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Vestibular migraines are a type of migraine characterized by dizziness and vertigo. Vertigo is the sensation of moving when you are not, and many patients suffering from vestibular migraine describe it as a back and forth motion. These migraines may or may not involve a headache.
Vestibular migraines can be difficult to diagnose, especially those that don't involve headaches. To qualify for a migraine diagnosis, you'll need to experience headaches located on one side of your head, come with pulsating pain, and have at least one additional symptom, including light sensitivity, sound sensitivity, or visual auras.
Getting a vestibular migraine diagnosis is difficult if your migraines don't involve headaches. Your doctor will need to rule out other conditions that can cause vertigo, like Meniere syndrome and benign paroxysmal positional vertigo. These conditions can overlap, but they are distinct from vestibular migraines.
It's also common for the dizziness to start after you've already been experiencing migraines for several years. The average age of onset for migraine-related vertigo is more than 20 years later than the average age for migraines to begin. This can make identifying vestibular migraines even more difficult since it can be hard to tell if the vertigo is a new problem or a complication of your existing migraines.
Doctors and researchers aren't certain about what causes vestibular migraines, but there is some evidence that diet is involved. Many people who experience migraines find that certain foods trigger their migraines. Identifying those foods and eliminating them from your diet can help prevent migraine episodes.
There is no set vestibular migraine diet, but many foods are associated with migraines. Eliminating these foods can help you and your doctor determine whether these foods are triggers for you. On the other hand, some foods may help with your migraine symptoms.
Identifying these is more difficult and will usually require some trial and error.
Because migraine trigger foods are different for each individual, you can use an elimination diet to identify which foods are a problem for you. Elimination diets are a two-phase process that helps you and your doctor figure out whether something in your diet is causing your migraines and, if so, what those foods are.
While some foods are associated with migraines, triggers can be different for everyone. To identify what is causing your migraines, it can be a good idea to keep a food diary to track what you eat and when. Look for foods that you eat before you have a migraine.
During the elimination phase, you stop eating potential trigger foods for about two or three weeks. If your symptoms improve during the elimination phase, you can be fairly certain that your diet affects your migraines. Since an elimination diet requires cutting out multiple food groups, you should work with your doctor or a dietician to ensure you're getting enough nutrients during the first phase.
In the second phase of the elimination diet, you'll reintroduce the foods you eliminated one at a time every 2 to 3 days. If you experience symptoms after eating a certain food, you can assume that food is related to your migraines, and you might need to eliminate it from your diet permanently.
Migraine trigger foods can be different for each person, but some relatively common ones can offer a good starting point. One study¹ found that 19% of participants were sensitive to either cheese or chocolate, and 11% were sensitive to citrus fruits.
Other common trigger foods include:
Coffee and tea
Beef and chicken livers
Artificial colors and preservatives
Nutrients and chemicals associated with migraines include phenylethylamine, aspartame, caffeine, nitrates, MSG, alcohol, and histamine. Consider avoiding foods that contain these.
Foods rich in calcium, magnesium, riboflavin, and tryptophan are associated with positive effects on migraines. These foods include:
Sesame seeds and pumpkin seeds
In addition to actively helpful foods, you should look for those that negatively affect your migraines. Most fruits and vegetables fall into this category. Some foods fall into both the potentially triggering and the potentially beneficial categories.
For example, milk is a good source of calcium, but it can also cause migraines. This is why an elimination diet that lets you identify your food triggers is essential for designing the right migraine diet.
Caffeine is another complicated food ingredient. Studies have found conflicting evidence showing that caffeine can sometimes trigger migraines but can sometimes help improve them. Caffeine is a common ingredient in migraine medications that many patients find effective and helpful. In addition, withdrawal headaches caused by eliminating caffeine can trigger migraines.
If you drink coffee or other caffeinated beverages regularly and don't find that caffeine triggers your migraines, you should try to consume a consistent amount each day to avoid these withdrawal headaches.
While dietary changes can be helpful for many people dealing with migraines, they aren't an immediate fix for everyone.
Elimination diets, especially in the first phase, are extremely restrictive. Cutting out all of the foods you want to analyze while getting all of the nutrients you need is difficult. To get accurate results, you'll need to stick to the diet perfectly, which can be challenging for many people.
Making a major, even if temporary, change to your diet can be stressful. Making changes to your diet plan will make your regular grocery shopping and cooking more complicated and make eating out difficult.
Of course, if you're struggling with migraines, the challenge of the elimination diet could be worthwhile. You can avoid some of these problems by discussing what you should be eating during the elimination phase with your doctor or dietitian. Make sure to have enough ideas planned using your safe foods. Skipping meals or going too long without eating can also trigger migraines.
This is unpleasant and can also make identifying food triggers more difficult.
Eating a trigger food once doesn't always lead to a migraine immediately afterward. Migraine triggers can be complicated. You might experience a cumulative effect from eating a certain food several times or after eating multiple trigger foods on the same day.
You might have a particular food that triggers a migraine sometimes, but not every time you eat it. This means that the elimination diet process doesn't always identify your problematic foods accurately.
Some foods have an especially complicated relationship to migraines. Studies have looked at caffeine and chocolate specifically and found that people sometimes consume these as a migraine is coming on because of their early symptoms.
For example, if sleepiness is a migraine symptom for you, you might reach for a cup of coffee when you start to feel tired. This results in you consuming caffeine before experiencing a migraine. The caffeine didn't trigger the migraine in this case. However, caffeine can be a migraine trigger for some.
Not all migraines are related to diet. If this is the case for you, your symptoms won't improve during the elimination phase. Trying an elimination diet can at least help you figure out that your migraines aren't related to food, which is useful information.
However, many people have both food and non-food triggers.
If your migraines are triggered by both stress and dairy products, for example, you might have a hard time determining whether a particular migraine was triggered by a difficult day at work or by reintroducing cheese.
Stress and lack of sleep are common non-food triggers of vestibular migraines. It's important to ensure that stress about your elimination diet isn't causing migraines. Don't forget about non-dietary factors in your health while focused on finding your food triggers.
While they aren't a perfect solution for everyone, elimination diets can be a good way to identify your vestibular migraine triggers. Since they are a short-term way to gather information, completing an elimination diet is safe for most people as long as they consider their overall nutritional needs.
Vestibular migraines are unpleasant episodes of dizziness and vertigo and might or might not include a pulsing headache. There isn't a well-defined cause of vestibular migraines, but diet can trigger migraines for many people.
Going on an elimination diet, in which you eliminate foods and then reintroduce them gradually, is a good way to identify food triggers for your vestibular migraines. Common food triggers include cheese, chocolate, milk, eggs, sugar, and coffee.
While elimination is a helpful tool for managing migraines, they aren't a perfect solution. Non-food triggers, like stress and insufficient sleep, can also cause vestibular migraines. Determining which foods are a problem for you can be difficult.
Still, dietary changes can reduce migraines for many people.
Migraine-associated vertigo (2022)
Migraine and diet (2020)
Nutrition guide for migraines | Medical University of South Carolina