I had a patient, female 43 years old. Her headache has lasted for 6 years diagnosed as a migraine headache.the brain MRI and lab data was normal. her headache is triggered by eating foods especially foods containing lipids and relieved by drinking sour tasted liquids and none of medicines in migraine is effective.
I think this should go into the diet-induced migraine type. Some dietary components are trigger factors in more then half of migraineurs, but a few patients seems to experience migraine only when some specific foods are ingested. For these patients, some (wacky) hypothesis call for an involvement of IgE or IgG-mediated hypersensitivity mechanisms. Tyramine-rich or fat-rich diet is anyway a well-known risk factor for migraine.
So, about the treatment: I would try an elimination diet to find out if a specific food type can be identified and avoided. For treatment of the attack, triptans should work; as chronic treatment, supposing the migraine is a severe one and you have already tried tricyclics and topiramate and ca-channel antagonists, I would give it a try to prednisone.
thanks for your answer but she told me almost whenever she eats something, her headache begins specially lipid contained foods.I have tried topiramate and tricyclics as well and triptans , valproate and fluxetin and etc.But it has been chronic and I think it does not respond.but may be prednisolone should be a good choice but I am worried about her weight gain , she is overweight right now.
any way thanks
if the migraine starts with any food, I wonder if it is migraine at all; I understand better the relationship with fatty foods, but still I wonder. Is there chance you are dealing with headache related to some endocrine dysfunction?
Food related migraine are common. However, relieving the migraine by drinking sour tasting liquids is very original. There is little chance that content from sour liquides would stop IgE or IgE hypersensitivity. There might be other mechanism in place. I would consider vascular tonus changes related to a reflex mechanism on the automous system. For the endocrine dysfunction, it could be possible but I can't find an explanation on why sourness would influence it.
I tend to consider the "sourness" not very relevant for diagnostic purposes; migraineurs (and even more often in non-migraineurs) usually display a large collection of rituals and purported effective treatments that are little more than self-administered placebos. Before considering further hypothesis, I would check thyroid status and cortisol/acth, if severe obesity is present.
I checked thyroid function test and was normal.but i should consider cortisol excess test.thanks
If she has dyslipidemia try simvastatin, it has migraine preventive action.
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