Comprehensive diets may be the panacea for migraine prophylaxis. These diets control nutrient intake, rather than eschew certain foods. Folate, vitamin D, omega-3 and omega-6 fatty acids, overall fat, and sodium consumption may impact migraine frequency. Citrus fruits, vanillin, alcohol, and decaffeinated coffee are known food triggers that patients can exclude from their diets. Caffeine can alleviate headaches, but acute consumption in naïve consumers can induce a migraine. Celiac disease, gluten intolerance, histamine intolerance, nitrite reactivity, and obesity  have been known to cause headaches, but are responsive to changes in diet.

Now, an article in the journal Headache identifies studies stating low-fat, high-omega-3/low-omega-6, ketogenic, and high-folate diets decrease migraine frequency.

The researchers collected relevant English-language studies available on PubMed and found good evidence to support diet modification.
·      A cross-over study and open-label trial found low-fat diets (less than 20% of daily calories) reduce migraine frequency and severity compared with normal intake (25% to 30% of daily calories).
·      High-omega-3/low-omega-6 diets are superior to low-omega-6 diets for daily headache prevention. Omega-3 fatty acids are antinociceptive, and omega-6 fatty acids are pro-nociceptive.
·      Ketogenic diets (low carbohydrate, high fat) reduced headache frequency and antiheadache medication administration by 75% during ketosis. This high-fat diet is incompatible with the low-fat                  comprehensive diet. Ketones enhance GABAergic and inhibit glutamate neurotransmission, thereby controlling headaches.
·      Migraine sufferers are more likely to have folate metabolism defects and low folate consumption than nonsufferers. Two randomized controlled trials found high-dose folate reduces the severity and        disability of migraine attacks.

Most studies have shown no relationship between vitamin D consumption and headaches. Separate studies found vitamin D supplementation may alleviate tension headaches in pediatric patients and statin-induced headaches in simvastatin patients.

High-sodium diets can cause hypertension-related headaches, but migraines are unaffected by sodium intake. Monosodium glutamate and aspartame can aggravate headaches through NMDA receptor agonism by glutamate and aspartic acid, respectively.

Migraine sufferers should identify their trigger foods, consider a disease-specific diet, and then consider a comprehensive diet (or combination) if their migraines are unresponsive. Providers need high-quality randomized controlled trials before recommending any particular diet.