find that the pill-free, ring-free or patch-free break triggers migraine attacks. If this happens to you then you do not need to stop your combined hormonal contraceptive. Tips for you to reduce headache frequency are given below.

by Dr Hayley Willacy, FRCGP

Case study: can the plant-based diet reverse migraines?

Now, a newly published report "suggests that a whole food plant-based diet may offer a safe, effective and permanent treatment for reversing chronic migraine", say researchers.

The recommendation comes after a patient who had experienced severe migraine headaches for over 12 years saw a drastic improvement after following an expertly devised diet, known as the low inflammatory foods everyday (LIFE) diet.

Before plant-based diet treatment the patient experienced:

• Chronic migraine headaches occurring 18-24 days a month.

• Sudden, intense and throbbing pain that usually lasted 72 hours.

• Other symptoms including sensitivity to sound and light, and nausea and vomiting.

• A self-described pain score of 10-12 out of 10.

Previously attempted treatments that the patient found ineffective:

• Prescribed medications (zolmitriptan and topiramate).

• Cutting out potential 'trigger' foods (chocolate, cheese, nuts, caffeine, and dried fruit).

• Yoga and meditation.

Results of the plant-based diet treatment

Significantly, the patient's headaches haven't returned for 7.5 years. He stopped taking his migraine medications, and although certain 'trigger' foods can still bring on migraine headaches, these were much shorter and less painful than previously experienced.

What is the plant-based diet and how does it work?

The rationale is that the plant-based diet works by reducing systematic inflammation and oxidative stress (an imbalance between reactive oxygen molecules and antioxidants in the brain), both of which are implicated in migraine headaches.

Dark green leafy vegetables are important sources of beta carotene, which has anti-inflammatory and antioxidant properties that are thought to relieve migraine headaches. The case study provides significant evidence to support this, as blood tests revealed that the patient's beta-carotene levels more than tripled after he started the plant-based diet.

Case study limitations

The case study has its limits because it focuses solely on one patient. For example, the man was also HIV-positive, and it's possible that his use of antiretroviral drugs had contributed to his migraine symptoms, which he then ceased taking. This makes it impossible to tell the full effect of stopping this medication on his reduction in migraine symptoms.

Although the case study focused only on one subject, Dr Dunaief believes that we can learn a lot from a case study, and that it is: "a good starting point" and "shows how powerful the LIFE diet can be for migraine".

While this report describes one patient's remarkable response, the plant-based diet has also been shown to reduce migraine frequency of several other patients. "A large, prospective, randomised controlled trial or even an observational trial is warranted," concludes Dr Dunaief.

Risks and benefits of a plant-based diet

No drug would ever be recommended on the basis of a single case study, or even a large number of anecdotal cases. There is a huge raft of evidence showing the power of the placebo effect: if someone is given a dummy treatment, they are more likely to improve if they believe their treatment will help.

Instead, drug development involves a series of laboratory and clinical trials, strictly controlled to ensure that any benefits seen are due to the drug itself rather than the placebo effect. They are also designed to account for so-called 'confounding factors'. In this case study, for instance, the change in medication, rather than the diet, could have accounted for the patient's improvement.

Drug trials look for side effects/risks as well as benefits. Only if the national drug regulators are confident that the benefits of a drug at a population level outweigh its risks will it be licensed.

The risks of the plant-based diet, by contrast, are likely to be extremely small for most people. A whole-food, plant-based diet high in vitamins, minerals and micronutrients is already advocated for the whole population. This means that even if the benefits in terms of chronic migraine are actually very small, the risk:benefit profile is still likely to fall on the side of benefit.

The only caveat is that major changes to diet can result in vitamin or mineral deficiencies (in this case, for instance, some versions of the diet might have very low levels of calcium). They should therefore ideally be undertaken with supervision from a dietician.

The plant-based diet and other chronic diseases

In recent years, studies have built up a body of evidence suggesting the plant-based diet may help to reduce the severity of other chronic diseases involving inflammation.

"As an internist focusing on dietary intervention, I have been caring for patients with chronic diseases for the past 12 years. Many of my patients have had rapid, marked improvements when they adhere to my (LIFE) diet," explains Dr Dunaief.

"I have seen reversal with other patients with migraines and improvements in many other chronic diseases as well, including high blood pressure, cholesterol, heart disease, and autoimmune diseases such as inflammatory bowel disease (Crohn's and ulcerative colitis), rheumatoid arthritis, and psoriasis. I have also seen substantial benefits for cancer patients."