Dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine.

Migraine, a neurovascular disorder characterized by recurrent attacks of debilitating pain associated with photophobia, phonophobia, nausea, vomiting, and sensitivity to movement, is a significant public health problem in the United States. Migraine is highly prevalent, affecting 17% of women and 6% of men,1 and the socioeconomic burden is substantial. Migraine causes 112 million bedridden days per year, creating considerable disruption to employment and family life.2,3 Moreover, costs of migraine-related disability and treatment in the United States exceed $24 billion annually.2,4 Migraine is comorbid with obesity and other chronic diseases, and this risk may be strongest in women of reproductive age.5-9 Although mechanisms underlying the migraine–obesity link are not well understood, one plausible mechanism is shared inflammatory processes. It is hypothesized that obesity, a low-grade chronic inflammatory state, may exacerbate the neurovascular inflammatory response in migraine.10-12 Migraine and obesity may also be linked through common behavioral risk factors that promote further inflammation, one being poor dietary habits.12,13 Our group recently showed that obese women with migraine spent nearly 1.5 hours per day less in objectively measured physical activity compared to obese women without migraine.14 However, whether usual dietary intake patterns differ between women with and without migraine, and if the relationship between diet and migraine is affected by weight status, is not known. Physicians have long debated the role of diet in migraine.15,16 Given inflammatory processes underlying migraine, both metabolic abnormalities and food allergies have been implicated in migraine onset. Commonly cited dietary triggers include chocolate, cheese, processed meats, and red wine;17 however, to date, there are no studies which unequivocally support the role of specific foods in migraine. Yet, elimination diets are often clinically recommended to mitigate migraine attacks.17,18 Other investigations suggest that eating frequency, meal timing, and the macronutrient composition of the diet may also play a role in migraine.19-21 Specifically, a study in over 1000 adults with migraine found that fasting was associated with migraine onset in 57% of patients.22 Further, results of a prospective cohort trial that evaluated the effects of a low-fat dietary intervention on migraine showed an association between higher fat consumption and higher headache frequency at baseline, and significant decreases in headache frequency, intensity, duration, and medication use following significant decreases in fat consumption at post-intervention.23 These findings suggest that a more detailed and comprehensive examination of dietary intake patterns in persons with and without migraine is warranted to better elucidate the relationship of diet and migraine. The purpose of the current study was twofold. First, we sought to characterize typical dietary intake patterns, including micro- and macronutrient composition, eating frequency, and dietary quality, of women with and without migraine who participated in the National Health and Nutrition Examination Survey (NHANES). Given previous studies conducted in smaller clinic-based samples showing associations of migraine with irregular eating frequency and high-fat diet,20,21,23 we hypothesized that women with migraine would eat less frequently, consume a higher fat diet, and have poorer overall dietary quality as compared to those without migraine. Second, we examined whether the relationship between migraine and dietary intake patterns differed by weight status. In light of the association between obesity and migraine risk, and the fact that diet is an independent risk factor for obesity,24 we anticipated that weight status would confound the relationship between diet and migraine. However, given the role of diet in inflammation and migraine-related and obesity-related comorbidities including elevated blood pressure and blood cholesterol levels, we also hypothesized that weight status would modify the relationship between diet and migraine.6,7,13 For example, in an obese woman who already has a significant level of inflammation, eating a pro-inflammatory diet low in omega-3 fatty acids and high in omega-6 fatty acids may differentially relate to migraine status as compared to in a normal weight woman.25,26