The Association of Adherence to the Mediterranean Diet and Sleep Disturbances with Migraines

by | Aug 21, 2024 | 2024, Brain Health, Headaches, Mediterranean Diet, Recent Articles

Written by Harold Oster, MD. Results suggest that poor adherence to the Mediterranean diet and the presence of sleep disturbances are associated with disabling migraines.

female-student-suffering-from-headache-in-libraryMigraine is a disabling headache disorder affecting at least fifteen percent of the population each year. Most patients experience recurrent attacks, and three percent develop chronic migraine, in which the attacks become very frequent or constant1. The pathogenesis of migraine is unclear but may involve diet, sleep disturbances, and other lifestyle factors2,3. The Mediterranean Diet is characterized by a high intake of fruits, vegetables, whole grains, and olive oil and the avoidance of red meat and processed foods. Adherence to the diet decreases inflammation and is associated with a reduced risk of cardiovascular and neurologic conditions4.

Roberta Bovenzi et al. studied the effects of the Mediterranean diet, sleep disturbances, and various lifestyle factors on migraine frequency and migraine-associated disability. The authors recruited 170 adults with migraine and one hundred matched controls. Exclusion criteria included a history of neurologic or psychiatric disorders, medical conditions that would affect the protocol, and the use of supplements. The authors performed a medical history to evaluate the frequency and nature of the migraine episodes. They divided patients into two groups based on migraine frequency: low-frequency (fewer than eight days of migraine per month) and high-frequency/chronic (eight days of migraine per month or greater). Participants were evaluated for demographics, past medical history, weight, lifestyle factors, and other possible covariables. The severity of the migraines was evaluated with the Migraine Disability Assessment Scale (MIDAS), which measures the number of productive days lost due to migraine5; the Headache Impact Test-6 (HIT-6), a six-item questionnaire that assesses the impact of migraines on usual daily activities6; and the Visual Analog Scale, in which the patient records their level of pain from zero to ten7. Adherence to the Mediterranean Diet was evaluated with the PREDIMED tool, a fourteen-question survey of dietary habits8. Each yes or no question reflects whether the participant follows a component of the diet. The participants were divided into three groups based on their total scores: poor adherence to the diet (less than or equal to five), moderate adherence (six to nine), and good adherence (ten or greater). The presence of sleep disturbances was tested with the Pittsburgh Sleep Quality Index (PSQI)9. The participants’ physical activity level was assessed with the International Physical Activity Questionnaire (IPAQ)10.

The authors noted the following:

  • Of the 170 participants with migraines, 81.77% were female.
  • Migraine sufferers were more likely to have poor adherence to the Mediterranean diet than controls. (11.1% vs 1.0%)
  • The presence of sleep disturbances was not significantly different between migraine sufferers and controls.
  • Migraine sufferers were more likely to be physically active than controls.
  • In low-frequency migraine sufferers, there was no association between adherence to the Mediterranean diet and migraine features.
  • Patients with high-frequency/chronic migraines with poor adherence to the Mediterranean diet were more disabled on the HIT-6 survey than those with moderate or good adherence to the diet.
  • In participants with high-frequency/chronic migraines, the presence of sleep disturbances was associated with more disability on the MIDAS questionnaire.

Results suggest that migraine sufferers are more likely to have a poor adherence to the Mediterranean diet than those without migraines. In those with high-frequency or chronic migraines, poor adherence to the Mediterranean diet and sleep disturbances are associated with increased disability. The study’s limitations include its short duration, small sample size, and possible reverse causation bias.

Source: Bovenzi, Roberta, Annalisa Noce, Matteo Conti, Manuela Di Lauro, Barbara Chiaramonte, David Della Morte, Alessandro Stefani, Antonino De Lorenzo, Nicola Biagio Mercuri, and Maria Albanese. “Poor Adherence to the Mediterranean Diet and Sleep Disturbances Are Associated with Migraine Chronification and Disability among an Adult Population in the Lazio Region, Italy.” Nutrients 16, no. 13 (2024): 2169.

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/
4.0/).

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Posted August 21, 2024.

Harold Oster, MD graduated from medical school in Miami, Florida in 1992 and moved to Minnesota in 2004. After more than 25 years of practicing Internal Medicine, he recently retired. Dr. Oster is especially interested in nutrition, weight management, and disease prevention. Visit his website at haroldoster.com.

References:

  1. Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nature reviews Neurology. Aug 2021;17(8):501-514. doi:10.1038/s41582-021-00509-5
  2. Khorsha F, Mirzababaei A, Ghodoosi N, et al. Association between diet and migraine characteristics: The role of dietary inflammatory index. Curr J Neurol. Apr 3 2020;19(2):67-75. doi:10.18502/cjn.v19i2.4943
  3. Duan S, Ren Z, Xia H, Wang Z, Zheng T, Liu Z. Association between sleep quality, migraine and migraine burden. Front Neurol. 2022;13:955298. doi:10.3389/fneur.2022.955298
  4. Guasch-Ferré M, Willett WC. The Mediterranean diet and health: a comprehensive overview. J Intern Med. Sep 2021;290(3):549-566. doi:10.1111/joim.13333
  5. Stewart WF, Lipton RB, Kolodner K, Liberman J, Sawyer J. Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia. Mar 1999;19(2):107-14; discussion 74. doi:10.1046/j.1468-2982.1999.019002107.x
  6. Yang M, Rendas-Baum R, Varon SF, Kosinski M. Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraine. Cephalalgia. Feb 2011;31(3):357-67. doi:10.1177/0333102410379890
  7. Delgado DA, Lambert BS, Boutris N, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. Mar 2018;2(3):e088. doi:10.5435/JAAOSGlobal-D-17-00088
  8. Martínez-González MA, García-Arellano A, Toledo E, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7(8):e43134. doi:10.1371/journal.pone.0043134
  9. Buysse DJ, Reynolds CF, 3rd, Monk TH, Hoch CC, Yeager AL, Kupfer DJ. Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep. Aug 1991;14(4):331-8.
  10. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. The international journal of behavioral nutrition and physical activity. Oct 21 2011;8:115. doi:10.1186/1479-5868-8-115

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