Review Assesses Relationship Between Pediatric Migraine, Nutrition

In a recent review published in Nutrients, authors outlined a potential link between pediatric migraine and nutrition, while focusing on the relationship between weight and headaches, the therapeutic effect of food for medical purposes, and other relevant research involving migraine and dietary factors.

Although the exact underlying mechanism of migraine remains unknown, it is thought to be multifactorial and can involve genetic, neuronal, and vascular mechanisms, the researchers explained.

“There is a heated debate on how certain foods can act as favorable or protective factors in relation to migraine attacks,” they said, while “an unhealthy diet seems to favor the onset of migraine and be associated with more serious phenotypes of the disease. This applies, in particular, to patients who are overweight and present a pro-inflammatory state.”

Previous studies have shown a particular food or drink can serve as migraine triggers in both adult and pediatric migraineurs, although the extent of this finding varies depending on populations surveyed. Effects of dietary triggers could also depend on other factors including dosage, timing of exposure, or genetic factors.

For example, one prospective observational case series found chocolate served as a migraine trigger factor in 22% of children. However, “all provocative studies have failed to confirm that chocolate can trigger migraine attacks,” researchers wrote.

When it comes to caffeine’s impact on pediatric and adolescent migraine, data are lacking. Research has shown caffeine can act as an effective treatment or trigger of migraine in some patients.

Similarly, although teens between the ages 12 and 17 account for a quarter of the alcohol consumed in the United States, “there are no studies evaluating alcohol as a trigger factor for migraine in pediatric patients.” Research conducted in adult populations revealed between 29% and 36% of migraineurs self-reported that alcohol use brings on attacks.

Aspartame, monosodium glutamate (MSG), and nitrites have also all been investigated as potential migraine triggers, but the authors note more research is needed among pediatric patients. In addition, based on the literature, they concluded food allergy “cannot be considered a cause of migraine” in this population.

Obesity is a growing problem among youth and adults in developed countries. Several studies have demonstrated a relationship between excess weight and migraine prevalence. Citing results from one investigation carried out in 2008 in Israel, the authors highlighted that among 273 children between the ages 9 and 17, children considered obese had a higher prevalence of episodic migraine (8.9%) compared with overweight (4.4%) and normal weight (2.5%) children.

“A more recent cross-sectional population study showed an increased risk of headaches (40%) in overweight or obese adolescents compared to normal-weight adolescents. In particular, the risk of having migraine has been found to be 60% higher in overweight and obese adolescents,” the authors wrote.

Additional studies have shown females classified as obese tend to have a higher frequency of migraine compared with males and that weight reduction could lead to less frequent and severe headaches in adult and pediatric migraineurs.

With regard to the psychological aspects of this relationship, “both conditions may be associated with anxiety and depression, which, in turn, may correlate with disability,” the researchers said. “Our recent data showed that, at pediatric age, anxiety symptoms might be a vulnerability factor influencing not only the frequency of migraine attacks, but also the relationship between weight and migraine severity.”

Lack of physical activity could also exacerbate the association seen between headache and overweight in children, as research has shown a link between sedentary lifestyles and augmented risks of migraine among adolescents.

“Given the potential impact that body weight can have on migraine outcomes, special attention should be paid to children’s and adolescents’ body weight and lifestyle,” the authors stressed, adding increased physical activity and psychotherapy could benefit these patients.

Implementation of the Ketogenic Diet has resulted in benefits among patients with epilepsy but has not been thoroughly investigated among pediatric migraineurs.

Magnesium, riboflavin, coenzyme Q10, and polyunsaturated fatty acids are the most commonly used nutraceuticals for migraine. However, few data on the prophylaxis of migraine in children with melatonin pyridoxine, vitamin B12, folate, and vitamin D exist, leading authors to conclude “the retrieved studies provide no clear evidence of the efficacy of nutraceuticals for the treatment of pediatric migraine.”

Overall, when it comes to determining which foods trigger migraines, the researchers suggested individuals verify strict cause-and-effect relationships prior to making restrictive dietary changes.

“Popular beliefs about the role of nutrients in pediatric migraine need to be substantiated by scientific studies, as science is the only tool that can allow us to consider such roles as ‘true.’ If scientific evidence is lacking or even contradicts popular beliefs, that which is uncritically transmitted…should be declassified as a ‘myth,’” the authors concluded.

Reference

Papetti L, Moavero R, Ferilli MAN, et al. Truths and myths in pediatric migraine and nutrition. Nutrients. Published online August 6, 2021. doi:10.3390/nu13082714