If you ask a group of people with migraine, ‘does chocolate help headaches’, a majority of them will tell you that chocolate and migraine don’t mix. It has been accepted for many years that chocolate can and does trigger migraine attacks (usually in only 25% of people with migraine). (1) But other studies show that it is roughly the same as administering placebo. (2) But, as with all things related to diet and migraine, it tends to be complicated.
This article will unpack if chocolate can trigger migraine headaches, why it might be the villain many see it as today and what the real scoop is about chocolate and migraine.
**While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Why this article was important to me
I love chocolate! If you do too, this is the article for you. It may allow you to treat yourself to some delicious chocolate…all in the name of science!
I have tried to anticipate the questions that would most likely come up. The science is part of what we do and looking at the breakdown of chocolate and how it could be a trigger was interesting.
To be perfectly transparent, I wanted to write this article to help each of you look at chocolate and its potential to trigger migraine attacks a little differently. We talk about triggers a lot in our private Facebook community. Most of us will only ever have a few foods that will trigger us reliably. If the list of food triggers you are keeping track of is more than a dozen, it might be that you are making associations where there aren’t any. My initial list of triggers was 12. And I was certain they were all triggers. Turns out, I have just a few foods that will initiate an attack. If you find your ‘yes’ list of foods shrinking, I encourage you to really examine if all of those foods are triggers.
While this article is about chocolate being a specific trigger for migraine, this type of examination is what we should be doing for any food that is on a personal ‘no’ list somewhere. I love food and want others to feel the same way. If you really miss a particular food you have been avoiding as a suspected trigger, that would be a great first choice to test to see if it is really affects your head.
First, how does migraine really affect the body?
Part of the reason for the confusing nature of determining migraine food triggers is that migraine is a complex neurological disease. Migraine is often associated with a bad headache. However, that is just one of the symptoms that can occur. The reality is that it isn’t just the brain that is affected by migraine, but also the brain stem and central nervous system.
If we only focus on head pain, we miss out how the central nervous system controls the functions of the body – thinking, speech, movement, the 5 senses and spatial awareness. If we understand how complicated multi-sensory migraine symptoms are, we can stop thinking of it as ‘just a headache’.
Why are migraine triggers so hard to determine?
The Bucket Theory explains why food triggers are so hard to determine. The every day layering of triggers make them hard to pinpoint the ones that need to be addressed.
A brief overview of the Bucket Theory – imagine a bucket with water about 1/2 full. Each potential trigger goes into the bucket (some pebble size, some rocks the size of softballs) and based on how much those individual triggers influence your trigger threshold (water level) they increase the level of the water in the bucket until it overflows. Then a migraine attack ensues.
What types of triggers go into the bucket? Things like stress, sleep changes, dehydration, hormones, certain foods or drinks, weather etc. The list can end up quite lengthy and make pinpointing individual triggers more difficult.
How the Bucket Theory may shape our assumptions about chocolate and migraine
Say I went to a party with friends, where a band was playing loudly and their stage show had flashing lights, I stayed out later than normal, had a couple of drinks, had some typical bar food and a chocolate dessert, went home had an argument with my partner and slept lousy. Then I woke up with a migraine attack. What was the trigger?
I count at least nine possible contributing factors. But most of us will blame the things we consumed (drinks, bar food and chocolate) without taking into account the way the other items (loud music, bright lights, stress and lousy sleep) would also fill up our bucket. The reason they are so easy to blame is that we have complete control over them. It’s easy to point to chocolate as the culprit. At best, it’s oversimplification. At worst, it’s misplaced blame on poor, innocent chocolate!
Why is looking at diet and migraine so complicated?
Recall bias is a real thing. (1) We often talk about how inaccurate our historical recall is. For instance, what did you have for dinner 4 days ago? Lunch the day before that? I can’t pull this information from my memory, largely because I eat a wide and varied diet. Without writing down each meal, I will forget when I ate a particular food and if it induced any symptoms of migraine. Writing down our food intake is important if we are planning on trying to determine if we have food triggers.
Having an accurate written history of our migraine attacks and our food intake (if we are testing that) is crucial. If I go see my headache specialist and haven’t had an attack in the week prior, I will invariably report that I am doing well. Likewise, if I have had several attacks in the previous week, I report that I am not doing well. The reality is usually somewhere in between. Having a headache diary to refer to is more accurate overall.
The cause or the association with migraine
This is particularly important when it comes to dietary triggers. We tend to focus on the last thing we consumed as the most likely villain for the current attack we are fighting. While this can be the case, it is something that needs to be tested to avoid the association-causation fallacy. (1) This is where we postulate that something we have associated with triggering an attack is actually causing (triggering) it.
There is nothing wrong with postulating this, but to leap to the conclusion that the food item has definitely triggered the attack without testing it multiple times is where the fallacy comes into play. It’s also how we see many people shrink their diets to an unsustainable level or develop disordered eating.
When we add the Bucket Theory on top of that, it’s very complicated. Migraine also affects us differently based on what stage of the attack we are in (prodrome, aura, attack, postdrome). We’ll be talking about postdrome.
What is prodrome?
Prodrome is the first stage of a migraine attack. It does not occur with every person or even with every attack. But when it does, the symptoms can consist of:
- Anxiety or depression
- Difficulty concentrating
- Dizziness
- Excitability
- Fatigue/Weakness
- Food cravings – increased thirst
- Increased urination or diarrhea
- Irritability
- Nausea
- Neck stiffness or pain
- Sensitivity to light and/or sound
- Sleep disturbances
- Yawning or runny nose
Food cravings are a real issue that many of us struggle with. In at least 1 out of 4 attacks, food craving was reported by 38% of migraine subjects the day before an attack, and by 26% during the hours immediately preceding an attack. (1) Cravings can also make it difficult to tell if a certain food is what we are craving in prodrome or a migraine trigger. I have awful food cravings before an attack and I rarely realize what is happening until the pain hits. Then I have an ‘Aha’. And this is the crux of the matter. Are we being triggered by a certain food, or are we just craving it right before an attack making it look like the culprit?
The most common foods that are craved during prodrome are chocolate, sugary and salty foods. (1) I used to crave Doritos and Cheetos (both contain MSG), chocolate and ice cream. I was pretty convinced that MSG and chocolate were triggers. More later on my experience with both.
There are a variety of possible explanations for why chocolate may trigger migraine in some people. It could be the caffeine, or another stimulant such as theobromine. It could be certain compounds in chocolate, which act as vasoconstrictors, narrowing blood vessels and causing inflammation. While this isn’t the cause of migraine, it still plays a role.
The science of chocolate and migraine – The good, the questionable and the…prevention?
The good- Is chocolate good for migraine headaches?
Chocolate contains a number of vitamins and minerals, mostly magnesium, zinc, selenium, copper, potassium, riboflavin, and iron. (3) It is also high in polyphenols and flavonoids. The beneficial effect of polyphenols on health is thought to be associated with its high content of antioxidants. (3) Most of the health benefits are seen from consuming dark chocolate.
Many people with migraine need additional magnesium. It could be the body is craving the magnesium that just happens to be in the form of a luxurious, delicious treat.
The questionable
Chocolate also contains both caffeine and theobromine. These are both members of a family of substances called methylxanthines which are stimulants. One of the side effects of methylxanthines is headache. Caffeine works on the central nervous system while theobromine stimulates the cardiovascular and pulmonary systems. (4)
Is caffeine a friend or foe (more on caffeine below)? Perhaps the body is craving this substance cloaked in a candy coating. Wishful thinking? Maybe not.
These stimulant effects are why you sometimes find yourself reaching for a candy bar in the afternoon for a pick me up to finish your day. *Raises hand* Am I the only one who does this?
Nitric oxide (NO) production may increase when consuming chocolate. This NO production may be responsible for vasodilation and blood pressure reduction. However the role of vasodilation in being a cause of migraine has come under scrutiny in the past several years. While it plays a role, it isn’t the cause of migraine.
Another possible link to chocolate and migraine is that cocoa may play a role in the release of serotonin. An increase in serotonin is thought to play a role in migraine attacks. This is theoretical and has not been proven. (3)
The prevention? Does chocolate actually help headaches and migraine?
On the other side of the coin is CGRP (calcitonin gene related peptide) which when released starts a cascade of events that ends in triggering migraine attacks. When people with migraine are administered CGRP, it will trigger an attack. A study demonstrated that a cocoa-enriched diet prevents inflammatory responses in trigeminal ganglion neurons by inhibiting the expression of CGRP. (3)
This image from the study titled To Eat or Not to eat: A Review of the Relationship between Chocolate and Migraines shows the different mechanisms that could contribute to chocolate being a trigger for migraine or actually being a preventive.
The chart is a bit complex, but maybe all the arrows pointing to chocolate as a possible preventer is something to get excited about. Maybe chocolate does help migraine headaches after all.
Where does that leave us?
I think we have shed enough doubt on chocolate definitely being a trigger for migraine. We’re back to determining if migraine is a personal trigger for us. One of the studies I read for this article found “Overall…there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it.” (3) If that’s the case, each of us will need to test for ourselves if chocolate can trigger migraine attacks. More on testing in just a bit.
Why does chocolate give me a headache?
Speculation tends to point to both caffeine and theobromine. As these are both stimulants, they are often looked at as problems for those with migraine. It is also a common craving in the first stage of migraine. Before we even know that we are having an attack, prodrome is working in the background. We have to make sure that we aren’t blaming something we consume during prodrome cravings as the trigger of the attack. Is chocolate a trigger for some? Absolutely. Approaching food triggers with some skepticism is helpful so that we don’t give up foods unnecessarily.
If chocolate was once a trigger, will it always be a trigger?
Not necessarily. It depends on how well controlled you are. The more chronic a person is, the more likely they are to feel that everything is a trigger. If you have definitely tested chocolate and found it is a trigger for your attacks (and not prodromal craving), testing it again once your attacks are less frequent is an option.
Wine used to trigger me for a number of years. I had to use a Pure Wine Wand to help filter the wine before I drank it. All of a sudden, this year I don’t need to worry about most wine. What changed for me? Menopause and a successful preventive routine may have helped reduce my sensitivity to food triggers.
I also mentioned above how I thought that MSG and chocolate were definite triggers for me. When I challenged my thoughts on this and tested both foods, I didn’t find that either were a significant trigger. The question is whether they did trigger me when I was having daily migraine symptoms and was intractable. At that time, literally everything felt like a trigger, so it’s hard to know.
How to test if chocolate is a migraine headache trigger for you
It’s always a good idea to start off a day that is as free from other triggers as possible. A day with nice weather, not during a menstrual cycle, when you have had a good nights’s sleep etc.
Don’t consider satisfying a chocolate craving as a good test. As we have already noted, prodrome cravings can look like triggers when they are actually just a warning sign that migraine is already on the way. Prodrome can last several hours up to a couple of days.
Read more about reaching baseline and testing food triggers.
What if you are low carb or keto?
There are many low carbohydrate and keto options on the market now. Staying away from chocolates that have sorbitol, mannitol and maltitol is a good idea because they can cause diarrhea in some.
While some of the other sugar alcohols can as well, they tend to be easier on the tummy when used in moderation. Finding your particular sweet spot can take a little bit of trial and error. Enjoy the testing!!
You can also find high quality dark chocolate as an option for a keto friendly treat. Here are some of my favorites. Notice there are some sugar free white chocolate options in there as well!
Is white chocolate a better option?
Dark chocolate is a mixture of cocoa powder, cocoa butter and sugar. White chocolate contains only cocoa butter, sugar and milk solids and no chocolate liquor or cocoa powder. (5) Technically white ‘chocolate’ isn’t really chocolate. If milk or dark chocolate are definite triggers, white chocolate could be an option.
If you believe chocolate causes migraine headaches for you rather than the craving being part of prodrome, you can give white chocolate a try.
Is imitation chocolate, like carob, a better alternative?
Carob doesn’t contain either caffeine or theobromine. It can act as a chocolate substitute, but the flavor is definitely not the same. Still…it’s better than nothing if chocolate is a migraine trigger for you.
Is there enough caffeine in chocolate to help a migraine attack?
It depends on the amount of caffeine that usually helps you. Here is the breakdown of caffeine in typical servings of chocolate, coffee and tea as well as Diet Coke and Coke.
- 1 oz square of baking chocolate contains 23mg of caffeine
- 3.5 oz bar of dark chocolate (70-85%), contains 80 mg
- 3.5 oz dark chocolate (50-69%) contains 70 mg
- 3.5 oz milk chocolate bar contains 20 mg of caffeine
- 8 oz cup of coffee contains 95 mg of caffeine
- 8 oz cup of tea contains 26mg of caffeine
- Shot of espresso contains 64 mg of caffeine
- 1 12 oz can of Coke/Diet Coke contains 34mg of caffeine
- 8 oz cup of hot chocolate contains 5 mg of caffeine
Final thoughts on chocolate and migraine
I hope this article has given you some things to think about when it comes to chocolate and migraine.
Does chocolate help headaches? My personal opinion is that for many it does as it may be providing nutrients that the body needs while satisfying a craving. And the bit of caffeine it contains can certainly offer a boost to migraine medications used to treat attacks.
While it can be a trigger for roughly 25% of people with migraine, maybe you will be one of the lucky ones that can still have it!! I encourage you to challenge your assumptions if you’ve been cautious about chocolate and migraine headaches. Give it a try and let us know how it goes!
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8636453/
- https://pubmed.ncbi.nlm.nih.gov/25567457/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146545/
- https://www.scientificamerican.com/article/carob-versus-chocolate/
- https://www.diffen.com/difference/Dark_Chocolate_vs_White_Chocolate
