Thirty-eight patients with a history of diet induced migraine were studied with recording of clinical responses and electroencephalography at the Departments of Neurology and Biometry, Kansas University Medical Center, Kansas City, Kansas. The subjects consisted of 30 females and 8 males aged from 17 to 38 years, all having a history of migraine attacks consistently provoked by either chocolate, cheese, or alcohol. With the exception of one patient with a febrile seizure at age 2, none had a seizure history. There was a family history of migraine in first degree relatives in 22 patients (58%). Tests were carried out on an initial baseline day and on a second day, after challenge with chocolate, red wine, cheese, and fasting. Migraine headache occurred in 16 (42%), four with scintillating scotomata. Electroencephalograms were abnormal in 12 subjects (32%) most abnormalities being nonspecific slow waves. In three cases there were paroxysmal features. Electroencephalographic response to hyperventilation was exaggerated in eight subjects (21%) but was not related to the occurrence of a headache. Photic stimulation showed high frequency driving in all 16 patients who developed headache but in only 14 out of 22 (64%) who did not develop headache. 
COMMENT. Foods are commonly cited by patients as the cause of some migraine attacks. Tyramine is present in high concentrations in certain substances frequently producing migraine (various cheeses, beer and wine). Electroencephalographic abnormalities are found during asymptomatic periods in patients with migraine, and focal and unilateral delta rhythms have been described in patients with migraine during symptomatic states. Paroxysmal epileptiform discharges are unusual in adults with migraine but not uncommon in children. Temporal relationships between headache and severe episodic EEG abnormality (“ictal headache“) have been reported.