Plant-based diets are gaining popularity due to their potential health benefits, ethical considerations, and environmental impact. While many people adopt a vegan diet to improve their health, protect animals, or support the planet, some may experience headaches or even migraines. This article explores the potential causes of headaches in individuals following a plant-based diet and offers strategies for managing them.
The Potential Benefits of a Plant-Based Diet for Migraine
Research suggests that plant-based diets may reduce migraine pain. A study published in the Journal of Headache and Pain by the Physicians Committee found that a plant-based diet reduced migraine pain. The severity of participants’ worst headache pain improved significantly when they were consuming a plant-based diet. Another, smaller case series published in 2022 found that three individuals with chronic migraines were able to reduce their migraine frequency and severity and reduce or eliminate their need for painkillers after adopting a whole food, plant-based diet.
The decline in migraine pain may be due to the elimination of dietary pain triggers such as meat and dairy products or by weight loss or hormonal changes brought on by the diet change.
Common Headache Triggers in a Plant-Based Diet
It's important to recognize that food triggers are unique to each individual. Some people are not triggered by foods. However, some vegan foods might actually be triggering headaches or even full-blown migraine attacks. From years of experience in working with people living with migraine, I have found that many people have a small handful of food triggers. You should not read the below and assume you are triggered by all of these foods. Rather, there may be one or two foods that you’d be better off banishing from your life for a while.
Highly Processed Proteins
People enjoying a plant-based diet usually look to the protein and fat to give the meal “staying power” and a sense of being satisfied. Plant-based smoothies, shakes and protein bars are very common for breakfast and between meals. Protein powders are often added to a delicious blend of fruits and veggies. The protein not only adds to the nutritional value, it gives the liquid more body and a more pleasing mouthfeel.
Read also: Delicious Plant Paradox Breakfasts
When certain proteins go through the process of becoming convenient, palatable powders, they naturally become high in substances considered common migraine triggers. The process of pulverizing, liquifying, concentrating, “hydrolyzing” and preparing a marketable powder often makes the proteins into natural glutamate that is similar to MSG. The vegan headache can often be explained by natural glutamate. Fortunately, most people are not sensitive to MSG and natural glutamate. However, many people prone to headaches and migraine episodes cannot tolerate highly processed proteins. The migraine brain is different than the typical brain.
Umami Ingredients
Umami is its own category of taste. It’s often described as a meaty, savory, rich flavor. It’s glutamates like MSG and other naturally-occurring MSG-like components that seem to “wake up the flavor” of many foods and give them a boost.
Some Asian cuisines endeavor to develop rich umami by adding fermented soy products like miso or soy sauce. These foods are delicious and satisfying in many vegan meals but can trigger the dreaded headache or full migraine attack.
Nuts and Legumes
Certain wholesome, delicious, unprocessed nuts, peanuts and legumes are considered common migraine triggers.
Nuts and legumes are typically key sources of protein in the vegan diet as they are nutrient-dense, portable and convenient. Additionally, they add a great deal of texture and flavor to meals and snacks. Toasted, candied or spiced nuts are often the stars of favorite salads and pasta dishes.
Read also: Nutritious Granola Recipes
Certain Fruits and Vegetables
Onions, avocados, bananas and citrus are often key parts of vegan meals and snacks. Unfortunately, they are also considered common migraine triggers. It is assumed that either the food component called tyramine is causing the problem OR the foods are causing a histamine reaction. Both histamine and tyramine are known culprits for some people with migraine and might explain vegan headache.
Other Potential Triggers
Other lifestyle factors that can trigger migraines are lack of sleep, dehydration, stress, chemicals such as perfumes and fragrances, alcohol, and environmental factors such as weather, medications, hormones, and skipping meals.
Addressing Potential Nutrient Deficiencies
For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets.
Vitamin B12
Dietary vitamin B12 for humans is only produced by the microbial and archaea kingdoms. Persons on a plant-based diet without vitamin B12 supplementation, as well as elderly or pregnant persons, are more susceptible to B12 deficiency.
Unfortified plant-based diets do not contain bioactive vitamin B12 (cobalamin). People on plant-based diets require vitamin B12 supplementation. The only reliable plant-based sources are processed foods fortified with vitamin B12. Examples include fortified plant milks, breakfast cereals, soy products, and nutritional yeasts. Fermented soy products (e.g., miso, tempeh), shiitake mushrooms, algae, and unfortified nutritional yeast contain inactive analogues of vitamin B12 can contribute to vitamin B12 intake, but are not considered reliable sources. The dried seaweed known as nori has been shown to provide active vitamin B12 .
Read also: Advantages of a Plant-Based Cleanse
Low vitamin B12 can adversely affect mood, memory, energy, and nerve function. Persistently low B12 can result in irreversible neurocognitive dysfunction.
Vitamin B12 is the necessary co-factor for only two enzymatic reactions in human physiology. The first enzyme, methionine synthase, is crucial in the methylation cycle. The second enzyme, L-methylmalonyl-coA mutase, is the last enzyme needed for fatty acids and amino acids to enter the Kreb’s cycle (via succinyl CoA rather than acetyl CoA). For women of childbearing age, B12 status is important for both maternal health as well as minimizing neural tube defect risk in the child. In infants, maternal and infant vitamin B12 status is relevant for normal feeding, gastrointestinal function, growth, and neurological development. In adults, common, non-specific symptoms of B12 deficiency include fatigue, nausea, anorexia, arthralgia, insomnia, dyspnea upon exertion, dizzy spells, feeling cold, pallor, muscle cramps, and digestive complaints. Additional deficiency signs are neurologic, cognitive, and psychiatric. Neurologic signs include paresthesias, sensory loss, ataxia, neuropathies including ocular neuropathy, age-related macular degeneration, autonomic dysfunction including urinary incontinence, orthostatic intolerance, excessive sweating and erectile dysfunction, plus motor disorders, cerebral atrophy, and spinal cord degeneration. Cognitive signs include word finding and concentration difficulties, disorientation, and dementia.
B12 absorption in the terminal ileum requires stomach hydrochloric acid and pepsin, as well as the sequential binding of three transport proteins: haptocorin (saliva and stomach), intrinsic factor (stomach and intestine), and transcobalamin (intestine into liver and systemic circulation). Risk factors for poor absorption include auto-antibodies to intrinsic factor and/or parietal cells, impaired acid production, Helicobacter pylori infection, gastric bypass, intestinal bacteria overgrowth, and malabsorption disorders. Iatrogenic risk factors for low vitamin B12 absorption include use of proton pump inhibitors or metformin. Oral B12 may not be readily assimilated in patients with one of several common genomic variations.
Cyanide-stabilized cobalamin, cyanocobalamin, is the most common B12 supplement. Cyanocobalamin releases a cyanide group for every molecule of B12 that is used. Theoretically, this could be important for persons with diets rich in cyanide via the ingestion of almonds, lima beans, soy, spinach, and seeds; who smoke; are uremic; or have the most common of inherited mitochondrial disorders, Leber hereditary optic neuropathy. Options include oral or sublingual methylcobalamin, adenosylcobalamin, or hydroxocobalamin. There are no clearly defined adverse effects produced by vitamin B12 supplementation. A no tolerable upper intake level (UL) has been established for B12, due to its low level of toxicity. Compounded methylcobalamin is available for intramuscular administration.
Vitamin B12 deficiency can be easily missed. The absence of macrocytic anemia does not rule out significant B12 deficiency. Additionally, measuring only a serum B12 level has poor sensitivity for identifying early insufficiency. The medical literature does not support a clear vitamin B12 cut-off for diagnosis. Evaluation of vitamin B12 status should include at least one systemic biomarker (serum B12 or holotranscobalamin) and one cellular biomarker (homocysteine or methylmalonic acid, MMA). Optimal testing for vitamin B12 needs to be conducted after 12 h of fasting and no B12 supplementation for at least one day. Of note, normal levels of serum B12, homocysteine, and MMA still may not exclude symptomatic B12 deficiency. Clinical suspicion must remain high. Of potential relevance to testing patients not supplementing, B12 may be an acute phase reactant. Measured B12 levels may be artificially elevated in myeloid, lymphatic, and solid tumors, alcoholism, cancer, liver-, renal-, autoimmune-, and bronchopulmonary diseases.
Iron
Iron deficiency is the most common cause of anemia across the globe, affecting one-third of the world population. About 10 million Americans are iron deficient and 5 million have iron deficiency anemia. Iron found in meats (heme iron) has a higher bioavailability than iron found in plants (non-heme iron).
Depleted iron stores and iron-deficiency anemia are commonly found in all persons regardless of diet. However, persons on plant-based diets, especially women of child-bearing age, children, and teenagers need to be aware of an increased risk. Plant-based sources of iron include Swiss chard, spinach, quinoa, soybeans, sesame, pumpkin seeds, lima beans, lentils, tempeh, tofu, cashews, almonds, blackstrap molasses, and iron-enriched baked goods such as bagels. Vitamin C aids iron absorption. Other food, spices, beverages, and supplements may impair iron absorption. These include rosemary, chili pepper, garlic, Pak hyeng, shallot, tamarind, soy beans, milk, eggs, coffee, green and black tea, as well as turmeric, calcium, resveratrol, and quercetin.
Iron is an important co-factor for the synthesis of hemoglobin, myoglobin, neuroglobin, nitric oxide, dopamine, and DNA. Iron is also an important co-factor as well as for oxidative stress management (superoxide dismutase), DNA repair, and mitochondrial function (aconitase, cytochrome c, cytochrome c oxidase). As a consequence, iron is important for cognitive performance, cardiac function, gastric digestion, muscle strength, endurance, and stamina, in addition to temperature regulation. Normal iron status is important during pregnancy for fetal brain maturation and optimal birth weight, as well as for the prevention of adverse maternal outcomes including mortality. Low-iron status (Ferritin levels less than 50 µg/L) is the leading cause of restless legs syndrome.
Dietary phytates and tannins, malabsorption, infections, small intestinal bacteria overgrowth (SIBO), digestive inflammation, as well as systemic inflammation can impair iron absorption even with adequate dietary intake. Blood loss, blood and platelet donations, and rapid growth contribute to iron deficiency. Gastric acid is necessary for non-heme iron to dissociate and increase its solubility for absorption. Acid-blocking medications and hypochlorhydria disrupt iron absorption. A normal hemoglobin does not exclude iron deficiency. Iron stores significantly influence non-heme iron absorption.
Serum ferritin is the primary indicator for iron deficiency. This test is the most efficient and cost-effective means for diagnosis. Ferritin levels less than 15 µg/L are diagnostic. Erythropoiesis may be affected even at higher levels of 40 µg/L.
Essential Fatty Acids
The essential fatty acids were originally termed “vitamin F” when identified as essential factors for growth and dermal function in 1929. Essential nutrients means that we must eat them; we cannot make them. The short-chain omega-3 and omega-6 fatty acids, alpha-linolenic acid and linoleic acid, are termed essential as they cannot be synthesized and must be ingested for multiple biological functions. Two families of essential fatty acids exist: the omega-3 and omega-6 fatty acids. Optimal plant-based short-chain omega-3 oils are found in walnuts, flaxseeds, hemp seeds, and chia seeds. Long-chain omega-3 fatty acids (termed EPA and DHA) are vitally important and can be produced from short-chain omega-3′s with the help of several vitamins and minerals; but the process may be inadequate. Low EPA or DHA levels can adversely affect mood, memory, and inflammation/pain in addition to infant development. Algae-derived DHA or brown algae with kelp oil may support long-chain omega-3 intake in plant-based diets.
Essential fatty acids needs can be met by a plant-based diet, but sufficiency requires planning and adequate co-factors. The short-chain omega-3 fatty acid termed alpha linoleic acid (ALA) can be converted into long-chain fatty acids omega-3 EPA and DHA; but the process may be insufficient with a low conversion rate, especially for men. Maternal DHA intake and supply is crucial in the third trimester and during breastfeeding for an infant’s neurological development and function. DHA regulates levels of neurotrophins, i.e., brain-derived neurotrophic factor (BDNF) and nerve growth factor. At all ages, cell membrane DHA content determines membrane fluidity and hormone- receptor binding capacity. Low DHA levels are associated with ADHD.
Strategies for Managing Headaches on a Plant-Based Diet
Identify and Eliminate Trigger Foods: The first step in tackling your migraines is to check whether any of the common triggers are causing them. To do this, you simply avoid these foods. At the same time, include generous amounts of pain-safe foods in your routine and see whether migraines occur, and, if so, how often.
- Elimination Diet: For two weeks, have an abundance of foods from the pain-safe list and avoid the common triggers completely. Foods that are not on either list can be eaten freely.
- Reintroduction: If your diet change makes your headaches disappear or become much less frequent, the next step is to confirm which foods are your triggers. To do this, simply reintroduce the eliminated foods one at a time, every two days, to see whether any symptoms result.
Focus on "Pain-Safe" Foods:
- Rice
- Cooked Green Vegetables
- Cooked Orange Vegetables
- Cooked Yellow Vegetables
- Cooked or Dried Noncitrus Fruits
Avoid Common Migraine Triggers:
- Dairy
- Chocolate
- Eggs
- Citrus Fruits
- Meat
- Wheat
- Nuts and Peanuts
- Tomatoes
- Onions
- Corn
- Apples
- Bananas
- Certain beverages and additives are also among the worst triggers, including alcoholic beverages (especially red wine), caffeinated drinks (coffee, tea, and colas), monosodium glutamate (MSG), aspartame (NutraSweet), and nitrites.
Ensure Adequate Nutrient Intake:
- Vitamin B12: Supplement with a reliable source of B12, such as fortified foods or a B12 supplement.
- Iron: Consume iron-rich plant foods and pair them with vitamin C to enhance absorption.
- Essential Fatty Acids: Include sources of omega-3 fatty acids like flaxseeds, chia seeds, and walnuts. Consider an algae-based DHA supplement.
Maintain a Regular Eating Schedule: Skipping meals can trigger headaches. Eat regular, balanced meals and snacks throughout the day.
Stay Hydrated: Dehydration is a common headache trigger. Drink plenty of water throughout the day.
Manage Stress: Practice stress-reducing techniques such as meditation, yoga, or spending time in nature.
Prioritize Sleep: Aim for 7-9 hours of quality sleep each night.
Consider a Food and Symptom Diary: Keep a detailed record of what you eat and any headaches you experience to identify potential triggers.
Consult with Professionals:
- Headache Specialist: Consult a headache specialist. Too often people live with untreated or undertreated migraine disease. There may be an individualized medical and/or lifestyle approach that would help you find lasting relief. If you do not have a headache specialist the American Migraine Foundation has a specialist locator to help.
- Registered Dietitian: Consult a dietitian familiar with migraine to help you develop a nutritionally balanced approach to figuring out possible migraine triggers.
Quick Migraine-Friendly Vegan Swaps
- Protein Powders: Hemp seed or pumpkin seed instead of pea or soy.
- Snacks: Fresh fruit with sunflower seed butter instead of peanut butter.
- Meals: Chickpeas, black beans, or quinoa for protein instead of processed powders or high-trigger legumes.
The Importance of Mindset
If you start with trepidation, with a negative filter, with a feeling of lack, seeing it as too hard, impossible, too rigid or expecting to feel deprived this is what you’ll most likely experience. One thing that I find can help you with this is a reminder that you are in the driver’s seat and that there is no external pressure pushing you forward trying to keep you in line. You are here because you want to make this change. Yes, even if it was your doctor who recommended it, yes even if you love animals but also love to eat meat. Yes, even if a concerned family member suggested it. Whatever brought you here, remember that no one has the remote other than you, when you are fully conscious and aware that this is something that is important to you, that your mindset will frame your outlook, but that you can hit the pause button, the rewind button, the fast forward button, as often as you need to.