Review Articles Open access

To feed or to fast? Nutritional triggers in migraine: a narrative review

Authors

  • Daniele Pala – articles in this journal Corresponding author Email Department of Medical Science and Public Health, University of Cagliari; Department of Biomedical Sciences, University of Cagliari, Italy.
  • Federico Tosto – articles in this journal Department of Neuroscience, Giovanni Paolo II Hospital, Catanzaro, Italy.
  • Antonio Munafò – articles in this journal Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence; Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy.
  • Andrea Burgalassi – articles in this journal Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence; Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy.
  • Marina Romozzi – articles in this journal Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome; Neurology, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Luigi Francesco Iannone – articles in this journal Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena; Digital and Predictive Medicine, Pharmacology, Clinical Metabolic Toxicology - Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, Policlinico di Modena, Italy.
  • Catello Vollono – articles in this journal Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome; Neurology, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Paolo Calabresi – articles in this journal Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome; Neurology, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Francesco Casillo – articles in this journal Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, ICOT Istituto Marco Pasquali, Latina, Italy.
  • Cherubino Di Lorenzo – articles in this journal Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, ICOT Istituto Marco Pasquali, Latina, Italy.
Published
23 June 2026
Section
Review Articles
DOI
10.4081/cc.2026.15921

Abstract

Background: Migraine attacks typically emerge in predisposed individuals after exposure to heterogeneous stimuli that vary widely across patients. A system-level perspective highlights migraine as a disturbance of homeostasis and allostasis: the brain integrates multiple inputs and generates adaptive responses to maintain physiological stability, but sustained physiological or paraphysiological stressors may impose excessive allostatic load. When compensatory mechanisms become energetically costly or insufficient, an “allostatic reset” may occur, clinically manifesting as a migraine attack. Within this framework, the concept of a migraine trigger is better viewed as a threshold modulator rather than a deterministic cause, i.e., a stimulus that lowers the attack threshold in susceptible individuals. Nutrition is among the most frequently implicated domains, including fasting, dehydration, specific foods and additives, and overall dietary patterns.

Methods: This narrative review synthesizes current evidence on dietary exposures as potential migraine precipitants and modulators of disease course.

Results: The most frequently reported food-related triggers include fasting, dehydration, alcohol, coffee and caffeine withdrawal, chocolate, milk and dairy products, processed and cured meats rich in nitrites and nitrates, citrus fruits, tea, onions, tomatoes, ice cream, nuts, spicy foods, and ultra-processed foods. Food additives such as monosodium glutamate, aspartame, sulfites, and other artificial sweeteners have also been repeatedly implicated, alongside dietary histamine and biogenic amines. Importantly, several studies suggest that overall dietary patterns, characterized by high glycemic load, irregular meal timing, excessive sugar and saturated fat intake, or ultra-processed foods, may exert a greater influence on migraine susceptibility than single food items.

Conclusions: Overall, the literature is fragmented and often contradictory, with a frequent mismatch between patient-reported triggers and results from blinded challenge studies, underscoring the roles of recall bias, expectancy effects, and prodromal symptoms (e.g., food cravings) misattributed to causation. Inter- and intra-individual variability – shaped by genetic background, metabolic state, gut-brain axis mechanisms, and comorbidities – suggests that “one-size-fits-all” dietary restrictions are inappropriate. Rather than endorsing broad exclusion lists, current evidence supports personalized trigger identification and prioritization of protective dietary patterns, regular hydration, and consistent meal timing to reduce attack susceptibility and overall disease burden.

Keywords

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