When it comes to “Food Triggers”, You’re You.

Yes, there’s no doubt that you’re you. But what am I talking about? I’m talking about the very different reactions that people have to different “trigger” foods.

Trigger foods are those foods that tend to start up or “trigger” the migraine chain-reaction. You might say, “Cheese gives me a headache”, although it’s a lot more complex than that.

There are many foods that are known as “typical” triggers. I’ve already mentioned cheese (particularly aged cheese), but there’s also alcohol, caffeine, chocolate, peanuts, and many more.

But a recent meta-study reminds us again that there’s no magic elimination diet. The study looked for other studies that measured chocolate, caffeine, and cheese as triggers. Now the big limitation to this study was that everything was self-reported – we’ll talk about that in a moment.

But here are the results, from the study published this year in IP Journal of Nutrition, Metabolism and Health Science:

• 13.9% reported chocolate as a trigger
• 12% reported caffeine as a trigger
• 8% reported cheese as a trigger

Now in a way those are fairly high numbers. But we don’t know, for example, if the chocolate triggered a migraine once in a while, or every time people at it. But still, that’s a little over 1 person in every 10 that might have a problem with chocolate.

But I agree with the study author that this is no reason to eliminate chocolate, caffeine and cheese from every migraine patient’s diet. Here’s the conclusion:

Chocolate, caffeine, and cheese are commonly reported migraine triggers; however, their effects vary considerably among individuals. Given the substantial heterogeneity [diversity] and reliance on observational, self-reported data, routine avoidance of these foods cannot be universally recommended. Instead, individualized trigger identification, supported by headache diaries, should guide dietary management. Further well-designed prospective studies are needed to clarify causal relationships.

Assessment of Chocolate, Cheese, and Caffeine as Migraine Triggers: A Systematic Review and Meta-Analysis of Patient-Reported Trigger Rates

It has also been noticed that patients aren’t always that good at recognizing their own triggers. For example:

• This time, was that a trigger or a coincidence?
• Do I always eat that thing under certain circumstances (e.g. under stress, on the weekend, when I also eat that other thing)?
• Is there something else I could avoid that would make this food less of an issue? (e.g. Food #1 + Food #2 triggers an attack, but #2 is much worse than #1….)

Chocolate is one we’ve talked about before – see Can Eating Chocolate Cause Headaches? And even if chocolate doesn’t trigger migraine for most people, there may be other concerns (the sugar that is usually paired with the chocolate, or the oxalates that are in cocao and dark chocolate).

So this leads us to a number of conclusions.

• You’re you. Don’t assume that another person’s triggers are yours.
• Consider a trigger app such as N1-Headache to narrow down your triggers.
• Think about the big picture – for most people, migraine attacks come from a variety of factors, whether food or environment or activities.
• Pay the most attention to your overall, long term health, not just eliminating “problem” foods.

Attempting to cut out certain foods that you highly suspect are a problem is one thing that you can do, but it’s not likely to “cure” your headaches. Cut out that food for 90 days, and keep a careful diary. But remember, your long term overall health is also important for improving your quality of life.