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Medically reviewed by Danielle Aberman, RD
The migraine brain is said to be hyper responsive to its surrounding environment. We respond with migraine attacks to things that people without migraine wouldn’t react to at all. The Bucket Theory was developed as a way to explain how difficult to control triggers (like hormones, stress and weather) fill up a portion of our bucket each day. While these triggers are hard to manage, the ones that we have some control over are the ones that we eat and drink each day.
** 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.
What Is An Elimination Diet?
An elimination diet is a short term modification of diet that allows us to remove the ‘commonly known’ migraine triggers. These triggers are either high in histamine and tyramine or substances like caffeine and MSG. The purpose of removing these items from the diet is to give the hyper responsive brain a chance to ‘calm down’. To become less responsive and relax. The elimination diet is not meant to be a new way of eating for an indeterminate amount of time. By removing things from the diet that are potentially affecting the brain’s ability to respond appropriately to the environment, we are allowing the potential for other approaches to work.
For instance, I had chronic and mostly intractable migraine for 18 years. I had suffered a migrainous stroke prior to starting on the diet and treatment plan. I felt this was my last ditch effort to get control of my migraine disease. While Topamax for migraine didn’t work by itself, when I combined it with an elimination diet and the Migraine Strong Treatment Pie, I was finally able to break the chronic cycle I had lived in for so long. I have been able to maintain being episodic since 2015. But (for me) I only followed the elimination diet strictly for four months before I began to reintroduce the foods I had eliminated. Working with the members of our closed Migraine Strong Facebook group, we have found that this time varies from person to person depending on a few factors, including how long it takes to reach baseline.
What Is Baseline?
Baseline is different for all of us. It is when our migraine attack frequency and severity has decreased significantly from beginning the elimination diet/treatment plan. We can’t really give you numbers here. I can give you my example of baseline and you can extrapolate from there, but we are all different.
When I began my elimination diet, I was having daily migraine attacks and it was difficult to determine the ending of one attack and the beginning of the next. My baseline was reached when I was having about 2-4 attacks per month. However, I thought that I could do better, so I held out for going 30 days without an attack. I’m glad I gave up on this unrealistic idea because I didn’t achieve it for more than 3 years! That would have been WAY too long to stay on my elimination diet. Basically, if you are chronic (more than 15 headache days a month) and can get to episodic (less than 15 headache days a month) and the attacks are less severe in intensity, you are on your way to baseline.
We did a recent survey in our Migraine Strong Facebook group. This feedback was about elimination diets and if they helped (or not) and how long it took to reach baseline. A whopping 89% said they had a reduction in severity and frequency using an elimination diet and the Migraine Strong Treatment Pie. The majority, 61% used the Heal Your Headache diet, and 47% had reached baseline. Most interesting of all of the polling numbers was the number of people that started this journey with chronic migraine (69%) or intractable migraine (17%) and were helped with the multi modal approach. I was in the same place when I started in 2015. My success was the impetus for starting the Migraine Strong Facebook group in the first place.
How Long Do We Tend To Stay On An Elimination Diet?
In the Heal Your Headache book, by Dr. David Buchholz he recommends four months for the elimination diet. We have found it’s better to use reaching baseline as your guide, with a few potential adjustments along the way. Some people with episodic migraine may be able to reach baseline within four months. Others with chronic migraine, intractable migraine or 24/7 vestibular migraine may take longer to see their symptoms reduce to baseline. To understand this we look back to the severity of the hyper responsiveness of the brain in these examples. If the migraine symptoms are 24/7, the time it takes for the brain to ‘calm down’ may take longer than another brain that is experiencing less than 15 symptom days a month.
In our survey, 43% of our members who reached baseline did so within 5-9 months, 33% within 2-4 months and 23% slightly longer at over 10 months. We think these are realistic numbers based on our members tending to be people with chronic, intractable, vestibular and/or 24/7 migraine. Treating migraine is hard. Finding the right combinations of medication, supplements and other modalities takes time.
Some Tweaks To Make
Generally speaking, we like to make a few recommendations if you see no improvement within 6-8 weeks after beginning the elimination diet. Take the extra step to eliminate apples and eggs that are served on their own (eggs baked in things are fine). Sometimes eliminating these two extra items will make a significant difference. Though it is not recommended to do that in the beginning. If there is no improvement after that, we always encourage Migraine Strong members to reach out to us. It’s possible a part of the Treatment Pie might be under utilized.
While most of our members have improvement in their overall migraine condition and are helped with diet, some are not. And that’s ok. We all are unique and have different triggers.
As important as the elimination phase of the diet is, reintroduction of eliminated food is perhaps even more important to continue our healthy relationship with food.
When Do We Start To Reintroduce Food?
Using baseline as a guide, the reintroduction of food will start when your migraine attacks have significantly reduced in frequency and severity. At this point you will have more control over your migraine attacks than you did when you started the diet. The attacks will also respond to your acute and rescue meds better than when the treatment plan began. Many people feel a normal amount of anxiety when they get to this point and will sometimes delay the reintroduction phase because they are feeling so much better. This is completely normal but we encourage everyone to be brave!
Most the of the foods that you have eliminated during the elimination phase will not end up being your personal triggers. The purpose was to allow the brain to have a break from all of the ‘commonly known’ triggers in an effort to calm the hyper responsiveness. Having achieved that, it’s time to add back in the foods that you have truly been missing. We recommend choosing something that you have really missed! Or something that makes meal prep easier.
Everything Is a Trigger…Or Is It?
This process isn’t as complex as it seems. There are just a few factors that have to be taken into consideration when thinking about outcomes. Many people have anxiety when reintroducing a potential trigger food. This can trigger an attack on its own. It’s important to remember that a majority of these foods will not be your personal triggers. Most of us don’t have a laundry list of food triggers.
Many times, food cravings (hello chocolate!!) during prodrome seem like triggers when the attack phase happens shortly afterwards. It’s important to set these ideas of past triggers aside (we know how hard this is!!) It’s also important to consider the Bucket Theory and how our bucket can fill up with other things on the days that we are also testing new foods.
The Reintroduction Process
The reintroduction process is simple. Choose the food you want to reintroduce. Eat it every day for five days and see if you react to your chosen food. It’s super common if you normally have some anxiety to get migraine symptoms on the first day…power through. Make note of how you have been sleeping, and the weather and any additional stress. We can’t control everything and there will never be a perfect time to try a new food. If you have an increase in attacks around your cycle, it’s a good idea to avoid that week for food testing.
My Experience With Reintroduction
Everyone will have different examples of what they consider a successful reintroduction. For me, I really wanted to be able to have guacamole so avocado was high on my list of foods to reintroduce. I started with half an avocado each day for five days. By day five, I was having some moderate head feistiness. I was able to treat the attack with no problem. My takeaway from the test was that avocado was likely a very low grade trigger. I could likely have it three days in a row, but not five. In my mind, it was a successful reintroduction. I didn’t have avocado or guacamole more than a couple of times a week, so I was in good shape. As the years have passed, I can now eat avocado daily with no repercussions.
It’s easy to blame food/drink because it is the one of the only things that we can truly control. I try to look at all of the other things that might have affected me before I blame food. Diet can be a powerful ally in how we treat our disease, but in the end, it’s not the only thing that helps us improve. It is just one slice of the Treatment Pie, one tool in our toolkit.
The Treatment Pie – A Multi Modal Approach
The success rate in our Facebook group comes from a large percentage (84%) using the Treatment Pie, with just 8% opting for trying the approach initially without prescription medication. This can be most effective for those with episodic migraine. We see most of our members improving more rapidly when they combine prescription medication with the multi modal approach demonstrated in the Treatment Pie (also including supplements, movement, diet, sleep, therapy, meditation, hydration). Take a few minutes to read our blog on the Treatment Pie to understand why throwing everything at migraine can net you the best result.
What Do The Experts Say About Diet?
It seems every week we see a new headline about which diet is the ‘new healthy’ or the one that will lead us to our demise. The recommendations change monthly, sometimes weekly, about what we should and shouldn’t eat. Is it no wonder that there is little consensus in the migraine community about diet? Our blog about the science behind migraine diets explains the dilemma. Part of the problem is that an elimination diet isn’t super easy. It can be frustrating and annoying to do on your own. I know. I did it. Doctors also loathe adding to our stress by suggesting something that they can’t support in their offices. That’s part of the reason the Migraine Strong Facebook group is around. To offer a community to those that want to give this a try with support from those that are also doing the same thing.
Join us on Facebook for a fun, educational and supportive community which talks about a lot more than diet. However, if someone has told you that migraine diets ‘don’t work’, come check out our group to get the scoop on what is happening with us. We think there is a place for diet in the treatment of migraine. It can be a powerful tool that you just won’t know if it works until you give it a try. As always, we’ll be here to help.
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