A neurologist explains food triggers in children and how to safely and effectively conduct an elimination diet
What should parents do if they suspect a certain food is triggering their child’s migraine attacks? How do caregivers safely eliminate foods from a child’s diet? To answer those questions and more, we talked with Dr. Jennifer Hranilovich, an Associate Professor with the University of Colorado and a child neurologist and headache specialist at the Children’s Hospital Colorado. She explains the science behind food triggers and strategies to safely identify and remove foods that don’t work.
No one pathway to migraine
When talking to families in the clinic, Dr. Hranilovich always explains that there is no one underlying reason for migraine attacks. Rather, causes and triggers vary from person to person. She points to studies that look at hundreds of thousands of people living with migraine and their DNA. “About 150 different genes are maybe associated with migraine,” she says. “There are a lot of different ways that your body can end up at the final end point of a migraine.” Similarly, we think that food triggers vary from one person to another, so there is no one size fits all approach that can be used.
Food triggers: Cause or correlation?
It’s important to realize that food might not always cause migraine attacks and many children do not have food triggers. Dr. Hranilovich explains that people sometimes experience cravings during the prodrome, the two- to 48-hour period before the headache. She explains how someone who craved and ate chocolate during prodrome and experienced a migraine attack the next day might think chocolate caused the headache.
“It’s sometimes not cause and effect but an association in time,” she says. “It can be tricky as a person who lives with migraine to tease out any patterns and determine if there is a true trigger phenomenon going on.” As a pediatric neurologist, Dr. Hranilovich is often asked by parents and children to help them carry out an elimination diet to find and remove food migraine triggers.
What is an elimination diet?
Medical professionals often use elimination diets to help patients figure out foods that they are allergic to, or in this case, foods that trigger migraine attacks. An elimination diet removes foods thought to cause uncomfortable symptoms and reintroduces them at a later time. The patient’s symptoms are recorded and help inform doctors about their allergies or triggers.
How to Start an Elimination Diet
#1 Call a professional. Adults and children can both benefit from eliminating foods linked to their attacks. But it’s important to speak with a professional and seek supervision in cases of pediatric migraine. Children are still growing and need to maintain a balanced intake of carbohydrates, proteins, fats and nutrients, so any elimination should happen under the guidance of a physician. That way, they can monitor the child’s growth and look out for vitamin deficiencies.
#2 Ensure that the child buys in. As with all migraine-related lifestyle adjustments, the person living with migraine needs to buy in and be an active participant in their care. Dr. Hranilovich says that explaining the diet with the help of a nutritionist might be beneficial, and caregivers should frame the diet as a way for the child to take action and manage their migraine. If a child views the elimination diet as a punishment, or it creates stress and social friction at school, it might be more harmful than helpful.
#3 Keep careful track. Elimination diets work when people exclude only one food group or food item at a time. They also work best when people keep careful track of their meals and migraine attacks. A migraine diary is one way to remember all the possible food factors that preceded a migraine attack. It can also track the success of an elimination diet. “As humans we like to see patterns and sometimes people could be associating things that maybe line up but don’t always have a cause and effect relationship,” says Dr. Hranilovich. “The diary helps to see if there’s a true pattern.”
Diet is a vital part of maintaining a healthy routine and practicing migraine self-care. Not skipping meals, eating healthy and avoiding triggers can all contribute to fewer migraine attacks. If you’re interested in making changes in your child’s diet to reduce migraine frequency, please consult your doctor to put together a personalized migraine management plan that everyone buys into.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library or Pediatric Migraine Content Hub. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.