New Rx: Is the 'McDonald's migraine hack' better than real treatments?
Key Takeaways
Industry Buzz
“This hack hints at two of the central tenets of lifestyle changes we recommend for migraine. Namely, regularity with caffeine and meals.” — Leon Moskatel, MD, clinical assistant professor and expert in headache medicine at Stanford
“Caffeine can treat a migraine attack for some people with migraine, but if caffeine is used too frequently, more than 2–3 times per week, then it can contribute to more migraine attacks.” — Amaal J. Starling, MD, associate professor of neurology, Program Director of the Headache Medicine Fellowship at Mayo Clinic
Patient suffering from a migraine? Have you ever thought about prescribing them a large coke and fries?
It may seem unusual, but some patients are turning to the "McDonald's migraine hack” to combat their attacks, and some experts say the idea could have merit.
Here's the science
“We think of migraine as being caused by multiple triggers that are partial and additive. Variations in caffeine and delays in eating can often be some of these triggers, so it is not surprising that for some patients [the] combination of a caffeinated beverage with food is helpful,” Leon Moskatel, MD, a clinical assistant professor of Adult Neurology and an expert in headache medicine at Stanford, tells MDLinx. “Caffeine independently can also be helpful for some patients for the acute treatment of migraine. Also, when you are in the middle of a migraine attack, sometimes comfort foods like a coke and fries are just nice to have.”
“This hack hints at two of the central tenets of lifestyle changes we recommend for migraine. Namely, regularity with caffeine and meals,” Dr. Moskatel continues.
“Patients do not need to stop caffeine but should ensure they have the same amount at the same time every day and similarly eat meals at the same time every day. We also recommend patients get regular sleep with the same hours of sleep nightly and exercise at least 20 minutes daily,” he says.
Satisfying cravings during migraine phases
Experts say another reason a large coke and fries could help those experiencing migraine is related to certain cravings that can be experienced in one of the migraine stages.
According to Amaal J. Starling, MD, an associate professor of neurology and Program Director of the Headache Medicine Fellowship at Mayo Clinic, the stages of a traditional migraine attack include the premonitory or prodrome phase, the aura phase (which occurs in about 30% of people with migraine), the pain phase, and then the postdrome phase.
“During the prodrome phase, there is abnormal activity in the hypothalamus which can trigger food cravings for something sweet or salty, often chocolate, but I could also see seasoned, salty fries as a food craving—which may actually be the initial stage of a migraine attack,” Dr. Starling tells MDLinx.
“Caffeine can treat a migraine attack for some people with migraine, but if caffeine is used too frequently, more than 2–3 times per week, then it can contribute to more migraine attacks. So, it is possible that the large fries is the salty food craving of the prodrome phase of a migraine attack, and the caffeine in the coke may treat the migraine attack itself—if used in moderation.”
Prescribing guidelines
So, should doctors be prescribing a coke and large fries for migraine? The experts who spoke with MDLinx say it’s best to stick to the guidelines for migraine.
“Choosing an initial medication for the prevention of migraine should center around multiple factors, including patients’ preferences, comorbidities, and contraindications,” says Dr. Moskatel. “The American Headache Society recommends the CGRP-targeted therapies as a first line treatment for the prevention of migraine, and these should be considered alongside the older non-specific oral medications."
“If insurance will cover the CGRP-targeted therapies without a trial of one to three non-specific oral medications, then these could be discussed as an initial medication, even if they have not tried other medications for the prevention of migraine previously.”
Read Next: Why CGRPs are failing your chronic migraine patients, and what to do about it