By A. David Rothner, MD

recurrent abdominal pain caused by many primary G. I. diseases, may contribute to the occurrence of tension-type headache.

What about food and migraine? The differences between food allergies and dietary triggers should be discussed. There is no question that chemical additives contained in food are vasoactive and, among other mechanisms, can cause true episodic migraine. These reactions are not immune mediated. There are discussions, disagreement, and some research regarding which food and what quantities have a role in migraine and possibly in tension-type headache.

Management In a youngster seeking consultation for significant refractory headache( migraine or C. D. H.), I routinely address: A. Patient / parent education( written materials) B. Confident reassurance that underlying problems have been excluded C. Stress reduction D. Adequate sleep

H.

Adequate exercise

I routinely exclude foods that the patient or parents feel play a role, plus: caffeine chocolate lunch meats aged cheese monosodium glutamate( MSG). I ask for complete cooperation for 6 to 8 weeks and then consider reintroducing food in moderation. Lists of other provocative foods are easily found.

Summary Research into allergies, diagnosed by a thorough history, skin and blood tests, or elimination diets has not definitively shown that they cause headache. In all cases, consult your physician or obtain a second opinion before embarking on an arduous expensive course of therapy. HW

A. David Rothner, MD, Pediatric Neurology Cleveland Clinic Foundation, Cleveland, Ohio

26 HEAD WISE | Volume 3, Issue 1 • 2013