Table 1.
Overview of studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Abbreviations: TTH–tension-type headache, MWA–migraine without aura, MA–migraine with aura, EM–episodic migraine, CM–chronic migraine, TF–trigger factor.
| Author (Year) |
Study Design | Study Design (Method of Identifying Trigger Factors) | Study Group: Type of Headache (Number of Participants) |
Study Population Age (Years) |
Chocolate/Cocoa Reported as a Trigger Factor (%) | Additional Information |
|---|---|---|---|---|---|---|
| Beh, S.C., 2019 [70] | Retrospective cross-sectional | Retrospective chart review | Vestibular migraine (n = 131) | No data | 3.8 | |
| Tai, M. S., 2018 [61] | Prospective cross-sectional | Comprehensive dietary check list |
Migraine (n = 319) TTH (n = 365) MWA (n = 188) MA (n = 128), CM (n = 91) |
Migraine 37.1 ± 14.3 TTH 46.5 ± 18.1 |
Migraine 11.6% TTH 3.8% |
Chocolate was significantly associated with migraines compared to TTH. |
| Taheri, S., 2017 [71] | Prospective observational case series | Food diary | Migraine (n = 65) TTH (n = 50) |
Range 10–15 Mean 10.5 |
22 | 87% of patients achieved complete resolution of headaches by the exclusion of 1–3 triggers |
| Park, J.W., 2016 [63] | Prospective cross-sectional | Smartphone headache diary application | Episodic Migraine (n = 62) MWA (n = 60) MA (n = 2) |
Mean 37.7 ± 8.6 | Cheese/ Chocolate 1.5 |
|
| Peris, F., 2016 [72] | Prospective cross-sectional | Detailed 90-day paper diary database from the PAMINA migraine study | Migraine (n = 326) |
No data | 2.5 | |
| Constantinides, V., 2015 [36] | Prospective cross-sectional | Interview | Migraine (n = 21) MWA (n = 39) MA (n = 12) TTH (n = 12) |
Migraine 41.4 ± 12.9 TTH 37.5 ± 15.5 |
Migraine 11.4 TTH 0 |
There was a tendency toward more frequent reports of chocolate as a trigger in migraine patients. |
| Rist, P., 2014 [73] | Cross-sectional study among participants in the Women’s Health Study | Semi-quantitative food frequency questionnaire | Non-migraine headache (n = 5573) Migraine (n = 7042) MWA (n = 2972) MA (n = 1974) |
Mean 53.6Mean 53.6 | Not applicable | Migraine patients with an aura were more likely to have a low intake of chocolate. Patients with non-migraine headaches were less likely to have a low intake of chocolate. |
| Mollaoglu, 2013 [7] | Prospective cross-sectional | Interview TF checklist | Migraine (n = 146) MWA (n = 73) MA (n = 53) |
Mean 36.32 | 18.3 | |
| Camboim Rockett, F., 2012 [35] | Cross-sectional study | Predetermined list of 22 dietary factors | Migraine (n = 123) MWA (n = 84) MA (n = 39) |
Mean 43.2 ± 13.9 | <20 | |
| Neut, D., 2012 [74] | Retrospective | Predetermined list of TF | Migraine (n = 102) MWA (n = 71) MA (n = 22) |
Mean 12 Range 7–16 |
11.8 | |
| Finocchi, C. 2012 [3] | Prospective cross-sectional | No data | Migraine without aura (n = 100) |
Mean 41.7 ± 14.2 | 20% of migraine attacks were triggered by food, among them 45% from chocolate | |
| Schürks, M., 2011 [75] | Cross-sectional study | Mailed migraine-specific questionnaire | Women’s Health Study (n = 1675) |
No data | 24.7 | |
| Yadav, R., 2010 [40] | Prospective cross-sectional | Questionnaire | Migraine without aura (n = 182) |
Mean 30.7 Range 14–58 |
None | None of the subjects reported chocolate as a trigger. |
| Andress-Rothrock, D., 2000 [34] | Prospective cross-sectional | Headache trigger checklist | Migraine (n = 200) EM (n = 56) CM (n = 144) |
Mean 41.1 Range 16–75 |
3 | |
| Chakravarty, A., 2009 [4] | Prospective and retrospective cross-sectional | Migraine trigger checklist | Migraine (n = 200) MWA (n = 197) MA (n = 3) |
Range 7–15 | 1.5 retrospective study 0.3 prospective study |
|
| Fukui, P., 2008 [5] | Prospective cross-sectional | Predetermined list of TGG | Migraine (n = 200) |
Mean 37.7 | 20.5 (22.84% females, 10.53% males) |
|
| Wöber, C., 2006 [76] | Cross-sectional study | Two predetermined TF checklists (patients’ personal experience and theoretical knowledge) |
Migraine (n = 71) TTH (n = 49) |
Range 18–65 Migraine 36.8 ± 11.4 TTH 39.5 ± 12.7 |
Theoretical knowledge 61.7 Personal experience 14.3 |
The difference between theoretical knowledge and personal experience was statistically significant and the largest for chocolate. |
| Takeschima, T., 2004 [39] | Door to door survey | Structured questionnaires | headache (n = 1628) migraine (n = 342) MWA (n = 301) MA (n = 41) |
No data | None | |
| Bank, J., 2000 [77] | Population-based epidemiological survey | Self-administered headache questionnaire | Migraine (n = 62) |
Mean Women 41 Men 43 |
1.4 | |
| Marcus, D., 1997 [78] | Double-blind study | Headache (n = 63), 50% migraine, 37.5% TTH, 12.5 migraine + TTH |
Mean 28.3 | 17.5 | No significant difference of migraine attacks between chocolate and placebo. | |
| Ulrich, 1996 [79] | A cross-sectional study | Mailed questionnaire | Migraine (n = 484) MWA (n = 342) MA (n = 163) |
No data | 1.7 | Only migraineurs experienced chocolate as a precipitant of tension-type headaches |
| Van Den Bergh, 1987 [80] | Retrospective | Unstructured recall/free self-report | Migraine (n = 217) |
Mean 40 | 22.5 | |
| Peatfield, R., 1984 [81] | Retrospective cross sectional | Interview | Migraine (n = 490) |
No data | 19 | |
| Dalton, 1975 [37] | Prospective cross- sectional | Self-administered postal questionnaire | Migraine in women (n = 1883) |
No data | 33 | |
| Moffet, A.M., 1974 [82] | Retrospective study | Questionnaire | Migraine (n = 332) |
No data | 26.5 |