The literature relating to food and headache is reviewed by an authority on migraine, Dr Clifford Rose of the London Neurological Centre, London, UK. Wine was the earliest reference to dietary migraine, a comment attributed to Celsus (25BC-50AD). Fothergill (1712-1780) was the first to incriminate chocolate as a precipitant of migraine. More recent studies have postulated the phenylethylamine content as the active provocative ingredient. Martelletti and colleagues (1994) studied the involvement of the immune system, and found a link between interleukins and other cytokines, immune messengers, with histamine and serotonin, neuromediators of pain in migraine. Hanington (1967) proposed the theory of tyramine contained in cheese as a precipitant of dietary migraine, but subsequent studies provided conflicting results. Caffeine withdrawal is one explanation for weekend migraine sufferers. Octopamine, a biogenic amine, is thought to be the active ingredient in citrus fruit headache. Food additives blamed for exacerbations of migraine in some patients include aspartame (diet-soda headache), nitrites and nitrates (hot dog headache), and glutamate (Chinese restaurant MSG headache). Red wine contains more phenolic flavonoids than white wine, which might explain the reported red wine sensitivity of some migraineurs; sensitivity may be related to a low level of phenosulphotransferase P, an enzyme that detoxicates the flavonoid phenols. Alcohol-induced headache has been related to an increase in body water. Ice cream headache is an accepted phenomenon, but the mechanism is controversial. Fasting is a generally accepted migraine trigger, but hypoglycemia may not be the mechanism. Elimination diets have had mixed results in controlling migraine. The author concludes that apart from a sensitivity to red wine and other alcoholic drinks, proposed dietary triggers require additional factors to induce migraine attacks. [1]

COMMENT. Diet and headache is a controversial topic that needs further scientific study. Anecdotal evidence and limited controlled experiments are very persuasive for items such as chocolate, milk, cheese, coffee, aspartame, nitrites, MSG, and red wine. However, results of elimination diets and challenge experiments are sometimes conflicting in groups of patients, and individual differences in sensitivity or combinations of factors may explain the controversies. After working with Dr John Wilson in his clinic at Great Ormond Street Hospital, London, I am convinced of a relation between dietary factors and headache in children. (For reviews of articles on Diet and Migraine, see Millichap JG, ed. Progress in Pediatric Neurology Vol I, 1991;ppl46-150; Vol II, 1994;ppl66-168; Vol III, 1997;ppl70-171). My experience in the United States, however, is hampered by a reluctance of parents to embark on a time-consuming, hypoallergenic dietary therapy, often requiring the added expense of nutritional counselling and supervision. At best, parents and patients can sometimes be persuaded to try the avoidance of caffeine and aspartame-containing diet sodas, often consumed in extraordinary quantities by young children, and the restriction of chocolate may also be attempted. A suggestion that milk and other dairy products may be the offending headache triggers is frequently received with a look of disbelief. Patients have been educated in reliance on the “pill.”