STUDIES BOLSTER LINK OF FOOD AND MIGRAINES - The New York Times
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NEW research is lending credence to a long debated idea that food allergies may cause migraines in a majority rather than a minority of people who have the headaches.
Several studies conducted in the United States and England in the last five years have shown that about 75 percent of migraine patients are allergic to five or more foods, while some patients are allergic to 20 or more foods. When the patients were placed on diets that eliminated or drastically reduced contact with such ''trigger'' foods, their migraine headaches stopped or became less frequent and severe.
Despite the gathering evidence implicating food allergies, many specialists are not fully persuaded of their importance and say they are awaiting more data.
Most physicians agree that headaches, including migraines, are a symptom and not a disease. That is, there are underlying mechanisms that give rise to the sensation of head pain. Migraines affect one side of the head with pain lasting from a few hours to more than a week. Between 10 million and 20 million Americans experience migraines.
Two of the studies used ''double blind'' experimental techniques to verify the relationship between food allergies and migraines. Great care was taken to assure that patients and doctors taking part in the experiments were not swayed by personal biases. Both studies found that migraines were consistently provoked by trigger foods - foods the subject was allergic to - and not by placebos. They strongly support, therefore, the notion that the allergy-migraine connection is real for many patients.
Dr. Donald Dalessio, a migraine expert at the Scripps Clinic and Research Foundation in La Jolla, Calif., maintains that food allergies may be a factor in only about 10 percent of patients with migraines. He agreed that ''there are some foods that bother migraine patients, with alcohol being the most common.''
But, Dr. Dalessio said, there is no known mechanism through which food allergies have been shown to produce migraines. Until the fundamental mechanisms that cause migraines are understood, he said, skepticism about allergies is warranted.
According to Dr. Seymour Diamond, founder of the Diamond Headache Clinic in Chicago, less than five percent of his patients likely suffer migraines due to food allergies. Dr. Diamond said his clinic sees 2,000 new patients a year and has an average of 30,000 patient visits a year. ''We see people all the time who have undergone allergy testing and desensitization without it being any great success,'' he said. ''Special diets do not help many patients. I'm not sold on the idea.''
Researchers involved in the recent studies say, however, that physicians who treat migraines should keep an open mind. Dr. James Breneman was chairman of the food allergy committee of the American College of Allergy for 15 years and maintains a private practice in Kalamazoo, Mich.
''I am convinced three-fourths of migraines are food related,'' Dr. Breneman said in an interview. ''Those who are skeptical have not adequately investigated the role of food. It is a time-consuming process and the tests are sometimes faulty and difficult to do. But the tools we use are showing us there is a much higher incidence of food allergies than previously believed.''
Dr. Breneman said migraine patients tend to be allergic to common foods they eat every day - wheat, eggs, milk and corn. Moreover, these foods elicit a slow allergic response. Substances formed by the immune system in reaction to the foods are not manifest in blood vessels and other tissues until two or three days after the foods are eaten, Dr. Breneman said. As a result, migraine sufferers find it difficult to relate specific foods they eat to headaches they develop. Strategies and Results
The idea that food allergies cause migraines was suggested more than 75 years ago, Dr. Breneman and others said. It was fashionable in the 1930's and 1940's to think that food allergies caused many diseases, including schizophrenia and multiple sclerosis. As those ideas were discredited, however, the notion that food allergies cause migraines was similarly dropped. It is only now being revived by allergists. Neurolgists and internists prefer to treat migraines with drugs, Dr. Breneman said, because of their different training and outlook on the issue.
The recent studies showing the strong link between food allergies and migraine shared certain strategies and results.
Researchers first put migraine patients on a hypoallergenic diet for one week to four weeks. That is, care was taken to not feed the patients any foods that could cause an allergic reaction. In some studies the patients drank liquid ''astronaut formula'' foods consisting of simple protein, carbohydrates and vitamins. Others ate perhaps only lamb, rice and apple every day for a month. Some subjects chose to fast for a week, taking only vitamin and mineral supplements. The goal in each of the studies was to withdraw migraine patients from a normal, varied diet and from any foods to which they might be allergic.
After the migraine patients were headache free on the restrictive diets, the researchers slowly reintroduced foods, one at a time. The study designs varied, but in most cases foods that caused migraine headaches in patients could be singled out. In all the studies, however, some patients did not respond to the diet therapy. Their headaches continued no matter what they ate or did not eat. Ruling Out Imagination
Dr. J. Egger of the Hospital for Sick Children in London found that 82 out of 88 children with migraine headaches recovered completely after being placed on special diets. Most of the children were allergic to several foods. One child who reacted to 24 foods was symptom-free on a diet avoiding all 24 substances.
Children often craved the foods that provoked their migraines, Dr. Egger reported, and tended to eat them in large quantities. Reactions were often highly specific. Some patients reacted to white wheat flour but not to whole wheat flour. Others were allergic to bacon but not to pork. One could eat beet sugar but not cane sugar.
Dr. Egger's study, reported two years ago in the British medical journal Lancet, is considered one of the best in the field because he used the double-blind experimental technique to show the link between foods and migraines was not imagined by the children.
Forty children were fed specially formulated foods made to taste exactly alike. Some formulas contained a food to which each child was allergic and some did not. The majority of children, 87.5 percent, developed migraines after eating a food, hidden in the formula, to which they were allergic.
In a more recent study, reported in last August's issue of the Annals of Allergy, 43 adult migraine patients were similarly studied by Dr. Lyndon Mansfield of Texas Tech University Health Sciences Center in El Paso, Tex. After determining food allergies through skin tests, a third of the patients improved by going on special diets. Six were headache free.
Dr. Mansfield tested seven patients with double-blind food challenge tests. Subjects swallowed two kinds of capsules, sugar pills or capsules containing a food to which they were allergic. Five patients developed migraines when exposed to a trigger food. One woman used to eat cinnamon every day for breakfast, Dr. Mansfield said, until she found it was provoking her migraine headaches. Amino Acid Is Suspected
Several other studies reported in recent years claim that at least that two-thirds of severe migraine sufferers are allergic to certain foods. Some have theorized that migraines can be precipitated by foods containing the amino acid tyramine. Tryramine is found in aged foods such as cheese and alcohol as well as in chocolate and citrus fruits.
To help physicians determine if migraine patients have a food allergy, Everett Hughes, an assistant clinical professor of otolaryngology at the University of Southern California, has recently developed a diagnostic test that predicts who might benefit from long-term diet management. His work is reported in the July issue of the Annals of Allergy. Food Sensitivities Vary
The researchers stressed in their scientific papers that individuals with migraines might find no relief by eliminating foods commonly associated with headaches because individuals vary so greatly in their food sensitivities. In Dr. Eggar's study, if only foods high in tyramine had been eliminated, only five percent of the children would have improved.
In removing foods by guesswork, he said, a person may eat more of other migraine provoking foods and develop worse headaches.
On the other hand, diets undertaken by many migraine patients are notoriously hard to follow. ''Eating is one of life's pleasures,'' said Dr. Dalessio. ''I don't believe people should be put on rigorous diets unless there is a spectacular reason for it.'' The hypothesis that foods cause most migraines, he said, is not reason enough until there is better proof.
A version of this article appears in print on January 7, 1986, on Page C00001 of the National edition with the headline: STUDIES BOLSTER LINK OF FOOD AND MIGRAINES. Order Reprints| Today's Paper|Subscribe
STUDIES BOLSTER LINK OF FOOD AND MIGRAINES - The New York Times
Archives|STUDIES BOLSTER LINK OF FOOD AND MIGRAINES
https://nyti.ms/29oUWnG
NEW research is lending credence to a long debated idea that food allergies may cause migraines in a majority rather than a minority of people who have the headaches.
Several studies conducted in the United States and England in the last five years have shown that about 75 percent of migraine patients are allergic to five or more foods, while some patients are allergic to 20 or more foods. When the patients were placed on diets that eliminated or drastically reduced contact with such ''trigger'' foods, their migraine headaches stopped or became less frequent and severe.
Despite the gathering evidence implicating food allergies, many specialists are not fully persuaded of their importance and say they are awaiting more data.
Most physicians agree that headaches, including migraines, are a symptom and not a disease. That is, there are underlying mechanisms that give rise to the sensation of head pain. Migraines affect one side of the head with pain lasting from a few hours to more than a week. Between 10 million and 20 million Americans experience migraines.
Two of the studies used ''double blind'' experimental techniques to verify the relationship between food allergies and migraines. Great care was taken to assure that patients and doctors taking part in the experiments were not swayed by personal biases. Both studies found that migraines were consistently provoked by trigger foods - foods the subject was allergic to - and not by placebos. They strongly support, therefore, the notion that the allergy-migraine connection is real for many patients.
Dr. Donald Dalessio, a migraine expert at the Scripps Clinic and Research Foundation in La Jolla, Calif., maintains that food allergies may be a factor in only about 10 percent of patients with migraines. He agreed that ''there are some foods that bother migraine patients, with alcohol being the most common.''
But, Dr. Dalessio said, there is no known mechanism through which food allergies have been shown to produce migraines. Until the fundamental mechanisms that cause migraines are understood, he said, skepticism about allergies is warranted.
According to Dr. Seymour Diamond, founder of the Diamond Headache Clinic in Chicago, less than five percent of his patients likely suffer migraines due to food allergies. Dr. Diamond said his clinic sees 2,000 new patients a year and has an average of 30,000 patient visits a year. ''We see people all the time who have undergone allergy testing and desensitization without it being any great success,'' he said. ''Special diets do not help many patients. I'm not sold on the idea.''
Researchers involved in the recent studies say, however, that physicians who treat migraines should keep an open mind. Dr. James Breneman was chairman of the food allergy committee of the American College of Allergy for 15 years and maintains a private practice in Kalamazoo, Mich.
''I am convinced three-fourths of migraines are food related,'' Dr. Breneman said in an interview. ''Those who are skeptical have not adequately investigated the role of food. It is a time-consuming process and the tests are sometimes faulty and difficult to do. But the tools we use are showing us there is a much higher incidence of food allergies than previously believed.''
Dr. Breneman said migraine patients tend to be allergic to common foods they eat every day - wheat, eggs, milk and corn. Moreover, these foods elicit a slow allergic response. Substances formed by the immune system in reaction to the foods are not manifest in blood vessels and other tissues until two or three days after the foods are eaten, Dr. Breneman said. As a result, migraine sufferers find it difficult to relate specific foods they eat to headaches they develop. Strategies and Results
The idea that food allergies cause migraines was suggested more than 75 years ago, Dr. Breneman and others said. It was fashionable in the 1930's and 1940's to think that food allergies caused many diseases, including schizophrenia and multiple sclerosis. As those ideas were discredited, however, the notion that food allergies cause migraines was similarly dropped. It is only now being revived by allergists. Neurolgists and internists prefer to treat migraines with drugs, Dr. Breneman said, because of their different training and outlook on the issue.
The recent studies showing the strong link between food allergies and migraine shared certain strategies and results.
Researchers first put migraine patients on a hypoallergenic diet for one week to four weeks. 
That is, care was taken to not feed the patients any foods that could cause an allergic reaction. In some studies the patients drank liquid ''astronaut formula'' foods consisting of simple protein, carbohydrates and vitamins. Others ate perhaps only lamb, rice and apple every day for a month. Some subjects chose to fast for a week, taking only vitamin and mineral supplements. The goal in each of the studies was to withdraw migraine patients from a normal, varied diet and from any foods to which they might be allergic.
After the migraine patients were headache free on the restrictive diets, the researchers slowly reintroduced foods, one at a time. The study designs varied, but in most cases foods that caused migraine headaches in patients could be singled out. In all the studies, however, some patients did not respond to the diet therapy. Their headaches continued no matter what they ate or did not eat. Ruling Out Imagination
Dr. J. Egger of the Hospital for Sick Children in London found that 82 out of 88 children with migraine headaches recovered completely after being placed on special diets. Most of the children were allergic to several foods. One child who reacted to 24 foods was symptom-free on a diet avoiding all 24 substances.
Children often craved the foods that provoked their migraines, Dr. Egger reported, and tended to eat them in large quantities. Reactions were often highly specific. Some patients reacted to white wheat flour but not to whole wheat flour. Others were allergic to bacon but not to pork. One could eat beet sugar but not cane sugar.
Dr. Egger's study, reported two years ago in the British medical journal Lancet, is considered one of the best in the field because he used the double-blind experimental technique to show the link between foods and migraines was not imagined by the children.
Forty children were fed specially formulated foods made to taste exactly alike. Some formulas contained a food to which each child was allergic and some did not. The majority of children, 87.5 percent, developed migraines after eating a food, hidden in the formula, to which they were allergic.
In a more recent study, reported in last August's issue of the Annals of Allergy, 43 adult migraine patients were similarly studied by Dr. Lyndon Mansfield of Texas Tech University Health Sciences Center in El Paso, Tex. After determining food allergies through skin tests, a third of the patients improved by going on special diets. Six were headache free.
Dr. Mansfield tested seven patients with double-blind food challenge tests. Subjects swallowed two kinds of capsules, sugar pills or capsules containing a food to which they were allergic. Five patients developed migraines when exposed to a trigger food. One woman used to eat cinnamon every day for breakfast, Dr. Mansfield said, until she found it was provoking her migraine headaches. Amino Acid Is Suspected
Several other studies reported in recent years claim that at least that two-thirds of severe migraine sufferers are allergic to certain foods. Some have theorized that migraines can be precipitated by foods containing the amino acid tyramine. Tryramine is found in aged foods such as cheese and alcohol as well as in chocolate and citrus fruits.
To help physicians determine if migraine patients have a food allergy, Everett Hughes, an assistant clinical professor of otolaryngology at the University of Southern California, has recently developed a diagnostic test that predicts who might benefit from long-term diet management. His work is reported in the July issue of the Annals of Allergy. Food Sensitivities Vary
The researchers stressed in their scientific papers that individuals with migraines might find no relief by eliminating foods commonly associated with headaches because individuals vary so greatly in their food sensitivities. In Dr. Eggar's study, if only foods high in tyramine had been eliminated, only five percent of the children would have improved.
In removing foods by guesswork, he said, a person may eat more of other migraine provoking foods and develop worse headaches.
On the other hand, diets undertaken by many migraine patients are notoriously hard to follow. ''Eating is one of life's pleasures,'' said Dr. Dalessio. ''I don't believe people should be put on rigorous diets unless there is a spectacular reason for it.'' The hypothesis that foods cause most migraines, he said, is not reason enough until there is better proof.
A version of this article appears in print on January 7, 1986, on Page C00001 of the National edition with the headline: STUDIES BOLSTER LINK OF FOOD AND MIGRAINES. Order Reprints| Today's Paper|Subscribe