On a recent Sunday, I had a migraine headache. I’d felt pretty good that morning. I cleaned the kitchen and did a crossword puzzle with my husband. It promised to be a productive day. Then, at about 1 p.m., it struck out of nowhere. Unlike others that creep up on me during sleep or gradually appear over the course of the day, this one was sudden: a band of pain about an inch wide, starting in my shoulder and radiating over my head toward the back of my eye. I had to go back to bed, all promise of productivity lost. The throbbing and nausea stuck around until Thursday.
As always, I examined the possible triggers over and over in my head. I’ve had migraine for almost 25 years, and with every attack, I’m still stuck wondering, What caused this one? I felt slightly anxious about a minor social quandary when it started, but it didn’t feel strong enough to go from zero to 60 like that. The night before, I had gone to a friend’s birthday barbecue and had a couple of drinks, though I didn’t feel hungover when I woke up. And of course, there was the chocolate cake I had baked for the party and enjoyed a hefty slice of. Was that causing my pain? After all, chocolate is a migraine trigger, isn’t it?
If you suffer from migraine, you have probably been told this as fact. Maybe you believe it about your own migraine headaches, too. The advice to fear chocolate is everywhere: The American Migraine Foundation’s list of the “Top 10 Migraine Triggers” includes chocolate as part of its “laundry list of foods known to trigger a migraine attack.” I can’t even remember who told me this first — a doctor, a parent, a friend’s mom. The Cleveland Clinic, WebMD, Healthline, and other high-ranking search results include chocolate as a migraine trigger, as does Google’s own suggested list at the very top of the page.
Yet there is no solid evidence that chocolate triggers migraine, at least not for the vast majority of people. Millions of sufferers, most of whom are women, may be avoiding chocolate for no good reason. It’s a truly heartbreaking epidemic of people unnecessarily depriving themselves of one of life’s great pleasures. How did we get here?
The first thing to know about migraine triggers is that it’s extremely difficult to tell many of the most common ones apart from the early signs of a migraine attack. The first stage is called the premonitory phase, or the “prodrome.” It can include signs such as yawning or changes in mood or sleep (things that might commonly vary day-to-day anyway and can be hard to notice) or no signs at all, and it can last as long as two days. For the 20 percent of sufferers who experience aura, the weird visual symptoms like the classic star-shaped hole in your vision, the prodrome is where it happens. Many people believe bright lights and loud noises are triggers, but migraine researchers increasingly think those experiences may actually be premonitory symptoms: The brain becomes more sensitive to sensory inputs during a migraine attack, so lights and noise hurt because you’re already having one.
Another of those premonitory symptoms that’s hard to distinguish from a trigger is food cravings. Ever craved chocolate, given in, and gotten a headache later? I certainly have, especially before my period. It’s easy to see how you could end up believing the chocolate was the cause, but it may well be that people who believe this have the association right but the causality wrong: They ate the chocolate because they were having a migraine attack.
Although we make them for very understandable reasons, such assumptions often turn out to be incorrect. In one important study from 2023, participants were asked to record suspected trigger factors on an app every day, whether they were having an attack or not. Most migraine-tracking apps ask patients to record only the days when they have a headache, making spurious associations much easier to draw. One author of this study was Stephen Donoghue, vice-president of clinical development at Curelator, the company that designed the app used in the study. Donoghue told me that he and his colleagues had been “optimistic” about finding several factors for each individual that were statistically associated with more migraine attacks, which would then help people track and control their triggers. (You can imagine how a company might be able to profit from a product that can promise this sort of insight.)
Once they started actually looking at the data, though, they “weren’t getting very much,” Donoghue continued. The study found that chocolate was far more often associated with a decreased risk of migraine, rather than an increase, along with “salty foods, nuts, onions, alcohol, caffeine, happiness, relaxedness, longer sleep duration, higher sleep quality, waking up refreshed, and physical activity.” Sounds like a pretty nice life: Wake up refreshed, quick espresso martini, nuts ’n’ onions lunch, and a long walk. Chocolate cake for dinner, please.
It’s important to note that patients in this study had come in with an average of over 20 suspected triggers, according to Donoghue, but “most of what they suspected didn’t come out in the analysis.” Curelator had heard from patient associations that many migraine sufferers were living a “very restricted lifestyle” and were “terrified of doing anything” that might trigger attacks. Donoghue and his colleagues hope the findings of their study can liberate some sufferers from “the tyranny of the trigger,” or living in fear of associations that may or may not be true.
A 2020 review in the journal Nutrients found that “all provocative studies,” meaning those in which participants were given chocolate in an experimental setting, “have failed to confirm that chocolate can trigger migraine attacks.” It’s true that there haven’t been many experimental studies designed to test which foods trigger migraine. Dr. Vincent Martin, the director of the Headache and Facial Pain Program at the University of Cincinnati College of Medicine, sighed when I asked why there aren’t more studies like this. “They’re expensive to do,” he said, and the state of migraine funding is “abysmal.” Migraine is not prioritized, partly because it isn’t fatal, he said, even though it is the second leading cause of time lost to disability worldwide.
Still, based on the research we do have, the consensus is that if chocolate is a trigger, it’s so for a very small number of people. Martin told me a diary study had found “3 to 4 percent” of subjects had a statistically significant association between days with migraine attacks and consuming chocolate, meaning that if chocolate does trigger migraine, “it’s probably a rather rare event.” Martin added that “no foods have great evidence” for their role as a trigger. This isn’t to say foods can’t impact migraine, but they may be a lot less important than many people think: In a 2012 review published in Neurological Sciences, the authors found that the number of patients reporting food-based triggers in studies they examined ranged from 12 to 60 percent. In an interview with the American Headache Society, Martin said the number of sufferers who are triggered by food is probably more like 8 to 10 percent.
What explains this gap between reality and perception? Perhaps it’s partly that dietary changes are an easy suggestion to make. It doesn’t sound all that onerous to cut chocolate out of your diet, especially when the suggestion overlaps with a lot of preexisting advice about healthy eating. It’s also a free solution in a country where expensive drugs — none of the preventative drugs designed to treat migraine, which debuted in 2018, are available as a generic yet — and specialist doctors can be impossible to access.
Paul Martin, an adjunct professor at the School of Applied Psychology at Griffith University, has suggested another pitfall of this approach. By avoiding triggers too strenuously, sufferers become “sensitized” to those triggers, “losing tolerance” for them, which makes the triggers more potent upon exposure. He compared it to anxiety: “The more we avoid situations that cause us anxiety, the more those situations will cause us anxiety.” The solution in that case, he said, is gradual exposure, which leads to a “desensitization effect.” The same approach may work with migraine. Martin developed an alternative system to avoidance, which he called “learning to cope with triggers,” involving gradual experimentation and exposure to perceived triggers. In a study Martin authored that was published in Behaviour Research and Therapy in 2014, participants who had been instructed in how to cope with triggers experienced a threefold greater reduction in headaches than those who had been instructed to avoid triggers.
This research makes me wonder if some of it has to do with guilt: People simply remember food triggers more because there is so much cultural shame about food. The tracking app I used for years, Migraine Buddy, pre-populates a list of potential triggers to record based on the most commonly reported ones, including chocolate, processed meats, cheese, and caffeine. The repeated task of filling in this little diary of sins every time you have a migraine attack helps cement the association — and, of course, misses all the days when you ate those things and didn’t get one.
There seems to be something about chocolate above all the other food triggers, with the possible exception of alcohol, that sticks out to people. I have one idea why: Most migraine sufferers are women. There are extremely powerful, “virtually axiomatic” cultural assumptions and stereotypes about women and chocolate — that we crave it when we have our periods, demand it from our lovers, and derive some quasi-sexual pleasure from eating it. We are putting on our silk pajamas and eating a single square of Dove in our beautiful bed, or we are shoving fistfuls of chocolate cake into our mouth over the sink because we’re premenstrually crazy.
Being a migraine sufferer already results in a lot of guilt from all the responsibilities and expectations you fail to meet when you’re sick. Work goes unfinished, laundry goes unwashed. Then there’s the additional guilt of feeling as if you brought it on yourself through one trigger or another. I can’t count the number of severe attacks I’ve had during which I lay in bed, the ceiling spinning and the tiniest light a dagger, with the pain turning my thoughts abbreviated but persistent: I shouldn’t have eaten the pizza. I shouldn’t have gone to the movies. I shouldn’t have played a video game for so long. The search for answers inevitably becomes self-incrimination that you don’t eat only kale and mushrooms and drink only turmeric tea or practice yoga every 20 minutes. If you are not literally Gwyneth Paltrow, you’re not doing all you can to avoid migraine attacks, and they are therefore your fault. It doesn’t matter how thin the science is or who told you these things because their proximity to other types of shame about unhealthy living almost magnetizes them: They stick in your brain, and they’re hard to peel off.
After so many years of migraine, I have started trying not to think too much about what triggered my last attack. I could drive myself insane with spreadsheets of everything I did each day — every food I ate or smell I smelled, the brightness level of my monitors, the temperature of the air, and whether Mercury was in retrograde — and still worry that there was some missing phenomenon I wasn’t tracking, and know that it could all change next week anyway. I am submitting to the unknowable nature of migraine and eating chocolate whenever I feel like it. I’ll still feel guilty, but I’m going to do that anyway. I may as well have my chocolate, too.