The power of a plant-based lifestyle in managing migraines
by Tania Shukla, final year medical student at the University of Edinburgh
Even though it is, in effect, “all in their head”, migraine sufferers will tell you that making it through an episode can entail days of effectively doing nothing. As well as the throbbing one-sided headache, migraines provoke nausea, vomiting, visual problems and an aversion to sight, smell and sound for up to 72 hours.1 The alternative is taking medication in an attempt to abort the attack. This may sound appealing, but it also means subjecting oneself to side effects that most would be inclined to avoid; moreover, many still have no relief despite trying several drug types.2
Nonetheless, treatment has become increasingly pharmacological, and migraines remain the leading global contributor to disability in the under 50s.3 Hence, tackling its prevention and management is an area that would greatly benefit from intervention with a fresh perspective, which is where the possibility of dietary modification comes in.
The pathophysiology and aetiology of migraine disease remain largely undetermined, despite being the sixth most prevalent condition worldwide.4 Although incompletely understood, genetics, environmental factors, nutrition, and the immune system are all thought to play key roles.
Recently, there has been growing evidence advocating a dietary approach to migraine therapy, with encouraging results.5-8 This is partially founded on a prominent theory of pathogenesis implicating “neurogenic neuroinflammation” in driving the pain, and consequently combating it using the inherent anti-inflammatory properties of plant foods.
Factors such as diet and chronic stress trigger inflammatory reactions in the trigeminovascular system, involving the secretion of neuropeptides (notably calcitonin gene-related peptide, CGRP), meningeal vasodilation and mast cell degranulation.9 This sterile inflammation can then lead to “central sensitisation”, a process culminating in an exaggerated pain response and ultimately migraine chronicity. It may also explain the epidemiological link between the inflammatory biomarker C-reactive protein (CRP) and migraine.10
The use of anti-inflammatory (such as aspirin and ibuprofen) and anti-CGRP medicines in alleviating migraine pain supports this hypothesis.9 On the other hand, the fact that these drugs do not always work implies there is more to the mechanism, and warrants trial of alternative strategies – for example, consumption of ginger, grape seed and butterbur extracts has also been shown to lessen CGRP release.11 Another study discovered butterbur root extract combined with music therapy was valuable in preventing paediatric migraine.12
In fact, a whole-foods plant-based diet benefits migraines via numerous mechanisms. It naturally eliminates many migraine-provoking substances such as dairy, meat, sugar and processed foods. It is a rich source of anti-oxidants (carotenoids, polyphenols, vitamins C and E all mainly found in fruits and vegetables), which curb inflammation by reducing oxidative stress.7 Plants are also sources of calcium and magnesium (present in almonds, cashews, peanuts and spinach), micronutrients shown to reduce migraine frequency.8 Additionally, the diet’s low-fat nature fosters weight loss, also associated with symptom relief.13
The power of a plant-based lifestyle in managing migraines
A recent pioneering study reported the case of a 60-year-old photographer distressed by severe migraines for 12 years, before he succeeded in eradicating them in a mere 3 months.5 He had spent over a decade trialling the most powerful pharmacology, elimination diets and stress reduction therapies to no effect, making his job as a photographer “almost impossible” – until he, quite literally, discovered a new lifestyle. In other words, the Low Inflammatory Foods Everyday (LIFE) style; a nutrient-dense, whole foods plant-based diet.
The study incorporated a 32-ounce LIFE smoothie (containing dark green leafy vegetables [DGLV], blueberries, banana, cocoa powder, flaxseed, and non-dairy milk) into the participant’s diet, whilst limiting starchy vegetables, whole grains, oils, meat and dairy. Adherence was measured using blood beta-carotene levels, a nutrient abundant predominantly in DGLV and revealed to diminish inflammation and oxidative stress, which are both implicated in migraine pathogenesis.7,14 Over 7 years later the patient is still migraine-free. Interestingly, as well as migraine medication, he also ceased asthma and cholesterol treatment owing to improved allergy symptoms and lipid levels.5
This nutritional approach is supported by another study looking at the influence of a low-fat vegan diet on migraine frequency and intensity. It found 87.5% of those in the diet cohort experienced pronouncedly allayed migraine pain (compared to just 50% of those on a placebo supplement), with a significantly lower maximum headache severity and 19% reduction in analgesic medication required.6 Weight and cholesterol (HDL, LDL and total) levels were also significantly better, similar to the preceding study.5 Many participants refused to give up the plant-based diet at the end of the diet phase regardless of methodological protocol, an occurrence noticed in other studies too.15,16
Plant-based diets and other medical conditions
Dietary modification is conventionally viewed as a challenging and less potent means of managing illnesses compared to pharmacology. However, migraine treatment is just one example of the merits of plant foods when even the most sophisticated pharmaceuticals fall through. Indeed, plant-based, low-fat, high-fibre diets are advantageous to other neurological disorders as well, such as Alzheimer’s, Parkinson’s, and cerebrovascular disease.17
Analogous to taking tablets, the efficacy of taking the LIFE smoothie is shown to be directly proportional to the frequency and quantity of intake. Even a regular diet augmented with the LIFE smoothie lowers CRP levels by 30-40% in as little as 7 days – the most rapid diet-produced and statistically significant decrease in CRP in the literature.18 Elevated CRP is linked to migraines and other inflammatory disorders such as COVID-19, cancer and cardiovascular disease, as well as a higher risk of all-cause mortality. Furthermore, the likelihood of cardiovascular disease (such as stroke and myocardial infarction) is considerably higher in migraine patients, meaning that the established ability of a plant-based diet to lower the risk of both conditions in addition to CRP levels could be extremely valuable.19
Putting plant-based diets into practice
The healthcare sector exists to uphold human health, yet paradoxically has a hand in harming it by being a major contributor to environmental pollution. This is partly through improper disposal of pharmaceutical waste, as the majority of medicines are unduly prescribed or sold.20 Instead, prescribing a plant-based diet as primary prevention where relevant can help mitigate this medication overuse, as well as saving up to 80% in healthcare costs and providing the one billion migraine sufferers across the world a remarkably straightforward way out.4,21 Considering that it actually reduces the risk for most chronic diseases it has even been recommended that a plant-based diet be advised to all patients, for which Hever’s 6-step guide to discussing diet with patients provides a useful framework.21,22
Despite constant advances in pharmacology, migraine management has become a troublesome headache in the field of public health, calling for an auxiliary line of action. Perhaps going back to basics and looking at the building blocks of what else we put into our bodies may help; namely, food. Therefore, the answer may well lie in promoting a plant-based diet as a first-line treatment, in lieu of medication. The aforementioned studies bring to light promising areas for research and the potential to provide new therapies for multiple public health concerns, ranging from migraine to myocardial infarction. It also highlights the opportunity and requisite for plant-based nutrition to be integrated into medical education, given it isn’t currently a mainstream treatment modality.
Generally speaking, adopting a vegan diet has never been more pertinent. As well as offering countless health benefits, it does immense good for society, animals, and the planet. Therefore, implementing it into routine practice could prove invaluable in reforming the healthcare system, providing more holistic patient care, and paving the way for a more sustainable future – making plant-based medicine a novel, exciting area to explore further.
- 1. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988;8(7):1-96.
- 2. Gallagher RM, Kunkel R. Migraine medication attributes important for patient compliance: concerns about side effects may delay treatment. Headache. 2003 Jan;43(1):36-43. Available from: https://doi.org/10.1046/j.1526-4610.2003.03006.x
- 3. Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice?. J Headache Pain. 2018 Dec;19(1):1-4. Available from: https://org/10.1186/s10194-018-0846-2
- 4. Stovner LJ, Nichols E, Steiner TJ, Abd-Allah F, Abdelalim A, Al-Raddadi RM, Ansha MG, Barac A, Bensenor IM, Doan LP, Edessa D. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018 Nov 1;17(11):954-76. Available from: https://doi.org/10.1016/S1474-4422(18)30322-3
- 5. Perzia BM, Dunaief JL, Dunaief DM. Chronic migraine reversal and prevention with the LIFE diet: a nutrient dense whole food plant-based diet (WFPBD). BMJ Case Reports CP. 2021 Dec 1;14(12):e243987. Available from: http://dx.doi.org/10.1136/bcr-2021-243987
- 6. Bunner AE, Agarwal U, Gonzales JF, Valente F, Barnard ND. Nutrition intervention for migraine: a randomized crossover trial. J Headache Pain. 2014 Dec;15(1):1-9. Available from: https://doi.org/10.1186/1129-2377-15-69
- 7. Goschorska M, Gutowska I, Baranowska-Bosiacka I, Barczak K, Chlubek D. The use of antioxidants in the treatment of migraine. Antioxidants. 2020 Feb;9(2):116. Available from: https://doi.org/10.3390/antiox9020116
- 8. Meng SH, Wang MX, Kang LX, Fu JM, Zhou HB, Li X, Li X, Li XT, Zhao YS. Dietary intake of calcium and magnesium in relation to severe headache or migraine. Front Nutr. 2021;5(8):653765. Available from: https://doi.org/10.3389/fnut.2021.653765.
- 9. Ramachandran, R. Neurogenic inflammation and its role in migraine. Semin Immunopathol. 2018;40:301-314. Available from: https://doi.org/10.1007/s00281-018-0676-y
- 10. Lippi G, Mattiuzzi C, Cervellin G. C-reactive protein and migraine. Facts or speculations?. Clin Chem Lab Med. 2014 Sep 1;52(9):1265-72. Available from: https://doi.org/10.1515/cclm-2014-0011
- 11. Slavin M, Bourguignon J, Jackson K, Orciga MA. Impact of food components on in vitro calcitonin gene-related peptide secretion – a potential mechanism for dietary influence on migraine. Nutrients. 2016;8(7):406. Available from: https://doi.org/10.3390/nu8070406.
- 12. Oelkers-Ax R, Leins A, Parzer P, Hillecke T, Bolay HV, Fischer J, Bender S, Hermanns U, Resch F. Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study. Eur J Pain. 2008 Apr 1;12(3):301-13. Available from: https://doi.org/10.1016/j.ejpain.2007.06.003
- 13. Di Lorenzo C, Coppola G, Sirianni G, Di Lorenzo G, Bracaglia M, Di Lenola D, Siracusano A, Rossi P, Pierelli F. Migraine improvement during short lasting ketogenesis: a proof‐of‐concept study. Eur J Neurol. 2015 Jan;22(1):170-7. Available from: https://doi.org/10.1111/ene.12550
- 14. Erlinger TP, Guallar E, Miller III ER, Stolzenberg-Solomon R, Appel LJ. Relationship between systemic markers of inflammation and serum β-carotene levels. Arch Int Med. 2001 Aug 13;161(15):1903-8. Available from: https://doi.org/10.1001/archinte.161.15.1903
- 15. Barnard ND, Scialli AR, Hurlock D, Bertron P. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstet Gynecol. 2000 Feb 1;95(2):245-50. Available from: https://doi.org/10.1016/S0029-7844(99)00525-6
- 16. Dodson PM, Pacy PJ, Cox EV. Long-term follow-up of the treatment of essential hypertension with a high-fibre, low-fat and low-sodium dietary regimen. Hum Nutr Clin Nutr. 1985 May 1;39(3):213-20.
- 17. Ramírez-Salazar SA, Herren C, McCartney J, Ortiz García JG. Dietary Insights in Neurological Diseases. Curr Neurol and Neurosci Rep. 2021 Oct;21(10):1-1. Available from: https://doi.org/10.1007/s11910-021-01143-w
- 18. Perzia B, Ying G-S, Dunaief JL, Dunaief DM. Once-Daily Low Inflammatory Foods Everyday (LIFE) Smoothie or the Full LIFE Diet Lowers C-Reactive Protein and Raises Plasma Beta-Carotene in 7 Days. Am J Lifestyle Med. 2020. Available from: https://doi.org/10.1177%2F1559827620962458
- 19. Schürks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis. Bmj. 2009 Oct 27;339. Available from: https://doi.org/10.1136/bmj.b3914
- 20. Stahl-Timmins W, White M, Depledge M, Fleming L, Redshaw C. The pharma transport town: understanding the routes to sustainable pharmaceutical use. Science. 2013;339(6119):515-515.
- 21. Hever J. Plant-based diets: A physician’s guide. Perm J. 2016;20(3). Available from: https://doi.org/10.7812/TPP/15-082
- 22. Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J. 2013;17(2):61. Available from: https://dx.doi.org/10.7812%2FTPP%2F12-085