Irregular meal and migraine headache: a scoping review

Abstract

Introduction

Migraines are a type of headache, with certain types being more severe than others. The aim of this scoping review is to map the association between migraine headache and irregular meals, including skipping meals or missed diets and fasting.

Methods

The six-stages methodological framework of Arksey & O’Malley for scoping reviews was used. A protocol was registered on OSF on November 17, 2024 (10.17605/OSF.IO/Z8C7M) as OSF preregistration for Generalized Systematic Review Registration. Searches were made from the Cochrane Library, Research for Life, PQD Evidence, Global Index Medicus, Scopus, and MEDLINE databases. To make comprehensive searches, Google Scholar, Google, and grey literature sources, including databases of relevant organizations, were searched. Only studies published in English without a date limit were considered. Screening and data extraction were conducted by two groups of reviewers independently.

Result

Thirty-six studies were included in this review. It includes systematic reviews, randomized placebo-control trials, cohort studies, literature reviews, chart reviews, case control studies, case studies, and cross-sectional studies. Some studies found no clear link between meal omission and migraines, with mixed evidence on the role of dietary factors as triggers. But the majority of studies suggest that fasting and skipping meals, especially breakfast, can trigger migraines by reducing brain glucose levels and causing hypoglycemia, a known trigger. The timing of meals is crucial, as missed meals can provoke different types of migraines, including retinal and abdominal migraines. Moreover, irregular meal patterns, particularly in those with chronic migraines, are strong predictors of attacks. Consistent and balanced meals help to prevent migraines and manage symptoms.

Conclusion

While few studies show mixed evidence, the majority indicate that fasting or skipping meals can trigger migraines. Regular, balanced meals benefit preventing and managing migraines, as irregular meal patterns are predictors of migraine attacks. Moreover, some studies have low to moderate methodological quality, often lacking rigorous control groups and randomization. Thus, it is recommended to draw conclusions from interventional research having longitudinal research with better sample sizes.

Background

The International Classification of Headache Disorders (ICHD) classifies all known headache disorders. Those are migraine, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs), and other primary headache disorders. There are headaches attributed to trauma or injury to the head and/or neck, cranial or cervical vascular disorder, non-vascular intracranial disorder, a substance or its withdrawal, infection, psychiatric disorder, and disorder of homeostasis. Furthermore, headache or facial pain is attributed to a disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure. As well, painful lesions of the cranial nerves and other headache disorders [1]. The development of various headache types or their progression to chronic forms can be linked to a number of dietary practices and lifestyle choices [2]. Globally, an active headache disorder of any type was present in 52.0% of the populations studied [3]. Only 1% of us avoid headaches entirely in our lifetimes. An estimated 90% of people experience at least one headache over the course of a year. Approximately 16–17% of people will experience a migraine headache at some point in their lives. Migraines are a form of headache that can vary in severity [4].

Migraine headache disorder is a debilitating chronic disease that significantly impairs individuals and has an impact on society [5]. Migraine without aura and migraine with aura are the two major subtypes of primary headache disorder [1]. Migraine affects more than one billion individuals each year across the world. It is among the most common neurologic disorders, with a high prevalence and morbidity, particularly in young adults and females [6]. Migraine headaches represent a prevalent issue resulting from changes in the brain and adjacent blood vessels, with episodes lasting anywhere from 4 to 72 h. These headaches can significantly disrupt an individual’s daily routine [4]. Migraine is linked to a variety of comorbid conditions, including stress, sleep disorders, and even suicidal tendencies. The complex and largely undefined processes behind migraine development have led to the identification of various social and biological risk factors, such as hormonal imbalances, genetic and epigenetic influences, as well as cardiovascular, neurological, and autoimmune diseases [6].

The physiological mechanisms linking irregular meal patterns to migraines involve fluctuations in blood glucose levels leading to hypoglycemia, which triggers the release of stress hormones like cortisol and adrenaline. These hormones may increase neuronal excitability, promoting migraine onset [7]. On top of this, the most often reported migraine triggers are foods and drinks, which frequently include chocolate, cheese, nuts, citrus fruits, processed meats, monosodium glutamate, aspartame, fatty foods, coffee, and alcohol. Fasting or missed meals were more frequently reported as precipitating factors. Some migraineurs show reactive hypoglycemia due to diet-induced hyperinsulinism [8]. In addition, a correlation has been established between a familial history of migraines and the consumption of chocolate and alcohol as potential triggering factors [9].

Migraine can be managed by using the familiarity of some self-care remedies and by making simple modifications in the routine lifestyle [4]. While the pathophysiology of migraine is not completely understood, evidence suggests that dietary factors may play a role in several possible mechanisms. Diet may have an effect on the modulation of neuropeptides, neuroreceptors, and ion channels; the sympathetic nervous system; and cerebral glucose metabolism; and/or by causing inflammation, release of nitric oxide, and vasodilation [10]. Management of headache includes the promotion of a healthy lifestyle, including regular meals, sleep, and exercise. As well, avoidance or at least reduction of exposure to caffeine-containing drinks, chocolate, and taking analgesics more than twice a week to prevent the emergence of overmedication headache [11]. Based on the severity and frequency of the attacks, it may be necessary to use migraine medications either temporarily or for a long duration. However, the healing process may be accelerated by natural care along with appropriate drugs. Indeed, taking a holistic approach may even avert the happenings of migraine episodes in the first place [4]. Nevertheless, as far as the authors are aware, the existing evidence remains limited and fragmented, and this might be the first scoping review. Thus, this review presents a comprehensive map about the association between migraine headache and irregular meals, including skipping meals or missed diets (unintentional or inconsistent meal timing) and fasting (intentional prolonged food restriction). By synthesizing current findings and highlighting gaps, this review aims to provide a clearer understanding of how meal patterns influence migraine attacks, ultimately informing future research.

Methods

The scoping review used the methodological framework of Arksey & O’Malley for scoping reviews [12] and recommendations on the framework by Levac and colleagues [13]. This framework has six stages: (1) Identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collecting, summarizing, and reporting the results; (6) consultation with relevant stakeholders. A protocol was developed and registered on OSF on November 17, 2024 (10.17605/OSF.IO/Z8C7M) as OSF preregistration for Generalized Systematic Review Registration.

Identifying relevant studies

The following databases were searched to find relevant studies: Cochrane Library, Research for Life, PQD Evidence, Global Index Medicus, Scopus, and MEDLINE. The sources only studies published or written in English without a date limit were considered. The search strategy included all identified keywords and index terms for the included database and/or information source. The first search was undertaken on 22 October 2024 and updated on 26 November 2024. Furthermore, to make the search as comprehensive as possible, Google Scholar, Google, and grey literature sources, including databases of relevant organizations such as Addis Ababa University Institutional Repository and WHO Library and Digital Information Networks, were searched. These capture a wide range of unpublished or non-peer-reviewed materials. Relevance was assessed by selecting documents that directly addressed the relationship between irregular meals and migraines, ensuring the inclusion of high-quality evidence like high-level study design theses, policy papers, and reliable organizational repositories. All identified studies were then collected in EndNote 21.0 for organized screening and selection.

The search terms and keywords for the scoping review were systematically developed by deconstructing the objective into key concepts: “irregular meals” and “migraine headaches.“. Synonyms, related terms, and alternate phrasings were identified for each concept to ensure comprehensive coverage. For irregular meals, terms like “skipping meals,” “missed diets,” “fasting,” and “disrupted eating patterns” were included. For migraine headaches, variations such as “migraine attacks” were considered.

Study selection

Studies on migraine headaches related to irregular meal patterns (missed or skipped meals) regardless of study design were included. Studies on both sexes were included. Studies that lack scientific/systematic design were excluded.

The review process had two levels of screening: a title and abstract review and a full-text review. The corresponding author, SML, contributed to conceptualizing and designing the scoping review. Articles retrieved were screened independently by two groups of reviewers (SML & TH) and (AEA & BHJ) to assess eligibility, as determined by the inclusion criteria. Full copies of all potentially eligible papers were retrieved. Disagreements at any of the eligibility assessment processes were resolved through discussions, consultation and third-party arbitration with the team (BJB& ZDA) where necessary. All authors reviewed the manuscript.

Data extraction

Relevant information from selected studies was extracted using a form developed by the team. The data collection form included information on the author(s), year of publication, objectives, study design, and key findings as they relate to the scoping review question. Data extraction was conducted by two groups of reviewers independently. Reviewer differences were resolved through third-party arbitration from the team when necessary.

Result

Literature search

The literature search in this review yielded 1571 records from all the databases (Fig. 1). After removing duplicates and screening the titles and abstracts, 1501 studies were excluded. Full-text screening included 55 studies. Then, 19 studies were excluded because of unclear outcomes, and not directly related to irregular meals and migraine headache. Hence, the full texts of 36 potentially eligible studies were retrieved.

Fig. 1.

PRISMA flow diagram for the scoping review process

Excluded studies and reasons for exclusion

The studies were excluded, and their reasons for exclusion are summarized in Table 1 [11–28, 36]. Nineteen studies were excluded among the selected full-text articles. Studies were excluded for the triggers that were not about irregular meals (n = 6), were general headache/other headache types (n = 8), and had unclear associations of intervention and outcome/unreported outcomes (n = 5).

Table 1.

Excluded studies and reasons for exclusion

No	Authors	Year	Title	Reasons of exclusion
1	Ascha, M., Kurlander, D. E., Sattar, A., Gatherwright, J., Guyuron, B.[14]	2017	In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV)	The study ` Triggers` was more occipital-triggered than irregular meal.
2	Bektas, O., Ugur, C., Gencturk, Z. B., Aysev, A., Sireli, O., Deda, G.[15]	2015	Relationship of childhood headaches with preferences in leisure time activities, depression, anxiety, and eating habits: A population-based, cross-sectional study	The study was on general headaches rather than migraine
3	Hindiyeh, N. A., Zhang, N., Farrar, M., Banerjee, P., Lombard L., Aurora S. K.[16]	2020	The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review	The study intervention does not include irregular meals.
4	Rossi, L., Cortinovis, I., Menegazzo, L., Brunelli, G., Bossi, A., Macchi, M.[17]	2007	Classification criteria and distinction between migraine and tension-type headache in children	The study is about to compare between migraine and tension-type headache in children.
5	Mansouri, M., Sharifi, F., Shokri, A., Varmaghani, M., Yaghubi, H., Moghadas-Tabrizi Y., Sadeghi, O.[18]	2021	Breakfast consumption is inversely associated with primary headaches in university students: The MEPHASOUS study	The study is about headaches rather than specific migraine headache
6	Rapoff, M., Bickel, J., Powers, S., Hershey, A., Allen, J., Karlson, C., Litzenburg, C., Belmont, J.[19]	2014	Headstrong intervention for pediatric migraine headache a randomized clinical trial	The study is not about irregular meals. The intervention was headstrong or educational control CD-ROM program
7	Miller, R., Kim, M., Gunduz, M., Aylward, S.[20]	2024	Advancements in pediatric headache	The study does not clearly show the link between migraine headache and missed meals. The symptomatology associated with primary headache disorders has been compared with ICHD-3 criteria.
8	Moschiano, F., D’Amico, D., Ramusino, M., Micieli, G.[2]	2013	The role of diet and lifestyle in adolescents with headache: a review	The study is not about a specific type of migraine headache
9	Iyun, O., Okobi, O., Sams, N., Kebede, E., Ezie, O.[21]	2024	The impact of lifestyle factors on migraine frequency and severity in neurology	The study does not include irregular meals. The dietary habits, such as high-calorie, high-fat, and gluten-containing diets, were linked to migraine triggers.
10	Probyn, K., Bowers, H., Mistry, D., Caldwell, F., Underwood, M., Patel, S., et al.[22]	2017	Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components	The study does not include irregular meals. The intervention was non-pharmacological educational or psychological self-management interventions.
11	Raucci, U., Boni, A., Evangelisti, M., Vecchia, N., Velardi, M., Ursitti, F., et al.[23]	2021	Lifestyle Modifications to Help Prevent Headache at a Developmental Age	The study does not clearly show specific migraine headache and missed meals.
12	Jahromi, S., Ghorbani, Z., Martelletti, P., Lampl, C., Togha M.[24]	2019	Association of diet and headache	The study does not include irregular meals. The focus of the diet is the Ketogenic diet and the modified Atkins diet.
13	Skogvold, L., & Magnussen, H.[25]	2018	Chronic tension-type headache and coping strategies in adolescents: A qualitative interview study	The study is solely about tension headache rather than migraine headache
14	Paiva, T.[26]	2017	Risks and Comorbid Factors of Frequent Headaches during Childhood and Adolescence	The study is not about a specific type of migraine headache
15	Walter, S.[27]	2014	Lifestyle Behaviors and Illness-Related Factors as Predictors of Recurrent Headache in U.S. Adolescents	The study is not about specific type of migraine headache
16	Webster, K., Dor, E., Galbraith, K., Kassem, L., Harrington-Benton, N., Judd, O. et al.[28]	2023	Non-pharmacological interventions for prophylaxis of vestibular migraine	The study does not clearly show the link between migraine headache and missed meals. The RCT is a vestibular migraine comparing dietary modifications, vitamin and mineral supplements, herbal supplements, mind-body interventions, or vestibular rehabilitation with either placebo or no treatment.
17	Kroon, A., Ramsey, R., Aylward, B., Kroner, J., Sullivan, S., Nause, K., et al.[36]	2016	Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by Electronic Monitoring: The Adherence in Migraine (AIM) Study	The study not clearly show the link between migraine headache and missed meals. It focuses on lifestyle recommendations of consistent noncaffeinated fluid intake.
18	Buse, C., Rupnow, T., Lipton, B.[29]	2009	Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life	The study does not clearly show the link between migraine headache and missed meals.
19	Kacperski, J., Hung, R., Blume, K.[30]	2016	Pediatric Posttraumatic Headache	The study is not about a specific type of migraine headache

Characteristics of included studies

The scoping review includes a diverse array of studies examining the association between irregular meals, including fasting and skipped meals, and migraine headaches. The study populations represent a wide demographic range, including children, adolescents, university students, women during pregnancy or perimenopause, and individuals from varied geographic regions, such as Europe, the Middle East, Asia, and North America.

All included studies were carried out between 2002 and 2023. The majority of the studies (17) were literature reviews, while the remaining eight were cross-sectional studies; two were systematic reviews (an observational and a literature systematic review), two were cohort studies (retrospective and an observational longitudinal cohort study), two were chart reviews, two were case control studies, two were case studies, and one was a randomized placebo-controlled trial. This scoping review examined the nature of literature on irregular meals and migraine headache. Studies on the global context of migraine have examined a range of factors, including foods that may either prevent or trigger migraines, as well as those with no apparent association. The majority of the identified studies were focused on the skipping of meals as a precipitating factor for migraine headache. Similarly, many focus on dietary triggers, lifestyle factors, and behavioral patterns, with several exploring the effects of fasting during Ramadan or social isolation during the COVID-19 pandemic. While some studies emphasize lifestyle modifications and adherence to regular meals as prophylactic measures, others investigate the physiological mechanisms linking hypoglycemia and meal irregularities to migraine pathophysiology.

Studies on irregular meal or diet, and migraines headache

Thirty-six of the studies included in the review had the association with the irregular meal or diet and migraines headache. These studies included systematic reviews, randomized placebo-controlled trials, cohort studies, literature reviews, chart reviews, case control studies, case studies, and cross-sectional studies. The studies showed preventive and triggering results of meals or diets with migraine headache.

One retrospective cohort study and two cross-sectional studies showed that fasting can worsen and trigger migraine headaches by lowering brain glucose levels and causing neuron depolarization [31–33]. Similarly, four cross-sectional studies, seven reviews, two case studies, and two chart reviews found that missed or skipped meals predispose to migraine headache. Migraine attacks can be triggered or worsened by missed or skipped meals, as well as dieting practices. Skipping breakfast, for instance, can lead to hypoglycemia, a known trigger for migraines. The timing of meals plays a significant role, with fasting or missing meals being potent contributors to migraine onset. In particular, missed meals can not only exacerbate general migraines but also provoke specific types, such as retinal migraines. Additionally, abdominal migraines can be triggered by factors like meal omission. Hypoglycemia is often cited as a key factor in triggering these headaches [32, 34–47]. In contrast, one case-control study, one review, and one cross-sectional study reported no significant relation between skipping a meal and migraine headache. Skipping meals has not been consistently linked to any type of headache, including migraines. There is no clear or significant relationship between meal omission and migraine headaches. The role of dietary factors as migraine triggers remains a controversial and complex topic, with research yielding inconclusive results. While some studies suggest a potential link, the overall evidence is mixed, making it difficult to draw definitive conclusions about the impact of skipping meals on migraine occurrence [9, 48, 49]. Similarly, one case-control study indicated that the relationship between missed meals and migraine attacks is inconsistent. Nevertheless, studies have shown that missed meals and insufficient sleep are major triggering factors for migraine episodes [33].

Generally, half of a systematic review of observational studies results found a positive association with the regularity of meals and migraines [50, 51]. For instance, a systematic literature review indicates that in the first 3 to 6 days after delivery, women can encounter an exacerbation of migraine symptoms due to several factors, including irregular meals and decreasing estrogen levels [51]. Moreover, one randomized placebo-controlled trial, one observational longitudinal cohort study, three reviews, and one cross-sectional study pointed to the preventive factor of regular meals from migraine headache. Regular meals serve as a protective factor against migraines, helping to prevent attacks. Avoiding meal skipping is essential for migraine prevention, as consistent eating patterns contribute to better management of the condition. Ensuring that meals are not only regular but also balanced in both quality and quantity is crucial in reducing the frequency and severity of migraine episodes [4, 34, 52–55]. Table 2 summarizes the main aspects of the studies.

Table 2.

Summary of studies on migraine headache

No	Authors	Year	Aims/objective of the study	Study design	Sample Size	Key findings on migraine headache
1	Al-Hashel, JY., Abokalawa, F, Toma, R., Algubari, A., Ahmed, SF.[31]	2021	To study the impact of the Holy month of Ramadan on migraine headaches.	Retrospective cohort study	293	Fasting worsens and significantly predicts migraine headache
2	Ali Chouhdary, M. H.., Aslam, M., Amjad, A., Khalid, Z.., Erum, W.., Shehzadi, S., et al.[56]	2023	To assess the link of breakfast skipping with hypoglycemia and headache/migraine among undergraduate students.	A cross-sectional study	100	Frequent breakfast skipping significantly exposes one to headache/migraine due to hypoglycemia.
3	Baumann, RJ.[57]	2002	To assess the behavioral treatment of migraine in children and adolescents	Literature review		Adjust habits like irregular meal times that are thought to trigger migraine headaches.
4	Casanova A, Vives-Mestres M, Donoghue S, Mian A, Wöber C.[52]	2023	To determine if known migraine trigger factors and daily adherence to healthy lifestyle recommendations are associated with decreased probability of migraine attacks in some individuals.	An observational longitudinal cohort study	1125	Individuals with higher levels of adherence to healthy practices, particularly eating regular meals, were significantly older and had a longer history of migraine diagnosis than those with lower levels of adherence.
5	Leite, L. de I., Lôbo, I M. de B., Sousa, N. H. de., Capistano, P. S., Silva, H. M. S. L. S. Pinho, L.S.P., et al.[50]	2023	To systematically review the association between eating habits, lifestyle and migraine attacks during social isolation in the COVID-19 pandemic.	A Systematic Review of Observational Studies	3,256	Half of the included studies revealed a positive correlation between migraines and eating regularly.
6	Dumitru, A. E., Gica, N., Botezatu, R., Peltecu G., Panaitescu A. M.[51]	2022	To describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options.	A systematic literature review	25 articles	Women may experience a worsening of migraine symptoms in the first 3 to 6 days after delivery due to factors such as irregular meals and a drop in estrogen levels.
7	Dzoljic, E., Vlajinac, H., Sipetic, S., Marinkovic, J., Grbatinic I., Kostic, V.[33]	2014	To compare characteristics of migraine and some lifestyle habits in migraineurs with and without a positive family history for migraine.	A case-control study	245	Data concerning the association of missed meals and migraine attacks are inconsistent. Missed meals and little sleep were the major triggering factors for migraine attacks. Those who suffer from migraines and have a negative family history reported missing meals and eating less than three times a day.
8	Finkel, A. G., Yerry J. A., Mann, J. D. [38]	2013	To assess the dietary considerations in migraine management	A review		Meal timing, as shown by missing meals or fasting, is obviously a potent trigger and one most recognized by patients.
9	Gelfand, A. A. [53]	2018	To provides the practicing neurologist with a comprehensive, evidence-based approach to the diagnosis and management of headache in children and adolescents, with a focus on migraine.	Randomized placebo-controlled trials		As a preventive treatment, children and adolescents with migraines will benefit from lifestyle management counseling, which includes avoiding meal skipping.
10	Hatem, G., Mosleh, R., Goossens, M., Khachman, D., Al-Hajje A, Awada, S.[58]	2022	To assess the prevalence of migraine among university students using the ID Migraine screening tool and to evaluate risk factors associated with migraine.	A cross-sectional study	1144	Unorganized meals and fasting were the main predictors of migraine.
11	Iliopoulos, P., Damigos, D., Kerezoudi, E., Limpitaki, G., Xifaras, M., Skiada, D., et al.[35]	2015	To compare the different characteristics of triggers among the most common primary headache subtypes (migraine without aura, migraine with aura and tension type headache)	A cross-sectional study	116	Skipping meals is one of the trigger factors for migraine with aura.
12	Ju, H-H. [44]	2021	To discusses the experience of a patient with type 2 diabetes facing retinal migraines during the coronavirus disease 2019 pandemic	Case study	1	Individuals with type 2 diabetes experienced distressing episodes of transient visual disturbances during the COVID-19 pandemic, where missed meals triggered and worsened retinal migraine attacks.
13	khan, A., khattak, H., Jamali, R., Rashid, H., Riaz, A., Ibrahimzai, A.[36]	2012	To assess the prevalence, common triggering factors and find out the common coping strategies for migraine in medical students.	Cross sectional study	500	Missed meals and dietary patterns were the next triggers of migraine.
14	Kurlander, D., Ascha, M., Sattar A., Guyuron, B.[46]	2016	To examines the effect of surgical deactivation of frontal migraine headaches on migraine triggers and associated symptoms besides the pain.	Charts Review	270	Frontal migraines can be linked to visual aura, blurred vision, and double vision, with missed meals acting as a trigger. Identifying and resolving these triggers, like missed meals, is strongly associated with a decrease in the Frontal-Specific Migraine Headache Index.
15	Kurlander, D., Punjabi, A., Liu, M., Sattar, A., Guyuron, B. [47]	2014	To examined the effect of surgical deactivation of temporal-triggered migraine headaches on migraine triggers and associated symptoms besides the pain.	Charts Review	246	A missed meal is one of the trigger associations with the site II Migraine Headache Index Reduction.
16	Lawrence, E.[5]	2004	To review the diagnosis and management of migraine headaches	Literature review and case studies		Irregular meals are one of the common migraine triggers.
17	Linde, M.[59]	2006	To review and future directions for treatment of migraine	Review		Less often, irregular meals or food trigger migraine attacks
18	Matarese, C., & Mack, K.[60]	2010	To identify the management considerations in the treatment of migraine in adolescents	Review		Irregular mealtimes are a common lifestyle factor among adolescents that can worsen migraines.
19	Milde-Busch, A., Blaschek, A., Borggräfe, I., Heinen, F., Straube, A., Von Kries, R.[48]	2010	To investigate associations between diet and lifestyle factors and different types of headache, i.e., migraine and tension-type headache (TTH) in adolescents.	A Cross-Sectional Study	1260	Skipping of meal intake was not associated with any type of headache.
20	Mutlu, M., Şahin, L., Ehi, Y.[61]	2016	To provide details of the workup and then provides treatment options for migraine during pregnancy and lactation.	Review		Irregular or inappropriate meals are most frequently reported triggers for migraine headache.
21	Nazari, F., Safavi, M., Mahmudi, M.[49]	2010	To examines the relation between migraine headaches and lifestyle in women refereed to university clinics in Iran.	A case-control study	170	There is no significant relationship between skipping a meal, missing breakfast, or having meal snacks and migraine headaches.
22	Ravisankar, P., Hundia, A., Sindhura, J., Rani, B., Anvith, P., Pragna, P.[4]	2015	To make a comprehensive review of migraine	Review		A regular and healthy meal routine can help with recovery and make migraine management easier.
23	Rockett, F., Oliveira, V., Castro, K., Chaves, M., Ada, S., Perry, I.[9]	2012	To evaluate the published evidence on dietary triggers	Review	45 studies	The significance of dietary factors as triggers for migraines is controversial, and the assessment of this issue is complex and inconclusive. For instance, most studies (five) found a significant link between skipping meals and migraines, while two studies found no such association.
24	Rustom, A., Audi, F., Samsam, H., Nour, R., Mursi, A., Mahmoud, I.[37]	2022	To determine the prevalence, awareness, and impact of migraine on University of Sharjah students.	A cross-sectional study	400	Hunger, or skipping meals, was one of the most common triggering factors for migraine headache attacks.
25	Naragatti, S., & Gupta, R.[45]	2019	To evaluate the efficacy of Yoga & naturopathy as an adjuvant therapy in migraine patient by assessing clinical outcome and autonomic functions tests.	case study		Missing meals is a potential migraine trigger.
26	Silva, H., Sousa, N., Araújo, A., Sousa, M., Santos, A., Pires, A., et al.[62]	2021	Evaluating the association between eating behavior and lifestyle habits and the increase of migraine attacks in university students during the Covid-19 pandemic.	A cross-sectional study	83	Regular meals with adequate quality and quantity are essential for preventing migraine attacks. Fasting can trigger migraines due to lower brain glucose levels and neuron depolarization.
27	Winner, P. [39]	2016	To review the most recent International Classification of Headache Disorders-3 beta for abdominal migraine, and discuss the differential diagnosis and current suggested management.	Review		Skipping meals can trigger abdominal migraine attacks, so all children with abdominal migraines should be encouraged to eat regularly.
28	Goadsby, P., Sprenger, T.[40]	2010	To discuss both acute and preventive treatment, as well as strategies for the management of medication overuse.	Review		Migraine is a hereditary tendency to experience headaches, often triggered by skipping meals.
29	Aguilar-Shea, L., Membrilla A., Diaz-de-Teran, J.[63]	2022	To review migraine for general practice	Review		Meal routine habits are known to influence migraine progression. An observational study of 350 migraine patients found that those with chronic migraines have significantly less regular meal routines than those with episodic migraines.
30	Athar, F., Zahid, A., Farooq, M., Ayyan, M., Ashraf, M., Farooq, M., et al.[34]	2022	To determine the frequency of migraine in Pakistan, its association with socio-demographic variables and triggering factors, and the coping mechanisms used.	A cross-sectional study	986	Missed meals and dieting significantly trigger migraine
31	Dasari, R., Clark, J., Boorigie, E., Gerson, T., Connelly, A., Bickel, L.[41]	2021	To examining migraine and lifestyle factors in children and adolescents.	Review	42 studies	Skipping meals is predictive of developing a migraine episode.
32	Gantenbein, R., Afra, J., Jenni, W., Sándor, S.[32]	2012	To assess the complementary and alternative treatments for migraine	Review		Some triggers of acute migraine episodes, such as missed meals, may be linked to abnormal processing of cortical information.
33	Graves, W.[54]	2006	To presents information and guidelines to assist clinical decision making.	Review		Medications alone do not control migraines; changing lifestyle habits, like eating regular meals, can be beneficial.
34	Hauser, L.[55]	2012	To reviews diagnostic criteria for migraine with and without aura, the impact of fluctuating hormones in peri-menopause on the experience of migraine and medication and non-medication approaches to managing migraine.	Review		According to the American Headache Society (2007), avoiding triggers and making lifestyle changes, such as eating regular meals, are key steps in managing and preventing migraines.
35	Kokavec, A.[42]	2016	To examine the effect (if any) of the most commonly reported migraine triggers on gluco-regulation.	Review		Fasting or skipping meals can trigger migraines, with hypoglycemia often cited as a common cause.
36	Millichap, G., Yee, M.[43]	2003	To provide a better understanding of the potential role of diet in the cause of migraine, and to emphasize the importance of excluding dietary and other migraine triggers before initiating long-term drug therapy.	Review		A balanced diet is important, and skipping meals or fasting should be avoided as they are known triggers.

Discussion

This scoping review aims to map the evidence relating to migraine headache and irregular meals, including skipping meals or missed diets and fasting. Although the majority of the studies show an association between irregular meals or diets and their potential effect on migraine headache, a few studies have not found its association. The variability in findings may be attributed to differences in study design, sample size, and population characteristics such as age, gender, genetics, and underlying health conditions. Additionally, inconsistencies in measurement techniques (self-reports vs. objective tracking) and other confounding factors like lifestyle, stress, hydration, and dietary composition contribute to mixed results.

This study`s results reported that fasting can exacerbate and trigger migraine headaches by reducing brain glucose levels and inducing neuron depolarization [31–33]. The International Classification of Headache Disorders (ICHD-3) stated that fasting can trigger headaches in people who already have a primary headache disorder, including migraine [64]. In addition, the practice of Algerian Muslims indicated that Ramadan fasting aggravates the frequency of migraine attacks [65]. Although headaches may occur under conditions of hypoglycemia-induced brain dysfunction, there is no conclusive evidence to support a causal association. Headache attributed to fasting can occur in the absence of hypoglycemia, insulin-induced hypoglycemia does not precipitate headache in migraine sufferers, and headache is not a complaint of patients presenting to the emergency department with symptomatic hypoglycemia [64].

According to the American Migraine Foundation, delayed or missed meals often result in a relative drop in blood sugar, triggering a migraine [62]. Similarly, this study found the same result. Migraine attacks can be triggered or worsened by skipping meals or dieting, with breakfast omission often leading to hypoglycemia, a known trigger. The timing of meals is crucial, as fasting or missed meals can provoke general and specific types of migraines, such as retinal and abdominal migraines. Hypoglycemia is frequently cited as a key factor in these attacks [32, 34–47]. In the same way, the study in Iceland indicated skipping meals (hunger) was the most common food-related triggers [66]. However, few studies indicate that skipping meals has not been consistently associated with migraines headaches, and no clear link has been established. The role of dietary factors as migraine triggers is controversial, with mixed and inconclusive evidence, making it difficult to draw definitive conclusions about meal omission’s impact on migraines [9, 48, 49]. The studies are not high-level evidence with low study designs. So, it is difficult to draw conclusions. Still interventional studies are warranted to assess these associations. But studies indicate that missed meals together with inadequate sleep are key triggers for migraines [33]. Overall, the variability in study designs, self-reported data, age, sex, and overlapping lifestyle factors contributes to the inconclusive nature of the evidence.

Based on migraine, a comprehensive guide from the Walton Centre NHS Foundation, lifestyle changes such as eating regular meals can make such a huge difference for most people suffering from migraine [63]. This study also shows a positive association noted between meal regularity and migraines [50, 51]. Women may experience a worsening of migraine symptoms in the first 3 to 6 days after delivery due to factors such as irregular meals and a drop in estrogen levels [51]. Similarly, irregular meal times are a major trigger for migraines, with individuals who have chronic migraines often following inconsistent eating schedules. Disorganized eating patterns, such as irregular meals, are key predictors of migraine attacks. Moreover, regular and balanced meals are key to preventing migraines, as consistent eating patterns help manage the condition and reduce the frequency and severity of attacks [4, 34, 52–55].

Generally, the findings underscore the significant role of meal regularity in migraine prevention and management, emphasizing the need for structured dietary habits as part of both clinical and public health strategies. Given that fasting and irregular meal patterns, particularly breakfast skipping, are strongly linked to migraine onset due to hypoglycemia-induced neuronal instability, healthcare providers should incorporate meal regularity into migraine prevention guidelines. Clinicians should educate patients, especially those with chronic migraines, about the risks associated with erratic eating schedules and encourage consistent meal timing to stabilize blood glucose levels and potentially reduce attack frequency. Public health initiatives can reinforce these recommendations by promoting dietary awareness programs and integrating meal regularity into broader headache prevention strategies. Special attention should be given to vulnerable groups, such as postpartum women, who may be at higher risk due to hormonal fluctuations and disrupted eating patterns.

This study publications included studies that exhibit several limitations that may affect the reliability and generalizability of their findings. Many of the studies rely on self-reported data, which introduces the risk of recall bias and subjective misclassification of migraine triggers and symptoms. Additionally, there is considerable heterogeneity in study designs, sample populations, and methodologies, making direct comparisons and meta-analyses challenging. A significant proportion of the studies are observational or cross-sectional, limiting the ability to establish causality between risk factors and migraine onset. Furthermore, several studies are of low to moderate quality, often lacking rigorous control groups, randomization, or standardized diagnostic criteria. These limitations indicate the need for more well-designed research like randomized controlled trials, having better sample sizes or strong study design, and longitudinal research to improve understanding of migraine pathophysiology and management strategies.

Conclusion

The majority of studies suggest that fasting can exacerbate and trigger migraine headaches by reducing brain glucose levels and inducing neuron depolarization. Skipping meals, particularly breakfast, often leads to hypoglycemia, a known trigger for migraines. The timing of meals plays a crucial role, as fasting or missed meals can provoke various types of migraines, such as retinal and abdominal migraines, with hypoglycemia frequently cited as a key factor. Furthermore, irregular meal times, particularly in individuals with chronic migraines, are strong predictors of attacks, and women may experience worsening symptoms in the first few days post-delivery due to irregular eating and a drop in estrogen levels. However, some studies present inconsistent findings, low to moderate quality, often lacking rigorous control groups, randomization, or standardized diagnostic criteria regarding the link between meal omission and migraines. Mixed evidence may result from differences in study design, sample size, population traits, measurement methods, and confounding factors like lifestyle and diet. The role of dietary factors as migraine triggers remains controversial, as evidence is mixed and inconclusive. Future research, like randomized controlled trials, having better sample sizes, or more robust study design, should aim to clarify the relationship between specific dietary patterns, particularly meal timing (meal frequency, macronutrient composition, glycemic impact) and migraine pathophysiology, helping refine nutritional guidelines for migraine sufferers.

Strengths and limitations of this study

As of the knowledge of the authors, this is the first scoping review on irregular meals and migraine headache. The search strategy included six electronic databases, including ancestor searching and grey literature. This scoping review provides information on the migraine headache, and irregular meals, including skipping or missed meals or dieting and fasting. As well, it shows the nature of evidence on study design and research gaps. Nevertheless, the study was limited to reviewing findings only from publications and grey literature with scientific methods and might therefore miss important information from other sources. In addition, the publications included were of low to moderate methodological quality, often lacking rigorous control groups, randomization, or standardized diagnostic criteria regarding the link between meal omission and migraines. Similarly, a key limitation of this study is the variability in findings due to differences in study design, small sample size, and population characteristics such as age, gender, genetics, and underlying health conditions. Additionally, inconsistencies in measurement techniques (self-reports dietary habits) and confounding factors like lifestyle, stress, hydration, and dietary composition may have influenced the results. On top of these, the study specifies only English-language publications that consider the potential impact of language bias on the findings.

Acronym

ICHD

International Classification of Headache Disorders

TTH

Tension-Type Headache

TACs

trigeminal autonomic cephalalgias

Appendix I: search strategy

MEDLINE (PubMed).

Search conducted November 26 2024: Results retrieved 143.

Query	Concept	Search Terms	Records Retrieved
1	Migraine Headache	“migraine” OR “migraine attacks " OR " migraine headache”	49,203
2	Irregular Meals	“irregular meals” OR “meal skipping” OR “missed meals” OR “dieting” OR “fasting” OR “disrupted eating patterns”	156,130
3	1 AND 2	(“migraine” OR “migraine attacks " OR " migraine headache” AND (“irregular meals” OR “meal skipping” OR “missed meals” OR “dieting” OR “fasting” OR “disrupted eating patterns”	174
4	Filter with Human AND English	(“migraine” OR “migraine attacks " OR " migraine headache” AND (1000/1/1:2024/11/26[pdat])) AND (“irregular meals” OR “meal skipping” OR “missed meals” OR “dieting” OR “fasting” OR “disrupted eating patterns” AND (1000/1/1:2024/11/26[pdat])) Filters: English, Humans,	143

Author contributions

SML conceptualizing and designing the scoping review. Articles retrieved were screened independently by two group of reviewers (SML & TH) and (AEA & BHJ). Disagreements at any of the eligibility assessment process were resolved through discussions and consultation with the team (BJB& ZDA). All authors reviewed the manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Informed consent

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.