Chocolate Lover? Review Finds No Definitive Proof It Triggers Your Migraines

Although it is the most commonly cited food-based trigger for migraines, there is insufficient evidence to prove chocolate is a migraine trigger, according to a review of 25 studies published in Nutrients.

Because of these findings, authors note doctors should not make implicit recommendations that patients with migraines should avoid chocolate. Authors reviewed all literature published up to January 2020 involving the relationship between chocolate and migraine. Studies published on clinical databases such as EMBASE, MEDLINE, PubMed, and Google Scholar were included in the review.

“All provocative studies have failed to confirm that chocolate can trigger migraine attacks,” researchers said. “Many possible mechanisms through which chocolate can influence migraines exist, and more are beneficial than unfavorable.”

In particular, authors note that common advice to identify and avoid triggers of any kind may be wrong. “If a migraine is a disorder of the habituation of the central nervous system to sensory signals, the brain should be trained to habituate rather than avoid the triggers,” researchers said. “There is no scientific evidence to recommend the so-called ‘migraine elimination diet’ to patients.”

Interestingly, one study cited by authors raises possible geographic variations in the question of chocolate as a trigger. “None of the patients among the Japanese and India survey groups reported chocolate consumption as a potential trigger for migraines,” authors said.

It has been postulated that chocolate could conversely serve therapeutic purposes to those who suffer from migraine. For example, chocolate contains magnesium and riboflavin which are recommended in migraine prevention. “There is strong evidence regarding the beneficial effect of magnesium for chronic pain conditions and migraines,” whereas riboflavin was “reported to be efficient in the reduction of the frequency of migraines in adult patients.” Authors point out dark chocolate, or chocolate with a high percentage of cocoa, tends to have the highest concentration of minerals.

Often, depression and mood diseases coexist with migraines and can exaggerate the condition’s course. Because of its orosensory properties, psychoactive ingredients, and activation of neural reward pathways, chocolate is known to have mood enhancing properties. It follows that consumption may be associated with improvements in patients’ mood states.

This evidence shows that chocolate may act as “a protective factor, possibly decreasing the probability of an attack over a period of time,” researchers concluded.

In addition to chocolate, the most frequently cited migraine dietary triggers are cheese, citrus fruits, nuts, processed meats, monosodium glutamate, aspartame, red wine, and coffee.

Researchers suggest a large prospective study is needed based on electronic diaries, in order to further understand the underlying physiological mechanisms linking chocolate to migraine.

Reference:

Nowaczewska M, Wiciński M, Kaźmierczak W, et al. To eat or not to eat” a review of the relationship between chocolate and migraines. Nutrients. 2020;12(3): 608. doi: 10.3390/nu12030608.