So many migraine diets—which to pick?
For a long time, people have talked about migraine diets. But with so many diets out there, we decided to look for evidence that any of them actually work. Dietary triggers commonly implicated in migraine include alcohol, caffeine, chocolate, monosodium glutamate (MSG), nitrates, and tyramine.
Elimination diets: The evidence supports the use of elimination diets, but these must be personalized, as not all patients are sensitive to the same triggers. Effect sizes for elimination diets, based on available studies, show statistically significant reductions in attack frequency, duration, and severity.
Ketogenic and low-glycemic diets: These have shown significant reductions in migraine frequency, duration, and severity in both observational and interventional studies. A Mediterranean-ketogenic diet, for example, led to significant reductions in migraine frequency and intensity within 4–8 weeks.
Mediterranean and DASH diets: Adherence to these dietary patterns is associated with reduced migraine days and disability. In an interventional study using the Healthy Eating Plate (HEP) model, ≥30% reduction in monthly migraine days was observed among adherent patients, particularly with reduced intake of carbohydrates and red/processed meats.
Low-fat, high omega-3/low omega-6 diets: Randomized controlled trial data indicate that increasing omega-3 fatty acids and reducing omega-6 linoleic acid can reduce headache days by up to 4 days per month and decrease total headache hours per day (mean difference: -1.7 hours/day for combined omega-3 increase and omega-6 reduction).
Weight loss in obese patients: Weight reduction is associated with improvement in migraine frequency and severity, likely mediated by reductions in systemic inflammation and improved metabolic function.
Lifestyle modifications are critical adjuncts to dietary interventions. Regular meal patterns, consistent sleep schedules, stress management, and physical activity (including aerobic exercise and yoga) are all associated with reduced migraine frequency and severity. Disruptions in daily routine—such as skipping meals, irregular sleep, or acute stress—are strongly linked to migraine onset.
Nutrients, supplements, and the gut microbiome also play a role. Magnesium, riboflavin, vitamin D3, and omega-3 fatty acids have demonstrated protective effects in some studies. The gut microbiome is increasingly recognized as a modulator of migraine susceptibility, with emerging evidence supporting the potential benefit of prebiotic and probiotic interventions, though robust clinical data are still lacking.
Limitations and gaps in the literature include a paucity of large, high-quality randomized controlled trials, small sample sizes, and heterogeneity in study designs. This limits the ability to make universal recommendations and highlights the need for further research to refine dietary and lifestyle guidelines for migraine prevention.
In summary, the most significant lifestyle and dietary changes that can reduce migraines are: identification and elimination of individual dietary triggers, adherence to comprehensive dietary patterns such as the Mediterranean, DASH, or ketogenic diets, increasing omega-3 and reducing omega-6 fatty acid intake, weight loss in obese patients, and maintenance of regular lifestyle routines. Effect sizes for these interventions include reductions in monthly migraine days by up to 4 days, ≥30% reduction in frequency with dietary adherence, and significant improvements in attack duration and severity.
