From diet to disasters, lifestyle factors can affect headaches and migraine (2023)

Searching for explanations for headaches is age old, dating as far back as ancient Mesopotamia.1 Headaches may be caused (or triggered) by a multitude of things, and clinicians, researchers, and patients alike often investigate ways to adjust, avoid, and alleviate them. While some aspects of life, such as diet, sleep, and social habits, influence headaches, other factors are entirely out of our control, such as one's genetics and/or environment. In this virtual issue, we assembled the most recent manuscripts published in Headache addressing lifestyle, both modifiable and non-modifiable factors, related to headaches and migraine. The impact of diet and nutrition on headaches has been extensively debated. Diet is believed to affect the modulation of neuroreceptors, neuropeptides, and sympathetic nervous responses, and to play a role in causing and/or relieving inflammation.2 Various diets, including low-fat, high folate, high omega-3 and low omega-6 fatty acid, Atkins, low sodium, and ketogenic, have each previously been reported to reduce migraine frequency. Further, several randomized controlled clinical trials have reported a reduction in monthly headache or migraine days through the elimination of foods associated with elevated levels of immunoglobulin G antibodies.3 In addition to diet, numerous studies and surveys have examined a variety of dietary triggers. The most common culprits include alcohol, dairy products (i.e., milk and cheese), chocolate, and caffeine. The relationship between headache and alcohol as a trigger has been well described and is reported in 27% of people with migraine3; however, a recent observational prospective cohort study found that, among individuals with episodic migraine (EM), alcohol actually did not have a significant effect on increasing the probability of having a migraine attack.4 The complex relationship between caffeine and headaches, as both a trigger and a treatment, via both intake and/or withdrawal,5 has also been widely debated. One proposed mechanism of action for caffeine influencing headache is caffeine's paradoxical effect on cerebral blood flow. Caffeine can both decrease and increase nitric oxide production. A recent study of individuals with EM demonstrated a lower degree of cerebrovascular reactivity within posterior cerebral arteries in those who consumed caffeine, which improved after caffeine cessation. These results suggest caffeine may have a negative impact on cerebral endothelial function, providing a possible beneficial reason for caffeine cessation in individuals with migraine.5 Dietary nutrients such as riboflavin, magnesium, thiamine, and coenzyme Q10 have also been studied as potential treatments of headaches and migraine.6 Two cross-sectional studies examining the results from the National Health and Nutrition Examination Survey (NHANES 1999–2004) in relation to headaches have been conducted recently. The first assessed thiamine and riboflavin intake and reported that individuals with higher thiamine intake had reduced odds of headache, while no significant reduction in headache was seen with higher riboflavin intake.7 The second examined magnesium and reported that inadequate dietary magnesium intake was associated with a higher likelihood of having migraine in adults.8 Further, hunger is a well-known trigger for headaches. Two papers discussing the fasting customs during the Islamic holy month of Ramadan have demonstrated an increased frequency of migraine attacks.3 One of these studies further illustrated that this effect was primarily seen within the first 10 days of the holiday, then subsequently subsided.9 Inadequate sleep is another commonly reported trigger for headaches, and poor sleep quality has been shown to be a risk factor for migraine progression.10 A prospective cohort study of individuals with EM demonstrated that those with poor sleep had a higher headache frequency over the course of 6 weeks.11 Achieving adequate sleep in teenagers can be cumbersome, for their circadian phase delays as they develop. One cross-sectional survey found that adolescents in high schools with start times after 8:30 a.m. reported lower frequencies of headache than those in schools that started at an earlier time.12 Headaches can also be related to life events like major childhood experiences and natural disasters or calamities (such as a global pandemic). Childhood maltreatment has previously been associated with an increased likelihood of developing migraine.13 This was further demonstrated through the first longitudinal data following children from ages 0–1 to 14–15 years old. Children who experienced adverse childhood experiences had a greater likelihood of having migraine compared to children who did not.14 Calamities like the COVID-19 pandemic and natural disasters can greatly affect a person's physical and mental health, and thereby headaches. The Migraine Clinical Outcome Assessment System project was a multi-stage study that took place during the pandemic and focused on assessing outcome measures/endpoints to be used in the development of migraine treatments. Most participants reported more than one pandemic-related impact on their migraine.15 In addition, during the time of the 2018 Japanese floods, there was an observed increase in the number of prescriptions for acute migraine medications among victims, suggesting that acute migraine attacks occurred more frequently after the natural disaster.16 Headaches can impact nearly every domain of life including physical and psychological health, interpersonal relations, and even financial stability. While there are myriad inciting factors for headaches, this virtual issue shows the significance of several lifestyle influences. Still, there is much more to be learned and understood about how our daily habits and customs affect headache health. We look forward to seeing more data and information about lifestyle choices as they relate to headaches and migraine being published in Headache in the future. Dr. Fred Cohen and Dr. Sarah Bobker declare no conflicts of interest.