Comparison of Diet Quality Between Women With Chronic and Episodic Migraine

Samaneh Hajjarzadeh, M.Sc. student; Zeinab Nikniaz, PhD; Davood Shalilahmadi, MD, PhD; Reza Mahdavi, PhD; Maryam Behrouz, PhD


Headache. 2019;59(8):1221-1228. 

In This Article

Abstract and Introduction


Background/Objectives: Different triggers including environmental, hormonal, and dietary factors have been introduced as migraine risk factors. There is some evidence to suggest that a high quality of diet could be effective regarding management of migraine. In this present study, we hypothesized that the diet quality of women with chronic migraine (CM) might be different from women with episodic migraine (EM).

Methods: In this cross-sectional study, 116 women with chronic and 169 women with episodic migraine (25–55 years old) were recruited from the neurology clinics of Golestan hospital in Ahvaz (southwest Iran) based on the International Classification of Headache Disorders-III. Anthropometric data including weight, height, waist, and hip circumference were measured. Dietary intake data were obtained using a reliable and valid semi-quantitative food frequency questionnaire that included 168 food items. The diet quality of subjects was calculated using the Healthy Eating Index-2015 (HEI-2015).

Results: The mean HEI score of participants was 57.29 ± 7.98. The participants were classified into 3 groups of "poor," "needs improvement," and "good" based on their diet quality. The frequencies of each group were 50/285 (17.5%), 233/285 (81.8%), and 2/285 (0.7%), respectively. Moreover, the mean of HEI score in women with CM was significantly lower than women with EM (55.93 ± 7.90 vs 58.93 ± 7.93, P = .02). Moreover, there was a significant negative association between CM and HEI score of women (β = −2.03; 95% CI: [−3.97 to −0.10]; P = .04).

Conclusions: Women with CM had a lower diet quality than that of EM. Moreover, CM was significantly and inversely associated with HEI score in women.


Migraine is a disabling headache[1] with unpredictable attacks resulting in reduced quality of life and intrusion with normal daily activities.[2] Based on the Global Burden of Disease survey 2016 (GBD-2016), migraine ranked as the sixth prevalent disorder and the second most disabling condition worldwide in terms of years of life lived with disability.[3] Migraine affects 11% of the total adult population globally.[4] Chronic migraine (CM) is one of the migraine subtypes that usually originates from episodic migraine (EM). Episodic migraineurs convert to chronic migraine with an approximate annual rate of 3%.[5] It has been indicated that the process of chronification can be overturned by mitigating the risk factors of migraine attacks.[5]

Different triggers including environmental, hormonal, and dietary factors have been introduced as migraine risk factors.[6,7] In this regard, specific elimination diets have been recommended for migraine management.[8] Moreover, some studies assessed the effect of 1 or more ingredients on migraine in the format of interventional diets such as low-fat diets, low-omega-6 and high-omega-3 diets, ketogenic, and Atkins diets.[9] But, the role of overall diets made from core components of foods such as carbohydrates, proteins, fats, vitamins, and ions on migraine is a controversial topic yet.[8,9] Diet quality is one of the common approaches in the way of assessing the relationships between diets and diseases.[10] Evans and colleagues[8] have revealed significant differences between the diet quality of women with and without migraine and suggested that improving diet quality may be effective as part of the migraine treatment process.[8] In addition, some evidence indicates that a higher consumption of healthy food items including fruits, vegetables, and whole grains and a lower consumption of fats might be effective in reducing migraine severity and attack frequency.[9,11–14]

As far as the researchers of the current study could find, no study comparing the overall diet quality in women with CM and EM has yet been conducted. So, the purpose of the current study was to compare the diet quality using HEI-2015 in Iranian women with CM and EM.