Lifestyle changes, dietary restrictions, and nutraceuticals in migraine prevention

Migraineurs commonly identify sleep disturbance, stress events, and dietary substances as provokers for headache. The medical establishment universally recommends dietary restrictions while inconsistently addressing other causes. Before frequent headaches develop, sufferers need to minimize risks of headache progression through lifestyle changes. As headaches increase, both sufferer and practitioner begin to consider prevention, the type of which may differ. Both US Headache Consortium and American Migraine Prevalence and Prevention Study recommendations exist for introduction of drug prevention. Patients consider conventional prevention, but restrict their presumed substance triggers and use alternative therapies as well. Options available include alternative and complementary therapies, optimized lifestyles with changes as necessary, dietary and substance changes, and drug prevention with either conventional pharmacotherapeutics or nutraceuticals. This article discusses this practitioner's empiric recommendation for lifestyle changes and graded evidence for dietary changes and nutraceuticals in migraineurs. Alcohol, aspartame, nitrates, and monosodium glutamate are Grade B-rated dietary substances needing restriction, with MSG lacking data specific for migraine. No consensus yet exists on the hierarchy of efficacy for the nutraceuticals. Given the number of patients studied and data consistency or lack thereof regarding efficacy, Petadolex appears to have best proof followed by magnesium > feverfew (no commercially available MIG-99 forms) > riboflavin > coenzyme Q10 > thiotic acid.

Keywords: US Headache Consortium, AMPP, Behavioral headache management, Dietary triggers, Nutraceuticals, Evidence grading