The Association Between Dietary Acid Load and Odds of Migraine: A Case–Control Survey

DOI: https://doi.org/10.1007/s40120- 021- 00247- 2

Abstract-Summary It has been shown that a high acid load in the human body can affect inflammatory factors and the nitric oxide pathway.

These factors are also thought to play an important role in the initiation of

migraine attacks.

We have therefore explored the association between dietary acid load and odds

of migraine in a case–control study.

Estimation of the dietary acid load was performed using three different mea- sures: potential renal acid load (PRAL) score, net endogenous acid production (NEAP) score, and protein/potassium ratio.

Multivariable logistic regression analysis showed that, in comparison with the lowest tertile, the highest tertile of dietary acid load measures, including PRAL (odds ratio [OR] 7.208, 95% confidence intervals [CI] 3.33–15.55), and NEAP

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(OR 4.108, 95% CI 1.924–8.774) scores and the protein/potassium ratio (OR 4.127, 95% CI 1.933–8.814), significantly increased the odds of migraine (p value for trend ≤ 0.001).

High dietary acid load was associated with higher odds of migraine. It is therefore possible that restricting dietary acid load could reduce the odds of

migraine in susceptible subjects.

Extended: It has been shown that the levels of inflammatory factors, such as tumor necrosis factor-alpha (TNFα), C-reactive protein, and interleukin 6, increase in people with migraine headache compared to healthy subjects [605–609].

It has been found that people with migraine may have abnormalities in their

acid–base balance due to mitochondrial dysfunction [265, 610].

It has been reported that high blood flow and BMI may play negative roles in the

onset of migraine pathogenesis.

These factors are also thought to play a role in the initiation of migraine attacks

[165, 605–609, 611, 612].

We used three different measures for calculating the dietary acid load, namely, potential renal acid load (PRAL), net endogenous acid production (NEAP), and protein/potassium ratio; all three measures have been validated in previous studies [613, 614].

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Introduction It has been shown that the levels of inflammatory factors, such as tumor necrosis factor-alpha (TNFα), C-reactive protein, and interleukin 6, increase in people with migraine headache compared to healthy subjects [605–609].

Available evidence suggests that even a slight increase in acid load may stimulate the expression of induced NO synthases, increase levels of inflammatory factors, such as TNFα, and increase blood flow and adiposity measures (measurements that are used for obesity, such as body mass index [BMI], waist circumference, among others) [615–619].

A high acid load in the human body could be associated with inflammation, NO

pathways, blood flow, and adiposity measures [615–619].

It can be hypothesized that there is relationship between dietary acid load and the

development of migraine in susceptible subjects.

The aim of the study reported here, therefore, was to explore the association

between dietary acid load and the odds of migraine headaches.

Methods Inclusion criteria for both the patients and the control group included: age between 18–60 years, BMI between 18.5 and 35 kg/m2, and daily energy intake between 800 and 5000 kcal.

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2 Mechanisms

Participants reported the intake of each food item on the FFQ based on daily,

weekly, monthly, or yearly intake.

To explore the association between dietary acid load measures and odds of migraine, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using multivariable logistic regression models following adjustment for age (year, continuous), sex, BMI (kg/m2, continuous), total daily energy intake (kcal/day, continuous) as well as daily intake of carbohydrates (g/day), total fat (g/ day), Na (mg/day), and dietary food groups (i.e., total refined grains, whole grains, total sugar, vegetables, fruits, red meat, poultry and egg, processed meat, fish, dairy, and nuts).

Results Compared to those subjects without migraine, those with migraine disease were found to have a significantly higher consumption of total animal protein, total fat, dairy, processed meat, poultry, eggs, and fruits and also a lower consumption of total plant protein, grains, and vegetables.

Individuals in the third tertile of PRAL (median score 13.06) and NEAP (median score 71.99) scores were younger and tended to have a higher intake of refined grains, sugar, processed meats, total protein, and total fat and a lower intake of veg- etables, fruits, nuts, dairy, total energy, total carbohydrate, plant protein, and sodium than those in the first tertile of PRAL (median score − 27.05) and NEAP (median score 31.11) scores (p values < 0.05).

Regarding PRAL scores, individuals in the second tertile (median score − 1.53) had a higher BMI and a higher intake of red meat and animal protein than those in the first tertile (median score − 27.05) (p values < 0.05). Discussion The result of this large population-based observational study showed that high dietary acid load intake had a direct association with odds of migraine onset.

We found that high PRAL and NEAP scores and high protein/potassium ratio, which are related to meat, grain, and sugar consumption, were positively associated with the odds of migraine.

The association between the dietary acid load and odds of migraine has not been

studied to date.

Several possible mechanisms have been proposed to account for for the associa- tion between high dietary acid load and the onset of migraine attacks or increasing headache attack frequency in migraineurs [615–619].

The design of the present study does not allow us to determine the causal rela-

tionship between high dietary acid load and odds of migraine disorder.

To our knowledge, this was the first study to explore the association between

dietary acid load measures and migraine odds.

Conclusions The results of this large population-based observational study show that high dietary acid load intake had a positive association with odds of migraine onset.

As a strategy to reduce dietary acid load, restricting the intake of acidogenic foods (such as meat, grains, and sugar that are high in protein and phosphorous) and

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those low in alkaline precursors may be considered a suggestion for reducing the odds migraine odds.

Further investigation with a large sample size in cohort studies and well-designed clinical trials are required to identify the exact association between dietary acid load and migraine clinical features or even related health outcomes.

Acknowledgement A machine generated summary based on the work of Mousavi, Maryam; Jahromi, Soodeh Razeghi; Togha, Mansoureh; Ghorbani, Zeinab; Hekmatdoost, Azita; Rafiee, Pegah; Torkan, Boshra; Shirani, Pedram; Ansari, Hossein; Karami, Ahmadreza; Nourmohammadi, Morvarid; Khorsha, Faezeh. 2021 in Neurology and Therapy.

Fruit and vegetable consumption in relation to primary headaches: the MEPHASOUS study