Effects of Changes in Dietary Intake and Headache's Attacks
Effects of Changes in Dietary Intake and Headache's Attacks
Headache is a frequently disabling disorder, which occurs in about 30% of the adult
 population, particularly in overweight/obese women. Aim of the study is to modify the
 nutritional habits of the patients and to evaluate the effects of a low lipid intake vs. a
 normal lipid diet on the incidence and severity of migraine crises. Moreover vascular
 reactivity will be evaluated in a randomly selected subgroup of patients. This randomized,
 cross-over intervention trial will be performed in about 150 patients, affected by migraine.
 Adherence to the diet, particularly regarding energy intake, percent of energy from lipids,
 carbohydrates and proteins will be carefully assessed at baseline and during the 2
 intervention periods
Headache is a common disease in general population, which affects adult women more frequently
 than men. Among different factors which might be involved in the pathophysiology of the
 disease, eating or drinking a particular food or drink have been shown to act as a trigger of
 acute attacks. In particular foods such as aged cheese or red wine may trigger acute migraine
 attacks and dietary habits such as excessive caffeine intake may increase headache frequency.

 Moreover a close relationship has been detected between overweight/obesity and migraine
 severity even if other authors showed that obesity at baseline does not seem to be related to
 follow-up refractoriness to preventive treatment.

 At the first visit, patients will undergo a complete clinical examination and body weight
 (BW), height (HT), blood pressure (SBP/DBP) and heart rate (HR) will be also measured. Body
 mass index (BMI) will be calculated as BW/HT2 and expressed in kg/m2. We consider overweight
 patients with BMI> 25 and < 30 whilst frankly obese are those with BMI > 30. Patients will be
 followed-up for two months when treatment for the prevention of headache (usually the calcium
 entry blocker flunarizine 5 mg/day) will be added to the habitual dietary regimen. At the end
 of this run-in period all patients will be randomly attributed to one of the following two
 dietary regimens: a low lipid diet with a lipid content < 20% of the total daily energy
 intake and a normal lipid diet with a lipid intake between 25-30% of the total daily energy
 intake. In both diet lipid intake is mostly represented by monounsaturated fatty acids (14%
 in the low lipid and 19% in the normal lipid diet) with a low intake of saturated fats (<
 8%of the total calories, which is the percentage usually recommend in our diets). Patients
 will be followed-up for 2 months at the end of which they will be switched to the alternative
 dietary regimen.

 At baseline and during the observation period patients will be seen at the Headache
 Outpatient Clinic of our department at one month intervals. At each visit they will be given
 a form to be filled at home, summarizing the number of the monthly headache attacks, the
 severity of each one graded from 0.1 to 3 from mild to severe pain, and how many times they
 assumed pills for the therapy of the attacks during the last month. Headache attacks with
 severe pain will be considered those receiving a score > 2.5. Moreover, at each visit
 patients will fill-up a food questionnaire, validated in comparison to the 7-day food record
 (12), with the help of a well trained dietician. Data are expressed as daily percent caloric
 intake from each macronutrient and as the weekly number of a medium size serving.

 Main drugs suggested for the pain relief at each attack are the selective serotonin receptor
 agonists (triptans), which are abortive migraine medications, and the non steroidal
 anti-inflammatory agents.

 In a randomly selected subgroup of patients we will evaluate at baseline and after diet:

 1. Vascular dysfunction by echography at the brachial artery level after ischaemia (Flow
 mediated dilatation) and after nitroglycerin 0.3 mg;

 2. Intimal-media thickness at carotid artery level will be evaluated by b-mode echography;

 3. central pressure and pulse wave velocity by tonometry applanation.
Inclusion Criteria:

 -  All patients with primary headache on free diet

 Exclusion Criteria:

 -  Patients with laboratory or TC findings of secondary headache