Elimination diet for headache triggers

April 28, 2010 7:25 PM

Elimination diet to identify headache triggers: anyone have any experience with this? Why do various plans differ so widely? Are nuts in or out? Herbal tea? Pure maple syrup? Fruit? Rice? No caffeine or regulated caffeine? Do you eat strictly for three weeks or three months before you start adding foods back? Alternatively: are elimination diets unsubstantiated woo? The theory seems sound, but the sources are not confidence-inspiring.

These are the main sources I've read so far:

http://www.kitchentablemedicine.com/allergy-elimination-diet/

http://www.whfoods.com/genpage.php?tname=diet&dbid=7

http://healing.about.com/cs/conditions/a/headacherecipes_4.htm

http://www.drcranton.com/elimination_diet.htm

UW Integrative Medicine (pdf)

posted by arcticwoman to Health & Fitness (22 answers total)

IANA(Naturopathic)D, but I am working with one right now since I have suspected food allergies. She will be putting me on an elimination diet in months to come, so I'll be watching this thread closely. Because caffeine and nuts are common triggers for people I have never seen an elimination diet with these allowed. As for fruit, I think that's mostly for a candida elimination diet, but you never know with headaches, the pesticides could be the culprit. I skimmed through your links, and I think the last pdf said it well with 'everyone is unique', so there are no hard and fast rules about these things. I have had a lot of success with the elimination of certain foods from my diet, and I think most of what you'll find will be anecdotal evidence on the benefits of doing one of these. I think the key here is to keep a diet diary and track everything you eat, your mood and headaches, and then try to find correlations over several weeks or better yet 3 months. And the more basic you can get your diet the easier it will be to find the links. Good luck!
posted by gillianr at 7:58 PM on April 28, 2010

I suspect that the reason the plans vary so widely is either because
1) Not all headaches are alike, different headaches have different triggers, and some probably have nothing to do with diet. For example, do you have migraine headaches, tension headaches, or cluster headaches?
2) There is not much science behind any of this.
(or both).

But I can tell you for certain that caffeine is a treatment for certain types of headaches, though it is a trigger for others (particularly, caffeine withdrawal headaches!). For example, caffeine is found in Fioricet, a common prescription headache medication. Doctors give IV caffeine to patients for certain types of headaches.

Caffeine is the only thing you mentioned that has a medical use related to headache, so it's the only part I can comment on. IANYD as always, best of luck getting rid of your headaches.
posted by treehorn+bunny at 8:03 PM on April 28, 2010

do you or your doctors have any suspicion to what it could be?

my mom had pretty strong evidence that her problem was corn, so they took her to basically nothing for a week, then slowly started bringing things in, keeping corn out. after a month when everything had been brought back in besides corn, she had some and BAM! migraines, gastro-intestinal problems, the whole works.

(you would not believe what you have to read with a corn allergy - pills, toothpaste, hell, she can't even be around the corn packing peanuts)
posted by nadawi at 8:05 PM on April 28, 2010

Every single flavor of celestial seasonings herbal tea gives me a headache so yep, I'd eliminate herbal tea from your diet for sure.
posted by fshgrl at 8:12 PM on April 28, 2010

Best answer: Heal Your Headache is a GREAT book on the topic. I didn't manage the three months the book recommends, but after six weeks or so & allowing certain items back, I know my worst triggers are MSG, red wine, & dark booze, which I avoid like the plague. Lesser triggers are citrus, chocolate, and the roller coaster of caffeine; plus I get rebound headaches from taking consecutive doses of over-the-counter pills. Because my migraines are hormonal-based as well, I avoid the lesser triggers during that time of the month. Nowadays, I feel about 70% "in control" of my headaches, as opposed to maybe 20% before the program.
posted by changeling at 8:13 PM on April 28, 2010

I know little about these diets, but it seems to make more sense to eliminate one thing (that you consume regularly and that may be a cause) at a time and seeing if there is a difference, rather than eliminating numerous items, then slowly adding them back in. There are so many potential food-allergy related causes it seems more reasonable to narrow it down and try one at a time, instead of starting with an incredibly limited diet and slowly adding things back in.

Anecdotally, my cousin experienced crippling migraines for over a year before discovering she was severely allergic to chocolate. Have you explored other reasons for headaches? Caffeine withdrawal is a major cause, as is stress. My friend thought something was seriously wrong with her, she was having severe migraines on a regular basis. They disappeared when her deadbeat boyfriend did, and came back the next time she saw him, months later.
posted by catatethebird at 8:22 PM on April 28, 2010

are you suffering from migraine headaches? it might be beneficial to try a few weeks without dairy products before going whole hog. also, have you been checked for hypothyroidism?
posted by kimyo at 8:25 PM on April 28, 2010

anything with peanut butter will almost immediately give me a migraine the size of texas and i never recognized this until my sister (who also gets migraines) told me that it was a headache trigger. while looking at the list of possible things these sites tell you to eliminate, are you noticing anything hitting you like that? if you don't want to go all out elimination diet (i can only imagine how hard that is) and want it to be a little bit more personalized, i'd start out that way.

just an idea.
posted by itsacover at 8:26 PM on April 28, 2010

What you may want to try to start out with is just keeping a headache diary. Don't cut anything out, just note what you eat, time of awakening, and daily activities, and see if anything jibes with the headaches. You may be able to narrow down suspects that way without any ticky tinkering. For instance, my headache diary pretty clearly showed me something I had been missing: The 30 minutes I slept in due to having a later class in college lead to The Tuesday Migraine.
posted by thebrokedown at 8:40 PM on April 28, 2010 [1 favorite]

This recent migraine AskMe had a few comments (including mine) describing various food triggers and the ways we identified them.

Good luck. I do better with elimination diets if I think of myself as a big ol' science experiment than if I focus on all the awesome stuff I can't have.
posted by catlet at 8:43 PM on April 28, 2010

Are you keeping a food diary now? Even before you go on an elimination diet, you can record what you eat, how you feel throughout the day, and what you've done to treat your symptoms. You can experiment a bit if you suspect something. I have some severe allergy symptoms, and by keeping an anonymous blog, I learned a lot about what was triggering my symptoms and what worked and didn't work to alleviate them.

I have an older relative who has tested positive to antibodies to gluten, corn, casein, and eggs and has dropped all of these from her diet. The problem that she has is that her symptoms are inconsistent, so that she can drop something, feel better, but it might be a coincidence. So, an elimination diet might take a while. She did feel better almost immediately upon dropping those foods from her diet, though.

Caffeine withdrawal also causes headaches, so that's one thing you might want to taper off, rather than drop from your diet all at once.
posted by zinfandel at 8:47 PM on April 28, 2010

Best answer: What you may want to try to start out with is just keeping a headache diary. Don't cut anything out, just note what you eat, time of awakening, and daily activities, and see if anything jibes with the headaches

This is what I was going to suggest, and makes more sense scientifically. Migraine or other health triggers vary widely by person, eliminating a whole bunch of stuff based on random lists from other peple isn't necessarily helpful and can be a lot harder than it needs to be. Get some data first. Try to narrow down what your problem might be then test that specific thing rather than just change everything at once so you can't tell what did or didn't work (and sometimes a wholescale change can affect your health for a while just because of placebo effect). Then if you're still stumped go see either a licensed dietician or a nuerologist, depending on which seems more appropriate. They'll often ask for a food/symptom diary anyway so it makes sense to go already armed with that knowledge. There are a few triggers that are so widespread it won't hurt to try removing them, alcohol and msg for example, but they will show up pretty fast in a food diary too.

There is a lot of woo based around this too. When you hear things like 'candida diet', 'detoxify', and naturopath then you're way outside anything evidence or science based and firmly entrenched in woo. Might as well randomise your meal plan and cross your fingers. There is some science too though, you just need to make sure you're seeing real qualified doctor type people.
posted by shelleycat at 8:56 PM on April 28, 2010 [2 favorites]

If you've got migraines, I highly recommend getting a specialist neurologist to work you up; while you're waiting for your appointment, you could log your diet, moods, hormonal stuff, exercise, and headaches to give them some data to start analyzing.

My migraine guy did an hour and a half of preliminary workup, during which we didn't even start talking about potential treatment until the last 20 minutes or so-- it was all gathering history, talking about diet, talking about menstruation, investigating conditions that are often related to migraine, etc. After that, it was "oh, well, hm. Try this as a prophylaxis med, then if something breaks through that, have an Imitrex. If that doesn't work for you after three menstrual cycles, we'll try something else. I'm going to throw in an EEG and an MRI, but those are usually normal. And for God's sake, get 20-30 minutes of aerobic exercise every day. Also, observe, observe, and observe. We will figure this out with enough data."

Basically, you want to get enough recordkeeping on your side of things to give someone with the correct training someplace to start. The Mayo Clinic has a a list of foods that appear to trigger migraines in some people, and it's pretty short and to the point. If you think it's a specific food, the neurologist should be able to help you make that call and suggest something appropriate.
posted by fairytale of los angeles at 9:23 PM on April 28, 2010 [2 favorites]

Best answer: I tried eliminating one or several foods at a time, but without much luck in decreasing my headaches. When I cut out the processed sugar, white flour, artificial flavors,sweeteners, and colors, preservatives, caffeine, and ate primarily low fat, vegan and as organic as possible I noted a marked decrease in the intensity and duration of the headaches. It seems to be more of a cumulative effect. Cutting out one thing at a time may not make a difference if there are interactions between different foods. Triggers differ from person to person, a lot of it comes down to trial and error in finding what triggers your headache. Pick a diet and try it, you'll know soon if it is working or not. If it doesn't, try another one. There are so many possible triggers out there that it is almost impossible to cut them all out at the same time, but if you cut some of them out it may be easier to identify what is left.
posted by Lost at 9:57 PM on April 28, 2010

I came here to recommend Heal Your Headache as well, as mentioned upthread. Which is good, because I'm on my phone and getting the amazon link is a pain. But that book changed my life, just for the understanding aspects of it. If you spend $12 on your migraines, make it that book.
posted by cgg at 10:10 PM on April 28, 2010

I don't think it's necessary to be overly scientific about it to begin with. I did a very informal elimination diet after I seemed to be getting daily stomach aches. Rather than think of it in terms of ingredients (caffiene, preservatives, gluten), just eliminate actual foods that you eat/drink, and work your way down that way. I ended up figuring out mine was coffee.
posted by ryanbryan at 1:16 AM on April 29, 2010

I went to a naturopath about headaches as well as other symptoms and she recommended this book "the hypoallergenic diet" which has this comprehensive list of foods to consume and avoid.

If you look at it like using yourself as a science experiment it can help with the fact that it takes forever to reintroduce the various food groups. I discovered I have a really severe reaction to corn and factory farm eggs (interestingly, happy eggs are ok) and that sugar is evil. Once you eliminate sugar for over a month, eating candy is gross and painful, and you realize that it's everywhere. Also I found that red wine and cheap beer give me headaches (while I drink them - I'm not talking about a hangover) - vodka with soda does not.

Nthing everyone about keeping a food diary, starting now - it's the only way to really see what's going on.
posted by smartypantz at 1:24 AM on April 29, 2010

When I cut out the processed sugar, white flour, artificial flavors,sweeteners, and colors, preservatives, caffeine, and ate primarily low fat, vegan and as organic as possible I noted a marked decrease in the intensity and duration of the headaches.

My experience reflects Lost's. By cutting out the white foods, the intensity and duration of the migraines dropped notably. Aerobic exercise and meditation also helped in this regard, as did cutting back on analgesic meds.

But--here's the kicker--for me, not a single dietary change resulted in an absolute cure for the migraines. Not cutting out chocolate, not cutting out nuts, nada. The migraines continue despite these and other lifestyle changes, although they have lessened in intensity and duration, as I said above.

Some people may benefit, but for many migraineurs, there's no silver bullet. If you're one of them, it may prove pointless to play the "cutting out foods" game. I'd give it a try for a few months, but don't let yourself become overly optimistic as to the results.
posted by Gordion Knott at 5:14 AM on April 29, 2010

Best answer: Elimination diets absolutely work. If you want to do it FAST, drop back to just white rice and vitamins and see if your symptoms improve or disappear. Assuming the symptoms are constant, once you kick your addictions, you'll usually notice improvement within a week or so. If the problems don't abate, then switch to a simple-grain, rice-free diet for another week or two. If they still don't change, you're done... you probably don't have food triggers. You can still see an allergist just in case, but you've probably ruled out food allergies.

If symptoms do improve, then gradually add in foods and watch for symptoms. For speed purposes, you can add two foods at a time, and if symptoms develop, drop one of the two. That doubles the speed of food resumption, at a cost of a week or two per trigger you find. Add in staple foods first, the simplest possible example of each type. Don't go to processed foods until very late in the process.

If you want it to be convenient, eliminate foods one at a time and see if your symptoms change. But because it takes a week or two with each food, that can take a long time, a year or more. And it's harder to find combination problems that way. It's quite possible that the very last food you eliminate is what's causing the problem, and that means you'll have the symptoms until you get to it.

Note that in all cases, if your problem is intermittent, that can slow things down fairly dramatically.
posted by Malor at 6:30 AM on April 29, 2010 [1 favorite]

Response by poster: Ok, one more question: what about spices? I feel like I can eat rice and lentils for months if only I can throw various herbs and spices into it, can I do that? Alternatively, if I go the other way, I can track pretty much everything I eat and do, but tracking every pinch of cinnamon or thyme might be too difficult or tedious to keep up on. Are spices ok, or potential triggers/allergens?
posted by arcticwoman at 7:22 AM on April 29, 2010

I haven't come across too much implicating spices, but cinnamon does pop up on some "do not eat" lists, so you might try to avoid that. I found that ginger tends to trigger my headaches, but that is unusual, in fact ginger is frequently touted as a cure. You might try limiting the number of different spices you use initially, then change or eliminate them if you aren't getting relief, or slowly add some back in if you are.
posted by Lost at 9:37 AM on April 29, 2010

Best answer: Anything can be an allergen for anyone. Also allergies aren't the only, or the most common, cause of migraines. Tracking everything you eat for two or three weeks, yes including seasonings, is going to be much easier and better for you than living on rice and lentils. I've done it, it's really not difficult once you get started. Use a spreadsheet and copy and paste a lot. Print a list of your herbs and spices to keep in the kitchen and just put a tick by the ones you put in each day. Don't worry too much about tracking what's exactly in everything to start with anyway, if there are patterns emerging, or even if there aren't, you can look more closely at the days you have headaches once you've logged a few weeks and have some ballpark data to start with. Tabletting agents and other additives in vitamin tablets can also be allergens or headache triggers, so you don't get a free pass by taking a pill either.

If you're going to make a change to your diet that drastic for more than a short time (say a week) then you need to do so with the help of a properly trained professional, which in this case is a licensed dietician (not a naturopath or other form of quack). Otherwise you'll end up with other health problems to worry about.
posted by shelleycat at 1:29 PM on April 29, 2010