title: Effect of exclusion of frequently consumed dietary triggers in a cohort of children with chronic primary headache.
abstract: BACKGROUND
  Although dietary factors are known to trigger headaches, the relationship between food and headache in children remains unclear. This prospective, observational case series aimed to evaluate the effect of exclusion of frequently-consumed foods in a cohort of children with headache.
  
  
  METHODS
  One hundred and fifteen children aged 3-15 (mean 10.5) years with primary headache were followed in a paediatric outpatient clinic. Patients who frequently consumed foods or food additives known to trigger headaches were advised to exclude them for six weeks and to return for follow-up with headache and food diary.
  
  
  RESULTS
  One hundred patients attended follow-up. Of these 13 (13%) did not respond to dietary exclusion; 87 (87%) achieved complete resolution of headaches by exclusion of 1-3 of the identified food(s). Caffeine was the most common implicated trigger (28), followed by monosodium glutamate (25), cocoa (22), aspartame (13), cheese (13), citrus (10) and nitrites (six). One patient was sensitive to tomatoes.
  
  
  CONCLUSIONS
  This study demonstrates the potential scale and significance of seven frequently consumed foods or food additives as triggers for primary headache in children. Also this is the first study to show that headaches can be triggered by the cumulative effect of a food that is frequently consumed, rather than by single time ingestion.
authors.affiliation: Children's Hospital of Western Ontario, Department of Academic Paediatrics, London, Canada.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Taheri
mesh_terms: D000293:Adolescent; D001218:Aspartame / Q000008:administration & dosage / Q000009:adverse effects; D002099:Cacao / Q000009:adverse effects; D002110:Caffeine / Q000008:administration & dosage / Q000009:adverse effects; D002611:Cheese / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D000069956:Chocolate / Q000009:adverse effects; D002957:Citrus / Q000009:adverse effects; D004032:Diet / Q000009:adverse effects*; D015930:Diet Records; D005247:Feeding Behavior; D005260:Female; D005503:Food Additives / Q000008:administration & dosage / Q000009:adverse effects; D006261:Headache / Q000178:diet therapy* / Q000209:etiology; D020773:Headache Disorders / Q000178:diet therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000178:diet therapy* / Q000209:etiology; D009573:Nitrites / Q000008:administration & dosage / Q000009:adverse effects; D015985:Precipitating Factors; D011446:Prospective Studies; D012970:Sodium Glutamate / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D005503:Food Additives; D009573:Nitrites; D002110:Caffeine; D012970:Sodium Glutamate; D001218:Aspartame
keywords: Headache; child; elimination diet; food; migraine; triggers