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Chapter 15

Chocolate and Headache: Is There a Relationship?

Lisa Scharff and Dawn A. Marcus

Migraine is a common disorder, affecting approximately 17% of women and 6% of men in the USA (1). Exactly what factors migraine patients perceive as triggering their pain has been examined by several researchers (24) with varying conclusions. Stress and the menstrual cycle are by far the most commonly cited migraine triggers (4), and both of these factors have been empirically demonstrated to be related to migraine onset (5). Various foods have also been indicated as triggers by migraine patients, although studies have found inconsistencies in the percentage of migraineurs who implicate specific foodstuffs (varying from 0% (6) to 75% (7)). Chocolate tends to be the most frequently identified food as a headache trigger, with approximately 2375% of chronic headache sufferers indicating that eating chocolate is associated with headache onset (3, 7). The evidence that food in general, and chocolate specifically, triggers migraine is mixed. This chapter reviews such evidence, with special attention to chocolate.

The Rationale behind Foods as Headache Triggers

Various foods have been linked to headache, and there have been multiple studies investigating this relationship (79). Many migraine sufferers are educated about the potential link between food and headache, and are provided with a list of implicated foods by their physicians. A relatively small percentage of headache patients actually alter their diets after receiving this information, and many of them report that dietary changes do not affect their headache at all. One study (10) reported that 75% of a group of 130 headache sufferers were aware of the potential connection between food and headache; however, only about 37% had attempted dietary changes, and approximately half of those patients reported any degree of improvement. Because of the unenthusiastic response of many

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