Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease. This episode is brought to you in part by our generous sponsors Amgen and Novartis.
Learn how to use food as part of your migraine management regimen with natural food chef Alene Brennan. Alene simplifies the process of using a healthy diet to manage migraine as she talks about food triggers, allergies, elimination diets, pattern tracking, migraine-friendly foods, snack tips, and more.
Since 2015, Amgen and Novartis have been working together to develop pioneering therapies in Alzheimer’s disease and migraine. Together, Amgen and Novartis share in a mission to fight migraine and the stereotypes and misconceptions surrounding this debilitating disease.
Molly O’Brien: Hello and welcome to Spotlight on Migraine. I’m your host, Molly O’Brien. Today, we’re talking about how diet can impact migraine, and our guest is a certified nutrition coach. She’s been featured in many national publications. I’d like to say hello and welcome to Alene Brennan. Thank you so much for joining us.
Alene Brennan: Thank you for having me. Happy to be here.
Molly: Well, I’m really excited to chat with you, and you have chatted with the Association of Migraine Disorders before, so thanks for joining us again. Today, we’re going to start out by taking a look at how diet can impact migraine. Can you talk to us just a little bit about that?
Alene: Yeah, so we know that migraines can be incredibly complex. We don’t know quite exactly why we’re getting them all of the time and why they’re so unpredictable, but we do know that there is a connection with food and migraines. So it can be incredibly helpful if somebody is experiencing migraines and either not getting the relief that they want on medicine or just looking to understand a little bit deeper as to why they’re getting them, exploring that food connection.
Molly: So let’s talk a little bit about what we’re eating and our diet. Does it really matter what we eat and how it makes us feel? Can that really make a big impact with migraine?
Alene: It can. It can be the very thing that will trigger a migraine for you. I got interested in the connection of food and migraines because I grew up getting debilitating migraines, and I was on a rainbow of medication and still was not getting control of them. I still was not able to reduce the frequency or the intensity of them. And then I started to explore food a little bit more, and taking certain foods out and then reintroducing them, and really making a strong connection of how these foods can be the very thing that is triggering our migraines.
Now, the challenge, as I’m sure we’ll unpack a little bit more, is that the triggers can be different for each person. So we would love it if there was a list of — these are the definitive foods that definitely cause migraines for every person every single time, but unfortunately, that’s not the case. And that’s actually why it can be so hard to research food and migraines. Because there’s so many other variables, it’s hard to make that direct connection for every single person, but you are able to understand your specific migraine triggers.
Molly: Yeah, and many of us with migraine have triggers, whether it is weather, stress, food, drink, not eating, overeating. I mean, there are so many different types of triggers, so many of us with migraine are very familiar with that tricky word trigger. So let’s talk a little bit about that and some of those specific food and drinks that can possibly trigger migraine in susceptible people.
Alene: Yeah, so some of the more common food triggers can be gluten, dairy, nuts, alcohol, caffeine, artificial sweeteners. I know I’m kind of going into all the things where everyone’s like, “Don’t take away my wine and cheese!” or “Don’t take away my chocolate!” — all of the delicious things that we love and crave. But I can tell you as somebody who eliminated them as a child, it was definitely hard, but when you are able to make that connection of, “Oh, if I pass on the chocolate cake at the birthday party, I don’t go home and have a migraine” — I can have that food if I want it, but I know the next two to three days, I’m going to be in bed getting sick, the extreme head pain.
Yeah, so those are the more common food triggers. Of course, there is a laundry list, and when I sat in the neurologist’s office and he first handed me the list of food triggers, I immediately looked back at him, and I said, “This looks like an inventory list of the grocery store. What can I eat?” So it is pretty extensive, which is why the process of an elimination diet, cutting out all of those triggers, can be very tricky and overwhelming.
So if somebody’s open to that, that’s something that you can go all in on, and cut all of them out at once, and then reintroduce them in a slow way, like one at a time, to see what your body responds to. Other people will say, “Listen, I got so much going on right now. I want to get rid of these migraines, but cutting all of those foods out at once, that is enough stress to trigger a migraine alone.” So that’s where we’ll say, “Okay, let’s start with gluten. Let’s cut gluten out, and we’ll see how you do. If you get some relief from your migraines, we’re on to something.”
So, yeah, there’s definitely more common food triggers, but as you had mentioned, there’s also different variables of stress, lack of sleep, too much sleep, sleeping in on the weekends, different things like that that can make you more sensitive to some food triggers. So that’s where it becomes a little bit tricky, that you may have — a food trigger for me is definitely chocolate, and I may have a tolerance for that if all the other things in my life are coasting along. They’re on the lazy river there. But if I’m under a lot of stress, there’s no way I can touch one of my food triggers.
Molly: And I think that is what is difficult about migraine for so many reasons, right? Everybody responds differently. Everyone’s migraine journey is different. And so different things, different triggers, are different for everyone. I think we all can relate, though, right, when you said, “I was sitting in neurologist’s office and got that list of triggers.” You went like this: “What?”
I think so many people who are going to watch and listen to this can relate to that, because I know I related to that moment when I was a kid, thinking, “What? No peanut butter? No bananas? No chocolate? What? No pizza?” But again, it’s different for everyone.
So, Alene, let’s talk a little bit about — if people are interested in exploring if food can trigger their migraine, if they are susceptible to food triggers — talk a little bit about what you do. You’re a certified nutrition coach, so let’s talk — if people are interested in exploring this, talk a little bit about what you do and what you can help people with to identify if they have food triggers.
Alene: Yeah, so I walk people through that elimination diet process. So we’ll first take a good look at what you’re current eating on a regular basis, and it’s not to identify the food triggers there or there. Yes, we want to identify where the food triggers are, but I want to get a really good sense of just what you’re eating on a regular basis so that I know how to best support you in the elimination diet.
So if you’re having three meals a day or if you’re having six meals, the smaller meals, I want to see how much we’re adjusting, because it’s not just about taking things out. It’s equally important to know that we’re putting good foods in. They’re going to keep you satiated. They’re going to keep you enjoying your food, because we have to enjoy food, right? That’s a big part of why we eat — not the only part, but a big part.
So I walk them through that elimination phase. We identify all the food triggers that are in the current diet, cut them out, find good replacements to add in, but then also make it realistic for your particular lifestyle. So some people, they eat out a lot, just based on their work or their social schedule. Some people don’t know how to cook. They’re like, “Alene, I’m totally on board with whatever you want to take out or put in, but I don’t know how to cook anything in my kitchen.” So I’ll help them with some basic, basic recipes. We talk about the crock pot or InstaPot, the blender. There’s so many ways that we can simplify this.
The goal is to get you feeling better. The goal is not to add more stress. It’s to simplify this process, but at the end of it, be able to identify your specific triggers so that you can then move forward with knowing how to keep them out of your diet so that you’re keeping those migraines at bay too.
Molly: And I think that’s so important, and I like how you said, “We’re going to cater it to your lifestyle, what you need, and make sure we have the proper nutrition there,” because I think that’s really important. And when you think about the word elimination, it makes it sound a little bit scary, and for anyone who has done an elimination diet, it is. It is tough, especially if you don’t have help.
Can you talk to us a little bit about how — if people haven’t done an elimination diet before, how you get through this process safely? And I know you touched on it in the beginning a little bit, doing one food at a time, doing multiple foods at a time. How can people get through this process safely while maintaining proper nutrition?
Alene: Yeah, so you want to make sure that with the foods that you’re eliminating, that you’re making sure that you are replacing them with nutrient-dense foods. This becomes a big topic, especially when I’m talking to clients who are going gluten-free. It’s not just about buying the gluten-free version of whatever you had before, because that can create a whole host of other issues. We want to make sure if we’re cutting something out, we’re putting something even better in its place, so we are fueling your body with nutrient-dense foods.
So that’s one part of it, but then we also, as you had said — so an elimination diet is a minimum of 30 days. It’s 30 to 90 days, kind of depending upon a lot of different factors: the severity of the migraines, the progress that we get with it. But at minimum 30 days. So we’ll take that, for our example now.
After those 30 days, you want to reintroduce one food at a time and do so in a way that, ideally, all of the other potential triggers like stress; sleep; weather, we can’t control — but anything that is within our control, we want to make sure that that’s pretty even so that we’re getting a true representation of just that food’s response in your body. So we’ll reintroduce a food; give it about a good 24, 48 hours; see how your body feels; and then create another — I like to kind of add in one more day before we would reintroduce another food.
What can happen is at the end of an elimination diet, we get so eager to try things. We’ve cut out the gluten, dairy, and maybe wine, and then the first thing we have is pizza and wine. And then you get an instant migraine, and you’re like, “Oh, was it the red wine? Was it the cheese? Was it the gluten?” We don’t know. But at the end of an elimination diet, you have such a clean slate that it is such a perfect opportunity to really become connected with how each food is affecting your body.
Molly: Well, it sounds amazing to jump in and have a clean slate — a little bit of work to get there, but can definitely be worth it if you’re interested in taking that approach. So, Alene, let’s talk a little bit about how an elimination diet can differ from just a regular allergy test.
Alene: So with an allergy test, you’re going to your doctor’s office and they are performing a test there — oftentimes, it’s on the back — or some blood work. There’s a lot of different things that they can do that will test for allergies that somebody would be more likely to have an anaphylactic response to. That’s not the same as a food trigger with migraines. So where it can get a little confusing is somebody can go to their doctor and get tested for nuts, dairy, gluten, and they say, “No, you don’t have celiac. Nope, you don’t have a dairy allergy. You’re okay to eat them.” It doesn’t mean that that’s not a migraine trigger for you. So you can not have a true allergenic response based on the test, but it can still trigger migraines for you.
What’s interesting is that a lot of doctors are encouraging patients to try an elimination diet not just with migraines, but kind of across the board if they’re getting a reaction to something, because it allows you to get a clearer sense of how foods respond in your body, and you have that direct experience. One of the things that I feel like was one of the best gifts I got in this whole process is being so in tune now with how food feels in my body.
So through this process, I’ve just learned, eat real food and pay attention to the results. And then when you feel like, “Okay, I’m starting to get a headache. What–?” then you just start to think, “What did I eat?” And then you’re able to kind of pinpoint, “Oh, I didn’t realize that had an artificial sweetener in it,” or “I didn’t know that was cooked with a peanut oil” — something like that. But it’s very empowering when you can trace it back and understand what triggered that migraine, because then you just avoid that and, ideally, then avoid the migraine.
Molly: I really like that line of thinking, Alene, the really being mindful and becoming empowered, because we do make choices when we’re eating, and I think that really is a powerful statement. It is tough because we don’t always have time to think about every food decision that we’re making, but I think it is really empowering, like you were saying.
A lot of doctors say, “Keep a headache journal; keep a migraine journal,” which isn’t always easy. And then you hear, “Okay, well, write down what you eat,” that kind of thing. Can you talk to us a little bit about that, and can that help in the whole process of just writing it down?
Alene: It can help us to identify patterns that we may not be aware of in the moment. It’s helpful, then, to be able to look at something in that rearview mirror, and then you’re able to say, “Wow, I never realized that every Saturday morning, I’m waking up with a migraine.” And then you start to look, and you’re like, “Oh, that’s the first day that I’m sleeping in,” or “Oh, we go out to happy hour every Friday night.”
So you don’t always realized it, but that journal can really bring things crystal clear for you. So it’s work, right, because you’re having to log every single thing that you’re eating, everything down to mints and gum, beverages, all of those things. But keep in mind, it’s not something you’re doing forever. So if you can commit to it for 2 weeks, or if you can commit to it for 30 days, whatever you can do — the more data you collect, the better. But if you can commit to it 100 percent for a defined period of time, then you know that you’ll have good data so that, ideally, moving forward, it’s not something that you have to deal with.
Molly: I love that. Hold yourself accountable, and you can become more mindful, and it empowers you to move forward in your migraine journey and hopefully become more successful as you tackle your migraine.
So, Alene, a lot of people with migraine also have GI disorders. Can an elimination diet also help in that regard?
Alene: Absolutely. So we know that our health is directly connected with our gut health, and what’s interesting is that a term known as leaky gut, or intestinal permeability — so the lining of your intestines should have these tight junctions, and what happens — for a variety of reasons, they can weaken, and you can get little gaps in there. So undigested food particles and different things can get outside of that digestive tract and into the body.
And what they’re finding is that that can be the root cause of a lot of digestive issues. Gluten is one of the most aggravating foods for leaky gut and one of the very common migraine triggers. So it’s interesting that it’s the same food that creates a lot of digestive distress and also can trigger migraines.
So it’s helpful to, one, get that food out of your diet, because then you’re going to clear up the digestive system. You’re going to eliminate the migraines. But by clearing up the digestive system, you’re helping your overall health, not just the migraines.
Molly: All right. So, Alene, we’ve talked a lot about the elimination diets, things that you can do with that, and you have mentioned several times that nutrition-dense foods — so let’s forget about eliminating stuff for a little while, and let’s talk about really good, healthy, nutrition-dense foods. Are there any good foods that we should all be eating that can actually help with migraine?
Alene: When I talk about nutrient-dense foods, I’m focusing a lot on plant-based foods. So our vegetables are where we are getting our most nutrients. Fruits certainly have a lot of vitamins and minerals and phytonutrients as well, but we tend to gravitate more towards the fruit first, and then we’ll get to veggies when we get to them. Let’s bring them front and center. And there’s so many ways that we can enjoy them now without having steamed broccoli over and over again.
For dinner this evening, I had mashed cauliflower, and I absolutely love it. You steam up the cauliflower, mash it up. I put a little bit of non-dairy butter, salt, and pepper, and it’s done. It’s so fast. I feel like I’m eating mashed potatoes, but I’m actually getting a serving of vegetables in with it. You can do riced cauliflower, the zucchini noodles. There’s so many ways that you can creatively get vegetables into your diet.
And I think that’s especially important if you’re working with a younger population. So I definitely got my greens as a kid. It sounded like you did as well. Vegetables aren’t the first things kids are reaching for, right? So that’s something that we need to be realistic about, and how can we creatively get some of those vegetables in with — path of least resistance, right? So if a child is open to certain vegetables, let’s work on them first, and then maybe we tuck some in without them realizing it. Maybe we get them started on a smoothie, and you put it in a container that they can’t see. You tuck spinach in there, and it’s your green monster smoothie or something along those lines.
But, yeah, so a lot of vegetables, a select amount of fruit — and I say that because we know bananas we have to be mindful of. Some people are sensitive to citrus fruits. Berries are always great, low on the glycemic index, high in phytonutrients. So, yeah, a lot of the vegetables, select amount of fruits.
And I will say one thing that I often lean on when I do get a migraine is ginger. Ginger is fantastic for helping to reduce the intensity, I’ll say, of a migraine. It’s not necessarily going to banish your migraine completely, but if you have a minor one and you catch it early enough, maybe it will. But just chopping up some ginger and putting it in a big pot of water, steeping it. You can add some cinnamon in there as well, and sipping on that ginger tea throughout the day really can help cut the edge of that migraine. And it also helps to reduce nausea, so we’ll take that as a perk too.
Molly: We are big ginger fans in this house, so thank you for adding another recipe to my ginger list. Do you have any fun, fast snack ideas that you can share with us that are healthy and can make us feel good?
Alene: Yeah, absolutely. So one of the biggest things that you can do is prep in advance, right? So you say that there’s times where you’re just like — you don’t have the energy or the interest. It’s just like, “I need something to go.” So if you have a moment that you can take on a Sunday and prep some meals or some snacks.
It doesn’t have to look like the Pinterest meal boards do. It can be just some grilled chicken breast. It can be a big roasted thing of vegetables. You can do a big pot of soup, or smoothies you can do a little bit in advance. If nothing else, you can put the ingredients in a ziplock bag and put them in the freezer, so then you’re just taking that, emptying it out, putting some liquid in, and blending it up. That’s a really quick and easy thing that could be either a meal or a snack.
But then also we talked about getting some of those veggies in. If you can get some carrots or some bell peppers or celery, and then whatever dip you will tolerate — so a lot of people do well with hummus. If you don’t have a sensitivity to avocados, you can do some guac. So I would say trying to get as many of those vegetables in, and then creating a dip that you know that you can have. If you can buy it in the smaller packs in the grocery store, fantastic. If not, you can always make them yourself.
And for people who have a nut sensitivity because of their migraines, they do sell sunflower butter, and a lot of the people do really well on that. So you could always have that, maybe an apple with some sunflower butter, or put that on celery. There’s a lot of different things that you could do.
Molly: All sound very delicious. So, Alene, as we wrap up here, we’re so appreciative of your time and giving us a lot of good ideas, probably making a lot of people hungry out there. You’ve done a lot of good work with this, and you have also some more great ideas on your website, which we will share. But any final remarks as we send things off?
Alene: Yeah, I would just say that it’s easy to be skeptical. I certainly was with the level of migraines that I got. I mean, my worst migraine — they rushed me to the hospital. They thought I had spinal meningitis because I could barely move my body. I was at that point, and I was admitted to the hospital for a week. So I’m not coming on and saying that I had one migraine and now I’m speaking on migraines.
I have experienced the intensity of them, and I can get that they can be debilitating. And it can be challenging to imagine that food can really have an impact on them, but it can. And if you are in that level of pain and the frustrating of feeling like they’re running your life, and you can’t plan anything because you have no idea when one is going to swoop in and just cancel out all of your plans, it’s worth giving it a try. It’s worth giving it a try of cutting out the foods for the 30 days, getting some good foods in its place.
Molly: Definitely worth it, and I think, hey, when you are on your migraine journey, to get any sense of relief — definitely worth a shot, right? Why not? Why not give it a try?
And we’re wrapping up here on Spotlight on Migraine. I’d like to thank our guest today, Alene Brennan. She is a certified nutrition coach, and if you want to reach out to her, get some more information on possible elimination diets, or just connect, you can reach out to her on her website at alenebrennan.com.
Thank you so much for joining us to day on Spotlight on Migraine. I’m your host, Molly O’Brien. We’ll see you next time.
Thank you for tuning in to Spotlight on Migraine. For more information on migraine disease, please visit MigraineDisorders.org.
This podcast is sponsored in part by Amgen/Novartis.
*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.