Based on a review of the literature the authors discuss the role of nutrition in the precipitation of
migraine and
tension-type headache (TTH). The available information relies largely on the subjective assessment of the patients. Controlled trials suggest that alcohol and
caffeine withdrawal are the most important nutritional precipitating factors of
migraine and TTH. In addition, there is some evidence that missing meals is also an important factor.
Dehydration seems to deserve more attention. A selective sensitivity to red wine has been shown in some patients, the importance of chocolate has been doubted seriously, and scientific evidence for cheese as a precipitating factor is lacking. Despite a series of experimental studies demonstrating that NO donors such as
nitroglycerin and parenteral
histamine cause
headache the role of
histamine,
nitrates, and
nitrites in food remains unclear. Similarly, other
biogenic amines and
aspartame have not been proven to precipitate
headache.
Sodium glutamate causes adverse reactions including
headache probably at large doses ingested on an empty stomach. Therefore, patients should be advised that food plays a limited role as a precipitating factor of
migraine and TTH. Subjective sensitivity to certain foods should be examined critically, and proven precipitating factors should be avoided. General
dietary restrictions have not been proven to be useful.