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Dietary Modulation in Headache and Migraine

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Dr. Cinzia E. Cavestro

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Headache Centre, Department of Neurology, ASL CN2, Community Health Center—Former San Lazzaro Hospital, 12051 Alba, Italy
Interests: neuroscience; headache disorders; migraine; rare disorders; nutrition

Special Issue Information

Dear Colleagues,

Our lifestyle habits and dietary patterns profoundly influence the body in both health and disease. Headache and migraine represent a major global health issue and impose a substantial economic and social burden. Over the past two decades, an increasing number of studies have highlighted how dietary modifications may contribute to improvements in headache disorders, particularly migraine. The mechanisms through which such changes are presumed to exert their effects are diverse, with the most widely discussed involving the normalization of metabolic processes and the reduction of neuroinflammation.

This Special Issue aims to provide a comprehensive overview of the various nutritional strategies that have been proposed, along with the corresponding hypotheses or evidence supporting the pathophysiological mechanisms by which dietary interventions may improve headache disorders, and migraine in particular.

Dr. Cinzia E. Cavestro
Guest Editor

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Research

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20 pages, 2031 KB

Open AccessArticle

Myoinositol and Selenium (MYSE) Supplementation Is Associated with Favorable Changes in Thyroid Parameters and Migraine Outcomes in Patients with Migraine and Hashimoto’s Thyroiditis: A Retrospective Cohort Study

by Cherubino Di Lorenzo, Maurizio Nordio, Fiorenzo Brongo, Francesco Casillo, Sabrina Basciani, Gabriele Sebastianelli, Mariano Serrao, Giorgio Di Lorenzo and Gianluca Coppola

Nutrients 2026, 18(10), 1554; https://doi.org/10.3390/nu18101554 - 14 May 2026

Abstract

Background/Objectives: Migraine and Hashimoto’s thyroiditis (HT) are frequently comorbid, implying shared biological pathways. Selenium and myoinositol are involved in migraine pathophysiology, and their supplementation has been shown to improve thyroid function, particularly in individuals with HT. This study aimed to evaluate the impact of combined myoinositol and selenium (MYSE) supplementation on thyroid function and migraine outcomes in patients with migraine and HT. Methods: We conducted a retrospective study on a cohort of 163 adults with migraine comorbid with HT who received a 6-month MYSE supplementation. Thyroid parameters, namely thyrotropin (TSH), free thyroxine (fT4), and free triiodothyronine (fT3), and migraine features, namely monthly migraine days (MMDs), monthly migraine attacks (MMAs), and monthly symptomatic drug use (MSDs), were assessed at baseline and at follow-up. Because Shapiro–Wilk testing showed that all thyroid and migraine outcomes deviated significantly from normality, pre–post comparisons were evaluated with the Wilcoxon signed-rank test, between-group comparisons with the Mann–Whitney U test, and a three-tier non-parametric strategy (Aligned Rank Transform with ART-C contrasts, the Brunner–Langer non-parametric mixed model, and a trimmed-means between-within ANOVA) to analyze time × migraine × gender, adjusted for age and illness duration. Spearman rank correlations with percentile-bootstrap 95% confidence intervals were computed, and both robust MM-regression and rank-based Jaeckel regression were carried out. Another analysis stratified participants by baseline thyroid status: euthyroid vs. subclinical hypothyroidism (SCH). Results: After six months of MYSE supplementation, significant reductions were observed in TSH (median 3.60 → 2.80 mIU/L, Wilcoxon p < 0.001, rank-biserial r = −0.94), MMDs (14 → 11, p < 0.001, r = −0.99), and MSDs (14 → 11, p < 0.001, r = −0.99), while fT4 increased slightly (1.30 → 1.50 ng/dL, p < 0.001) and fT3 remained stable. For MMAs, a small effect was detected by the paired Wilcoxon test (p = 0.002) but the main effect of time did not survive adjustment in any of the three covariate-adjusted mixed models (ART p = 0.079; nparLD p = 0.55; WRS2 p = 0.084). Chronic migraine patients had higher baseline and follow-up headache burden but experienced greater reductions in MMDs. The percentage reduction in TSH was positively correlated with improvement in MMDs (Spearman ρ = 0.45, bootstrap 95% CI 0.31–0.57, p < 0.001) and was the only significant predictor in both robust MM-regression (β = 0.28, p < 0.001) and rank-based regression (β = 0.25, p < 0.001). The TSH–MMD association held within each thyroid-status stratum separately (ρ = 0.42 in euthyroid, ρ = 0.51 in SCH; p < 0.001 for both), indicating an individual-level signal rather than a between-group artefact. Conclusions: MYSE supplementation was associated with improved thyroid parameters and a meaningful reduction in migraine burden among patients with migraine and HT. The association between TSH reduction and headache improvement supports the hypothesis of an endocrine–metabolic contribution to migraine severity and warrants confirmation in prospective controlled trials. It also supports the clinical value of assessing and addressing thyroid function in this population. Full article

(This article belongs to the Special Issue Dietary Modulation in Headache and Migraine)

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18 pages, 1206 KB

Open AccessReview

Migraine and the Gut–Brain Axis—The Role of Microbiome-Targeted Biotics

by Márk Kozák, Tímea Sitku, Rebeka Hodossy-Takács, Flóra Sápi, István Várkonyi and Zsolt Barta

Nutrients 2026, 18(5), 720; https://doi.org/10.3390/nu18050720 - 24 Feb 2026

Cited by 1 | Viewed by 1796

Abstract

Background: Migraine is a highly prevalent and disabling primary headache disorder frequently accompanied by gastrointestinal symptoms and comorbid gastrointestinal diseases. Increasing evidence suggests that alterations in the gut microbiota and dysregulation of the microbiome–gut–brain axis may contribute to migraine pathophysiology through immune activation, oxidative stress, impaired intestinal barrier function, and neuroinflammatory signaling. Objectives: This narrative review aims to summarize current mechanistic and clinical evidence linking the gut–brain axis to migraine, with a particular focus on the potential roles of probiotics, prebiotics, and postbiotics as adjunctive strategies in migraine management. Methods: A narrative synthesis of experimental, translational, and clinical studies was performed, focusing on microbiome composition, gut barrier integrity, immune and oxidative pathways, and interventional trials evaluating probiotics, prebiotics, synbiotics, and microbiota-derived metabolites in adult and pediatric migraine populations. Results: Migraine has been associated with intestinal dysbiosis, increased gut permeability, and low-grade systemic inflammation. Probiotics, most commonly strains of Lactobacillus and Bifidobacterium, may modulate inflammatory cytokine profiles, enhance tight junction integrity, reduce oxidative stress, and influence neurotransmitter-related pathways along the gut–brain axis. Clinical trials evaluating probiotic supplementation report heterogeneous but promising signals, including reductions in migraine frequency, severity, disability scores, and analgesic use, particularly in chronic migraine and pediatric populations. Emerging evidence also supports a potential role for prebiotics (e.g., inulin-type fructans) and microbiota-derived metabolites such as short-chain fatty acids, although direct clinical data remain limited. Conclusions: Modulation of the microbiome–gut–brain axis represents a biologically plausible adjunct approach in migraine management. While probiotics, prebiotics, and postbiotics show potential benefits with favorable safety profiles, current evidence of their strain-, formulation-, and population-specific characteristics is lacking. Well-powered, placebo-controlled trials with standardized migraine endpoints and integrated microbiome and metabolomic analyses are needed to define responders, optimal interventions, and clinical relevance. Full article

(This article belongs to the Special Issue Dietary Modulation in Headache and Migraine)

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