Dr. Cremers’ Migraine Diet and Headache Diet: recommended and not recommended foods

Dr. Cremers’ Migraine Diet and Headache Diet: recommended and not recommended foods

Headache and Migraine Diet

Sandra Lora Cremers, MD, FACS

Headaches and Migraines can present in different ways depending on a patient’s particular brain-flow pattern, internal and external conditions (e.g., general medical health, immunological condition, hormones, hydration, humidity). Pain in the head or even seeing bright or dark spots in vision without a headache or flashing lights with or without a headache (assuming vitreous and retinal exam is normal) can be due to an alteration in the blood flow to particular parts of the brain and represent a migraine or Ophthalmic Migraine.

If the headache or migraine is new, changing patterns, only on 1 side of head, always in temple area, waking you from sleep, or getting worse or is not improved by any of these treatments, then see your MD AND eyeMD to do following:

1. Get a full refraction by an EyeMD: to be sure your headaches are not from eye strain: this is a very common cause of headaches

2. Request a Pentacam and Gonioscopy (if needed) to be sure headache is not due to Narrow angles which can cause headaches in some patients. I have had many patients tell me of their years of migraines and headaches, and multiple pill intake, which resolved after a low risk Laser Iridotomy procedure.

3. Check sinuses: first push on sinus are to see if it uncomfortable/painful: sometimes a CT with contrast or MRI is needed.

4. Request a full neurologic examination

If the eyes are fine and a general exam is normal, but you still have above symptoms, most primary MDs will recommend either a formal evaluation with a neurologist and/or a baseline brain scan (MRI or CT with contrast).

Things YOU can do to help with your headache/migraine:

A. Keep headache/migraine diary: when is it really bad; when are your good days & why? Note: visual symptoms, dizziness, light sensitivity and look for any association with:

1. Dehydration: are you drinking at least 64 oz of water per day. Dehydration is the #1 cause of headaches.

2. Gluten: if you can go gluten free for 2-3 months: did you notice any improvement in your symptoms? Many patients have noted their headaches and migraines resolve with a Gluten-Free, Sugar-Free, Dairy-Free diet. Some patients improve by just removing gluten.

3. Diet: avoid as many items on the list for at least 6 weeks: any improvement?

3a. Caffeine: too much or too little can set off a migraine: keep track of intake to see if associated with your headaches.

4. Stress & Anxiety: learn to pray and meditate and see if you can help control any pain from daily stresses.

4a. Push on your neck and shoulder muscles: do they hurt or are tender? Tense muscles in this area can cause tension headaches. Get a good massage to work out the “knots.” Find the pressure points that particularly hurt to see if you can “massage them out” gently.

5. Exercise: check with your general MD to be sure you can increase your exercise routine: any improvement or worsening with particular exercises?

6. Sleep: too little or too much can trigger headaches: find the best number of hours to sleep for you. For most people it is about 8 hours.

7. Weather patterns can be a factor: note the heat & humidity when you get a headache.

8. Heat: try to avoid extreme heat or cold: see which affects you more.

9. Light: especially fluorescent: avoid if affected

10. Loud Noise: some migraines are set off by this so make a note if so for you.

11. Hormonal changes: menstruation, ovulation, birth control pills can set off migraines: make a note

12. High Altitude

13. TMJ (Temporomandibular joint) pain or Teeth grinding: let your primary MD know & see a dentist.
14. Pregnancy: Check to see if you are pregnant.
15. Note there are many causes of headache. The last two are much rarer but if you ever have the worst headache in your life, you need to call 911 or go to ER as soon as possible. If you have a family history of either of these two, let your MD know if you have any new headache:
Aneurysm
Brain Tumor (benign or malignant)

B. Preventative Remedies: Over the counter:

1. Prayer and Meditation. Learn to close your eyes and take deep breaths many times per day with thoughts or words with positive statements.

2. Drink plenty of water & follow migraine diet sheet to avoid triggers

3. Magnesium Citrate 600 mg:

Read Reference below prior to taking. Some literature says 400mg any form works for some people as well. Magnesium deficiency can affect neurotransmitters and restrict blood vessel constriction, which can trigger a migraine. Reference: systematic review from 2017: notes magnesium therapy may be useful for preventing migraine. The American Migraine Foundation report that people frequently use doses of 400–500 mg per day for migraine prevention. Use this therapy under the guidance of their doctor.

4. Vitamin B12 (Riboflavin; not just a B vitamin): 400mg/day; Read Reference below prior to taking.

5. Coenzyme Q10: 400 IU/day or is 100 mg three times per day. Read Reference below prior to taking.

6. Riboflavin: 400 mg per day ; Read Reference below prior to taking.

7. Fish Oil at least 1200mg/day: for eyes or dry eyes, I recommend 2000-4000mg/day

8. Baby aspirin: coated: 81-325mg daily IF you have no history of allergy, stomach ulcers, rectal bleeding, GI issues.

9. Amitriptyline (or Nortriptyline) 25mg by mouth 3 times per day for insomnia and eye pain helps; they can make you drowsy: check with your primary MD before starting.

C. If nothing works, some patients try FASTING under Medical Guidance with a well-experienced MD or clinic. There are many kinds of Fasting: It is always best to Fast under the supervision of an MD. If you are Metformin or any of the medications listed below ** only fast UNDER the supervision of an experienced MD.

1. Time restricted Fasting
2. Intermittent Fasting
3. Prolonged Fasting
a. Water Only Fasting for 5-45days under MD supervision
b. Fasting Mimicking Diet (FMD): Dr. Longo developed

Sandra Lora Cremers, MD, FACS

References:
http://www.migrainetrust.org/assets/x/50129

Below: Modified from Dr. Katz’s Migraine Diet

Headache and Migraine Diet: Dietary Triggers

Food triggers do not necessarily contribute to migraines in all individuals, and particular foods may trigger attacks in certain people only on occasion. Be your own expert by keeping a journal of foods you have eaten before a migraine attack and see whether the removal or reduction of certain foods from your diet improves your headaches.

Skipping meals, fasting, and low blood sugar can also trigger migraines. If you are unable to follow a normal eating schedule, pack snacks.

—American Council for Headache Education

Food Type	Recommended	Not Recommended
Beverages	DRINK AT LEAST 64Oz WATER per day: most common cause of headache & migraines is DEHYDRATION. Max 6oz/day decaffeinated coffee, Non-citric fruit juices, Max 4oz/day white wine. Herbal teas without citrus, club soda, non-cola soda (ex 7up, ginger ale, etc). Max 2oz/day vodka White chocolate	Red wine, port, coffee, champagne, tea, iced tea, caffeinated sodas AVOID ALL DRINKS, FOOD, GUM with Aspartame & MSG Chocolate or cocoa
Breads and Cereals	Commercial breads: white, whole wheat, rye, French, Italian, English muffins, melba toast, crackers, rye, crisp, bagel All hot and dry cereals: cream of wheat, wheaten, oatmeal, cornflakes, puffed rice and wheat	Avoid the following for sure, but I still recommend avoiding all gluten for at least 3 months and keeping a headache diary to see if this helps each patients: Hot, fresh homemade yeast breads and crackers with cheese, croutons Fresh yeast coffeecake, doughnuts, sour dough breads Any breads containing chocolate or nuts
Dairy	Milk (2% or skim) Cheese: American, cottage, farmers, ricotta, cream cheese, egg Yogurt: limit to 4 oz per day	Some patients are particularly sensitive to dairy, others are note; there are some theories it may be related to blood type (but I have not seen any good studies to prove this yet); Cultured dairy such as buttermilk, sour cream, chocolate milk Cheese: blue, boursoult, brie types, camemberts, cheddar, swiss, gouda, Roquefort, stilton, mozzarella, parmesan, provolone, romano, and emmenlaler
Desserts	Sherberts, ice cream cakes and cookies without chocolate or yeast, Jell-O	All sugars increase inflammation so it is a good idea to avoid as much as possible: Chocolate in ice cream, pudding, cookies, cakes
Sweets	Sugar, jelly, jam, honey, hard candy
Food Type	Recommended	Not Recommended
Fruits	Any fruit juice such as prune, apple, cherry, apricot, peach, pear and fruit cocktail Limit intake to ½ cup orange, grapefruit, tangerine, pineapple, raspberry, plums, raisins, papaya, passion fruit	Avocados, banana ( ½ allowed per day) lemon, lime All nuts, peanut butter
Meat, Fish, and Poultry	Fresh or frozen turkey, chicken, fish, lamb, veal, pork, tuna	Aged, canned, cured, tenderized, processed meats, canned or aged ham, pickled herring, salted dried fish, chicken liver, aged game, hot dogs, sausage, bologna, salami, pepperoni, beef jerky, liver, any meal prepared with marinade
Sweets	Sugar, jelly, jam, honey, hard candy
Miscellaneous	Salt in moderation, lemon juice, butter or margarine, cooking oil, whipped cream, and white vinegar. Commercial salad dressings in small amounts as long as they don’t have additives to avoid

Migraine Triggers

“Triggers” are specific factors that may increase your risk of having a migraine attack. The migraine sufferer has inherited a sensitive nervous system that under certain circumstances can lead to migraine.

Triggers do not ‘cause’ migraine. Instead, they are thought to activate processes that cause migraine in people who are prone to the condition. A certain trigger will not induce a migraine in every person; and, in a single migraine sufferer, a trigger may not cause a migraine every time.

—American Council for Headache Education

Categories	Triggers	Examples
Dietary	Skipping meals/fasting Specific foods Medications	Overuse of over-the-counter medications can cause rebound headaches. Also, missed medication doses and certain medications (e.g. nitroglycerine, indomethacin) may cause headaches.
Sleep	Change in sleep patterns	Napping, oversleeping, too little sleep
Hormonal	Estrogen level changes and fluctuations	Menstrual cycles, birth control pills, hormone replacement therapies, peri-menopause, menopause, ovulation
Environmental	Weather Bright Lights Odors/Pollution Other	Weather and temperature changes, extreme heat or cold, humidity, barometric pressure changes Bright or glaring lights, fluorescent lighting, flashing lights or screens Smog, smoke, perfumes, chemical odors High altitude, airplane travel
Stress	Periods of high stress, including life changes Accumulated stress Reacting quickly and easily to stress Repressed emotions	Factors related to stress include anxiety, worry, shock, depression, excitement, mental fatigue, loss and grief. Both “bad stress” and “good stress” can be trigger (or prevent) migraines. Other triggers can include unrealistic timelines or expectations of oneself.
Physical	Overexertion Injuries Visual triggers Becoming tired or fatigued	Over-exercising when out of shape, exercising in heat, marathon running Eyestrain (if you wear glasses, make sure your prescription is current), bright or glaring lights, fluorescent lighting, flashing lights or computer screens

**
If you take the following Medications, do not FAST on your own. Discuss with your MD first and stay under MD supervision.

Metformin

Fenofibrate: (Moderate) Dose reductions and increased frequency of glucose monitoring may be required when antidiabetic agents are administered with fibric acid derivatives (e.g., clofibrate, fenofibric acid, fenofibrate, gemfibrozil). Fibric acid derivatives may enhance the hypoglycemic effects of antidiabetic agents through increased insulin sensitivity and decreased glucagon secretion.
Fenofibric Acid: (Moderate) Dose reductions and increased frequency of glucose monitoring may be required when antidiabetic agents are administered with fibric acid derivatives (e.g., clofibrate, fenofibric acid, fenofibrate, gemfibrozil). Fibric acid derivatives may enhance the hypoglycemic effects of antidiabetic agents through increased insulin sensitivity and decreased glucagon secretion.

Gemfibrozil: (Major) Dose reduction of rosiglitazone may be needed if given with gemfibrozil. Gemfibrozil results in increased rosiglitazone exposure and increases the risk for hypoglycemia. Gemfibrozil is a potent inhibitor of CYP2C8 and rosiglitazone is primarily metabolized via CYP2C8. Concomitant administration of gemfibrozil (600 mg twice daily) and rosiglitazone (4 mg once daily) for 7 days increased rosiglitazone AUC by 127%, compared to the administration of rosiglitazone (4 mg once daily) alone. Fibric acid derivatives also enhance the hypoglycemic effects of antidiabetic agents through increased insulin sensitivity and decreased glucagon secretion.

Lanreotide: (Moderate) Monitor blood glucose levels regularly in patients with diabetes, especially when lanreotide treatment is initiated or when the dose is altered. Adjust treatment with antidiabetic agents as clinically indicated. Lanreotide inhibits the secretion of insulin and glucagon. Patients treated with lanreotide may experience either hypoglycemia or hyperglycemia.

Octreotide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild, but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.

Pasireotide: (Moderate) Monitor blood glucose levels regularly in patients with diabetes, especially when pasireotide treatment is initiated or when the dose is altered. Adjust treatment with antidiabetic agents as clinically indicated. Pasireotide inhibits the secretion of insulin and glucagon. Patients treated with pasireotide may experience either hypoglycemia or hyperglycemia.