Understanding migraine: symptoms, treatment and the role of diet
With 14% of the UK population affected by migraine, more people experience this condition than asthma, diabetes and epilepsy combined.[1] Not only painful, migraine is disabling for many; estimates show that it is the third highest cause of disability-adjusted life years worldwide after stroke and neonatal encephalopathy.[2]
Migraine can have a significant impact on quality of life and personal wellbeing, which extends to mental health implications; anxiety and depression are more common in those who experience migraines when compared with non-sufferers.
Women are more commonly affected than men – approximately one in five women versus one in 12 men.[1] It can present early in life and can affect anyone at any age, but is often diagnosed during middle age or when people start working.[1] There are genetic links but triggers are associated with lifestyle or environment, and vary widely.[1]
The cause of migraine is not fully understood but research points to disorder in the ion channels on the nerve membranes, which causes neuronal malfunction.[1]
What is migraine?
People often describe the sensation of throbbing or pulsing head pain, which may intensify when moving the head and often only affects one side of the head.3 Typical symptoms include moderate to severe headache, sensitivity to sensory stimulation, nausea, vomiting, fatigue, dizziness, mood changes, visual disturbances and difficulty speaking.[3,4]
Migraines often present as an ‘attack’, where different symptoms emerge in stages (see Table 1). It’s a very individual experience and not everyone will have the same attack pattern.
Table 1: Key stages of a migraine attack and associated symptoms*
Stages of migraine attack
Stages | Description |
|---|---|
The prodrome stage | Can begin hours or days before the headache presents. Mood changes, fatigue and food cravings are linked to this stage. |
Aura | Up to one in five people experience aura.[5] Occurs soon before the headache. Can last for 15–60 minutes. Visual disturbances, difficulty speaking and memory loss may occur. |
Pain or pressure | Throbbing or pulsing pain affects the head but can radiate into the face, sinuses or neck. May last for hours or days. |
Recovery | Many people with migraine feel unwell for a day or two after an episode. Many report brain fog. |
*Adapted from What is migraine? National Migraine Centre
Types of migraine
There are many variations of migraine, some common forms include:*
Migraine with aura: See Table 1.
Vestibular migraine: Migraine with vertigo or balance disturbances before an attack or as the main symptom.
Hemiplegic migraine: With weakness or paralysis on one side of the body, affecting the face, arm, leg or all down one side.
Cluster headache: Severe one-sided pain in the head, usually around the eye.
Medication overuse headache: Overuse of pain relief medication in people affected by migraine can trigger more attacks.
Menstrual migraine: Occurs in the two days leading up to a period and the first three days of a period.
*Adapted from Types of migraine and headache. National Migraine Centre
Treatment for migraine
Acute treatment for migraine can include pharmaceutical interventions such as painkillers and antiemetics.[4,6]Triptans may be prescribed for acute management and can ease pain symptoms.[7]
Preventive medications may prevent attacks but may not suit everyone. Most options are not recommended in pregnancy and can be contraindicated for some medical conditions. Medications can include angiotensin II blockers and ACE inhibitors, anticonvulsants/antiepileptics, beta blockers, Botox injections and calcium channel blockers.[8]
Some are specifically developed for migraine, such as calcitonin gene-related peptide monoclonal antibody injections and gepants tablets.[8]
Migraine management may also benefit from lifestyle changes, including dietary alterations.[4] It’s globally recognised that limiting alcohol, eating a healthy diet and keeping hydrated are beneficial in the management of migraine.[2] Likewise, regular sleep, reducing stress and exercise play a role.[2]
Understanding migraine triggers is the ‘holy grail’ as people can have more control over the condition and apply preventive approaches. Triggers can vary depending on the individual, and keeping a migraine diary can help to identify them.
Food and migraine
The role of diet or certain foods is often explored by those who experience migraines, and is of interest to researchers.
Chocolate, cheese, citrus fruits and alcohol are top of the migraine trigger list and are commonly advised as culprit foods to avoid.[9] But as many factors can trigger a migraine attack, it is not always clear if a specific food or foods are indeed the trigger.
If certain foods are suspected triggers, it’s advised to keep a food diary for a minimum of three migraine attacks. This will show a record of the days before a migraine attack and any changes in dietary intake or routine (food cravings, hydration, sleep, stress and menstruation in women). Note that the diary may need to be kept for longer to identify patterns.[9,10]
A systematic review published in 2020 looked at the diet patterns, triggers and interventions in people with migraine.[11] It showed limited high-quality data for patterns or triggers. A range of diets were assessed, which include low-fat, elimination and ketogenic diets. Interventions such as elimination and low-fat diets showed some decrease in the frequency of migraine attacks. Alcohol and caffeine were most commonly cited as triggers.
Alcohol, when consumed in large amounts, is a known trigger for headaches in many people who do not experience migraine. People who have migraines are more predisposed to alcohol-triggering headaches. Some alcoholic drinks may be better tolerated than others but the experience is unique to each individual.[9] It’s recommended that alcohol is consumed in moderation – not at all if a known trigger – and people should avoid mixing drinks.
Caffeine is another headache-inducing substance for many non-migraine sufferers. Again, it may affect migraine sufferers in different ways.
Sudden withdrawal of caffeine can trigger headaches, particularly if it has previously been consumed in high doses. Caffeine may be tolerated in moderate amounts, for example, three cups of coffee or four to five cups of tea per day.[9] If caffeine is a known trigger, it’s generally advised to avoid it and opt instead for decaffeinated drinks.
Supplements and migraine
In addition to understanding more about food and its relationship with migraine, there has been interest in the role of supplements too. Data shows riboflavin, magnesium and co-enzyme Q10 may help alleviate symptoms or prevent migraine attacks.[12]
In 2024, two reviews studied the evidence of various supplements and their impact on the prevention and management of migraine attacks.[13,14] Both concluded favourable effects for several supplements, which may be offered to patients as treatment options. However, there was less evidence to support others (omega-3 fatty acids, probiotics, several different vitamins and herb feverfew).
Table 2: Supplements and migraine*
Supplement | Rationale | Recommended use |
|---|---|---|
Riboflavin (vitamin B2) | Supports cellular functions which provide energy. Disruption in energy supply may be linked to migraine. Has been shown to reduce frequency and severity of migraine attack for some people. | 400mg per day for a minimum of three months may help to prevent migraine attacks.[15] |
Magnesium | Plays a role in nervous system functions. May reduce frequency and severity of migraine attacks for some people. May help to increase the efficacy of some migraine medications. | Types of magnesium supplements: · Magnesium oxide · Magnesium citrate · Magnesium glycinate · Magnesium hydroxide Between 400–600mg per day. |
Co-enzyme Q10 | A natural antioxidant found within the body. Supports the generation of energy within cells. May reduce frequency, duration and severity of migraine attacks for some people. | The exact optimum dose is uncertain. A minimum of 100mg per day has been suggested, although higher doses may be required. |
Other supplements: Other supplements of interest include omega-3 fatty acids and probiotics, but there is limited data on their efficacy in migraine management.
*Adapted from Supplements for migraine. The Migraine Trust
Migraine symptoms and attacks can vary widely depending on the person, but there are a range of treatments available to potentially prevent and/or alleviate symptoms when they occur. There is data to support that diet and some supplements play a role in the management of migraine, however, there is no one size fits all approach. Whilst caffeine, alcohol, citrus fruits, cheese and chocolate have all been indicated as common trigger foods, it may not mean instant ban on them for everyone who experiences migraine. Triggers vary from person to person, and may not always be food or drink related. Recording and analysis of symptoms and routine are recommended before any elimination of foods and/or drinks.
Emma has been a Registered Dietitian for over 18 years and has experience in adult and paediatric dietetics. She has been the Editor of NHD for nine years, steering the editorial content and supporting the production process. Emma currently works in industry.
Emma Coates, RD
References:
National Migraine Centre. What is migraine? 2025. What is migraine? - National Migraine Centre
WHO. Migraine and other headache disorders. 2025. Migraine and other headache disorders
The Migraine Trust. What is migraine? 2025. What is migraine? - The Migraine Trust
NHS. Migraine. 2022. Migraine - NHS
National Migraine Centre. Types of migraine and headache. 2025. Types of migraine and headache - National Migraine Centre
NICE. Migraine: Drugs for acute migraine. 2025. Drugs for acute migraine | Prescribing information | Migraine | CKS | NICE
The Migraine Trust. Triptans. 2024. Triptans - The Migraine Trust
The Migraine Trust. Preventive medicines for migraine. 2025. Preventive medicines for migraine - The Migraine Trust
National Migraine Centre. Migraine and food. 2025. Migraine and food - National Migraine Centre
National Migraine Centre. Migraine triggers. 2025. . Migraine triggers - National Migraine Centre
Hindiyeh N et al. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. 2020; The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review - PMC
The Migraine Trust. Supplements for migraine. 2025. Supplements for migraine - The Migraine Trust
Talandashti MK et al. Effects of selected dietary supplements on migraine prophylaxis: A systematic review and dose–response meta-analysis of randomized controlled trials. Neurological Sciences. 2024. 46: 651–670 doi.org/10.1007/s10072-024-07794-0
Hajhashemy Z et al. Practical supplements for prevention and management of migraine attacks: a narrative review. Frontiers in Nutrition. 2024; 11 doi.org/10.3389/fnut.2024.1433390
NICE. Headaches in over 12s: diagnosis and management. Clinical guideline. Reference number:CG150 Published: 19 September 2012 Last updated: 3 June 2025
Comments