Why doesn’t keeping a migraine diary solve the problem of food triggers?


Although there are common food triggers, identifying them is difficult with a diary. Migraine is a genetic neurobiological disorder and attacks will happen no matter what you do.


“Yes, interestingly in the past I used to stress keeping track of triggers when they're keeping their diary. I would really talk to patients about, this is how you get empowered by keeping track of every single thing. All the different foods, all the different environmental exposures that you've had, and then we'll figure out what those are and then we'll eliminate those and you'll be better. Then there was a study that was published that demonstrated that for us to determine that there is one specific factor that's triggered your migraine attack, that only happens like once every two years. So after I heard that I thought ‘OK, I need to actually scale back.’ Actually, the better way to empower patients is to let them know these are the common triggers, but at the end of the day, migraine is a genetic neurobiological disorder. It is not your fault that you're having a migraine attack. It is not what you are doing to yourself that's causing you to have a migraine attack. This also lifts that guilt and lifts that stigma of migraine. It is a neurobiological disorder. It is a genetic disorder and there are some days and no matter what you do, you're gonna get a migraine attack.”

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Amaal J. Starling, MD, FAHS, FAAN

Mayo Clinic, Arizona

Dr. Amaal J. Starling is an associate professor of neurology at the Mayo Clinic College of Medicine. She joined Mayo in 2012 and is currently a consultant within the department of neurology. Dr. Starling received her MD from the Drexel University College of Medicine in Philadelphia. She completed a transitional year residency, a neurology residency, and a headache fellowship at the Mayo Clinic College of Medicine in Scottsdale, Arizona.

Dr. Starling is an active member of numerous migraine advocacy organizations, including the American Headache Society (AHS), the American Migraine Foundation, the American Pain Society, and the American Academy of Neurology. Annually, she is involved in events supporting migraine, including Headache on the Hill, Miles for Migraine, and the Alliance for Headache Disorders Advocacy. Dr. Starling is currently serving as chair of the advocacy committee of the AHS; Diversity, Equity, and Inclusion Taskforce member of the AHS; and she is a member of the Scientific Advisory Board of the International Concussion Society. Dr. Starling has been the recipient of numerous awards, including the AHS Above and Beyond Award for Service, Manfred D. Muenter Award for Excellence in Clinical Neurology, the American Academy of Neurology Annual Meeting Residency Scholarship, the 2012 Spirit of Mayo Clinic Award, and the Mayo Brothers Distinguished Fellowship Award.

Dr. Starling has several peer-reviewed publications and abstracts related to her fields of interest, which include migraine, concussion, post-traumatic headache, trigeminal autonomic cephalalgias, secondary headaches, telemedicine and teleconcussion, neurology resident education, and professionalism and clinical ethics. Dr. Starling’s hope is that her research and advocacy will advance care for people with migraine, post-traumatic headache, and other headache disorders. She envisions a future in which all people with headache disorders receive personalized, effective, and well-tolerated treatment options to improve their quality of life.

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