Intended for healthcare professionals

Rapid response to:

Practice Clinical updates

Abdominal migraine

BMJ 2018; 360 doi: (Published 19 February 2018) Cite this as: BMJ 2018;360:k179

Rapid Response:

Food allergies and smoking Re: Abdominal migraine

Food allergies, smoking and nutritional deficiencies

Angus-Leppan and colleagues write that abdominal migraine usually starts in children and from 2.4% to 9.2% of children are affected.1 They ask how better to explain or offer advice to patients and families with abdominal migraine but write that dietary treatments are unproven.

In fact, carefully conducted food exclusion and reintroduction studies in adults and children and adults with a range of conditions which include headaches, migraine and hyperactivity, all achieved similar results.2-5

In 1979 a Charing Cross Hospital migraine clinic study, “Food allergy and migraine”, required migraine patients to stop medications and avoid tobacco. The frequency of migraine attacks reduced 10-fold when ergotamine medications, contraceptive or menopausal hormones and smoking were each discontinued.2 Avoiding major headache precipitants must be done first before food exclusion and re-introduction diets. John Mansfield’s lamb and pears diet was used for the first five days but a rotation diet of high protein foods 3 times a day can also be used. The result was 85% of patients became headache free and the rest had few headaches.3

Professor Soothill then started a double-blind controlled trial in children and found that milk, wheat, orange, eggs and chocolate were common food triggers of migraine in children, just as we found in adults.4 Similar studies in children and adults with a range of conditions, including headaches and hyperactivity, achieve similar results with the five same foods, although adults were more likely to react to coffee or tea rather than chocolate.5

It is alarming that medications such as pizotifen, cyproheptadine, propranolol, flunarazine, sodium valproate, dihydroergotamine, amitriptyline, and topiramate could be given children or women in their child-bearing years. It seems unwise to give medications to suppress symptoms which warn of food allergies, environmental toxins such as parental smoking, and, common biochemical deficiencies of essential nutrients. Biochemical perturbations including zinc, copper, magnesium and Vitamin B deficiencies, can impede long-evolved homeostatic mechanisms if left undiagnosed and therefore untreated.6

1 Angus-Leppan H, Saatci D, Sutcliffe A, Guiloff RJ. Abdominal Migraine BMJ 2018; 360: k179 (Published 19 Feb 2018)
2 Grant ECG. Oral contraceptives, smoking, migraine and food allergies. Lancet 1978;2:581-2.
3 Grant ECG. Food allergies in migraine. Lancet 1979;1: 966-9.
4 Egger J, Carter CM, Wilson J, et al. Is migraine food allergy? A DB controlled trial of an oligoantigenic diet treatment. Lancet 1983: 2: 865-9.
5 Anthony H, Birtwhistle S, Eaton K, Maberley J. Food allergy intolerance investigation and management. In Environmental Medicine in Clinical Practice, 1997 BSAENM Publications, Southampton: pp 106-140.
6 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-116.

Competing interests: No competing interests

26 February 2018
Ellen C Grant
Physician and medical gynaecologist
Kingston-upon-Thames. UK