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Neurology Today Conference Reporter: American Headache Society Annual Meeting

Access daily, concise peer-reviewed reports from the American Headache Society Annual Meeting selected by the Neurology Today editors.

Monday, July 2, 2018

Chocolate Unlikely to Be a Trigger for Migraine Attacks

BY ED SUSMAN

 SAN FRANCISCO—The likelihood that eating chocolate is a trigger for migraine may be highly remote, researchers reported here at the annual meeting of the American Headache Society.

 While others will swear that eating chocolate is protective against experiencing a migraine, they, too, are likely to be mistaken, said Kenneth Shulman, DO, a neurologist and vice president for medical affairs for Curelator, Inc., of Cambridge, MA.

 "For the person for whom chocolate does trigger a migraine, the association is very real for that individual," Dr. Shulman said. But in their study the team found no association of chocolate consumption and a migraine attack in 95.7 percent of 606 patients who reported to have migraine attacks, Dr. Shulman told the Neurology Today Conference Reporter at his poster presentation.

As part of the study, participants answered questions about what they thought triggered migraine attacks and what they personally suspected, including questions specifically about chocolate. They were asked to rate the role migraine had on their migraine on a scale of 0-10 (0 for low, up to 10 for high).

The subjects used the Curelator Headache digital platform for 90 days, entering exposure to suspected triggers of attacks on a daily basis and a diary of their headaches. These results were then analyzed and the computerized system provides the results for probabilities of how chocolate  did — or in most cases — did not play a role in a migraine.

Dr. Shulman said the analysis of reports to the proprietary Curelator Headache digital program on the company's cell phone app or computer website indicated that for 2.6 percent of the respondents, it may well be that chocolate did trigger their migraine attack. It is also possible that for 1.7 percent of the patients involved in the study, having chocolate induced a protective effect that may have prevented migraines.

"Chocolate is certainly not a common trigger of migraine in most of the population," Dr. Shulman stated.

 Interestingly, Dr. Shulman said that where patients were asked about what they thought about chocolate as a trigger for the migraine attacks, more than 80 percent of 339 patients said they did not suspect a link. According to the analysis, they were  correct: about 20 percent of the patients in this group had responses that could not be analyzed.

Another 393 of the patients suspected there was a link – and about 70 percent of them were wrong (more than 20 percent of the patients in this group had responses that could not be analyzed.

"It is probably that  the low levels of association for both increased and decreased attack rates are simply stochastic," Dr. Shulman said. "Nevertheless we cannot rule out that chocolate may be a trigger  for some people and a protector for others – but they would be the exception rather than the rule.

Commenting on the study,  Andrew Charles, MD, professor of neurology and director of the UCLA Goldberg Migraine program and the Meyer and Renee Luskin Chair in Migraine and Headache Studies at the David Geffen School of Medicine at the University of California, Los Angeles, acknowledged that pinning down triggers of migraine is a complex task.

 "We as practitioners have to keep an open mind and consider that what a patient may think is a trigger may be the manifestation of a migraine attack that occurs before pain begins," Dr. Charles told the Neurology Today Conference Reporter.

 "Migraine is a multiphasic phenomenon that has a prodromal phase that may include light and sound sensitivity, change in appetite, change in mood and food cravings," he said. "So the question then becomes, in that context, whether those people who identify bright light as a trigger, for example, are experiencing the onset of a migraine attack and interpreting the symptoms of a prodromal phase as a trigger.

 "The same thing applies to chocolate: Are people craving chocolate, eating chocolate as part of the prodrome before the pain begins and then identifying that as a trigger? I think there may be a bit of both.

The answer, he said is far from definitive, Dr. Charles said. "We have anecdotal and observational studies, but no randomized trials on triggers for migraines."​

Dr. Charles disclosed commercial relationships with Amgen, Biohaven, Eli Lilly, and eNeura.

LINK UP FOR RELATED INFORMATION

Zaeem Z, Zhou L, Dilli E. Headaches: A review of the role of dietary factors. Curr Neurol Neurosci Rep 2016; 16(11):101.