Casey is 27 years old, and has had migraines since she was a teenager. They first started when she was in college, but they only occurred infrequently then — usually around stressful periods, like final exams. She would get a narrowing of her vision, occasionally see stars or spots, then the headache would come on. The pain was usually on the left side, and the only thing that would help was sleeping it off in a dark room. At its worst, light and sound were bothersome. Back then, she didn’t get nausea, and she only had to suffer through 1 or 2 migraines per year. When she came to see me, she was having 4 – 8 migraines per month. She had been to multiple neurologists, and they had tried various medications on her. Some of these, known as “triptans,” would sometimes help, and sometimes not. At best, she could abort a headache if she took the medication at the right time (just as it was starting, although it was not always clear if one was coming on). However, occasionally the headaches could persist for 3-4 days.
There seemed to be no pattern to her headaches. She works an 80+ hr work week at an advertising agency, which she admits to being stressful. Her diet is unrestricted. She eats plenty of dairy “to get my calcium,” she says. She had tried keeping a food and symptom journal, but nothing ever seemed to stand out to her. At this point, her neurologist was thinking of starting her on a daily medication, such as Topamax or Amitriptyline, to see if they could get her migraines under control. These are known as prophylactic remedies, as they help prevent, but they don’t treat the migraine once it is started. She was hesitant to do this, but she needed to do something. She could not go on living this way.
What are migraines? Why do people get them?
We still don’t have a clear explanation about why migraines start and persist. However, there seems to be an inflammatory component to them. It is generally recognized that the pain is caused by dilated blood vessels in or around the cranium.
In the Western medical model, there are plenty of remedies to attack the symptoms, but treating the symptom merely manages the problem, but does not help it resolve. About 16-17% of the population will get a migraine headache at some point in their lifetime. They are approximately 3x more common in women than men. The headache has been classically described as unilateral, but this is really only in 60% of the cases. About 80% will feel nauseous and be sensitive to light and sound. The brain scan to the right was taken during a migraine attack. As you can see there is a widespread increased activity and blood flow (as seen by the red and yellow regions).
The typical triggers include: weather [barometric pressure changes -- some people say they can predict a change in the weather pattern by their migraines], missing a meal, alcohol [and consequent dehydration from drinking], and foods like chocolate or cured meats. For some, a cup of coffee will make the migraine better. For women, about 50% report that their menstrual cycle is a trigger [likely due to the hormonal shifts]. With so many potential triggers, migraine sufferers can feel overwhelmed and defeated. Many just give up trying to keep track, and resign themselves to a life of “unpredictable” headaches. For many, the only option for controlling them has been medication or just a few of the classic food triggers, but not a broader analysis of the diet and its potential influence on their headaches.
The Food Elimination Diet
For Casey, getting her migraines under control involved trying a food elimination diet. A food elimination diet is simply a diet that eliminates one particular food, a combination of foods or condiment, or all solid food… from the diet. It is a very powerful tool, as often it can help uncover the hidden triggers for ailments such as migraines. It can take on various forms as listed below:
- Caveman diet [Lamb, pear, rice, potatoes]
- Food-specific restrictions [Gluten, Egg, Dairy]
- “Candida control” diet
- Refined sugars
- Dairy products (all types)
From my experience, however, the top two problem foods are bread and milk — in other words, gluten and dairy. In Casey’s case, we started with dairy, because this seemed to be the food that she ate the most of, outside of breads and pasta. This was a plan that Casey agreed she could try for 3 weeks, as she loved eating cheese and yoghurt.
We made a pact that she would take all dairy out of her diet for this duration. The only way to know if a food is a trigger is to eliminate it. Oftentimes the body may intially go through a detox reaction, during which symptoms may worsen, including getting one of the worst headaches she ever had. This is called a “healing crisis.” I warned her of this, and we proceeded.
An Integrative Approach:
Along with a food elimination diet, Casey also started using a few stress reduction techniques. She employed better time-management so that she could go to 2 – 3 yoga classes per week. She learned breathing exercises to manage the day to day work stresses. She also started a course of acupuncture once a week. Through this, she connected with a calmer self, which at first did not feel right. She was so used to being high-functioning and wired that the blossoming inner calmness felt foreign to her — almost abnormal. However, through time, she came to understand that this is where her normal should be.
After 1 week on the above regimen, her migraines reduced to 1 or 2 of lesser intensity. By the end of the second week, she had experienced 2 more migraines, but they were more easily attributable to triggers like poor sleep and a glass of wine (which she had, because she was feeling better). They both responded immediately to medication. By the end of the third week, she had been migraine-free for 7 days. She felt more in control, and more attuned to potential triggers.
This is a case study, and by no means represents the results every person will experience. However, it exemplifies a new approach to migraine-management that is often ignored. I have used this approach with multiple patients with great success. Not everyone will get rid of their migraines; however, most experience a reduction in the severity of the pain, and report that their migraines become more manageable and more responsive to medication. A food elimination diet is a powerful tool in the management of a seemingly unrelated disease. For confirmation, the inciting food can be challenged after 3- 4 weeks. If it is highly reactive, it will cause a migraine either immediately or within 24 hrs. What I tell my patients is that figuring out the foods is half the battle, the other half is figuring out what you can live with. Some people may never be able to eat dairy again without getting a migraine; however, most people will be able to “cheat” on occasion and get away with it. This style of medicine empowers the patient and really involves them to partake in their care and management. Sometimes, it is useful to look at at blood tests for food reactivity to further elucidate potential triggers. However, this additional information serves only as a guide, and is not 100% accurate. The gold standard is the food elimination diet and re-challenge.
I hope this case study was informative, and the next time a doctor gives you a medication to cover up a symptom, you ask them what is the root cause of your malady. They may not know! But it may simply be a food your are eating.
In future posts, I will discuss the food elimination diet in more detail.