Needed Approaches for Dietary Research in Migraine

Abstract Purpose of Review Diet is frequently cited among the lifestyle interventions important to managing migraine disease, but existing evidence informing dietary recommendations is hindered by limited and heterogeneous dietary study designs and results. Here, we review recent literature on migraine and diet with attention toward study designs needed to better inform dietary recommendations for migraine. Recent Findings Numerous recent observational studies agree that dietary intake of individuals with migraine is slightly different than their counterparts without migraine, and the disparity appears to be greater with more severe symptoms. The cross-sectional nature of the data prevents determination of causality. Meanwhile, mechanistic evidence is mounting that the relationship between dietary intake and migraine is bidirectional, yet little has been observed about the direct influence of migraine on dietary intake. Increasingly rigorous controlled dietary feeding studies demonstrate the ability of dietary modifications to impact migraine outcomes, and the strongest evidence exists for diets that diverge substantially from typical eating patterns. The implications of long-term dietary intake on migraine prognosis are also not yet known due to lack of prospective data. Summary Multidimensional evidence supports the existence of a bidirectional relationship between diet and migraine, but data are lacking on how this interplay actually impacts dietary intake and what it means for dietary recommendations. Future research needs include: expanded study designs to better elucidate how migraine influences diet, clinical trials evaluating interventions that support healthy eating behaviors in the presence of migraine symptoms, and prospective cohorts with longitudinal assessments of migraine and dietary intake, to provide data on the reduction of risk for migraine, its exacerbation and co-morbid diet-related chronic diseases.