1118 participants that filled the online survey were included in the study. Age, gender, presence of chronic disease, medications used, presence of headache, the clinical features of headache according to ICHD3 criteria, presence of irritable bowel disease symptoms, consumption behavior of patients regarding 125 food/food additives and whether or not these food/food additives trigger headache and/or abdominal pain were asked in the questionnaire. The participants were diagnosed as migraine and medication overuse headache according to ICHD3 criteria.

88% of the participants had migraine and 32% of the participants had MOH. 63.9% of the MOH patients and 52% of migraine patients had irritable bowel disease whereas only 31.3% of the participants without headache had irritable bowel disease. Specific food triggers for MOH patients were, banana, apple, cherry, apricot, watermelon, olive, ice cream and yogurt. The common characteristics of food triggers such as banana, apple, cherry, apricot, watermelon specific to MOH are that they are healthy fruits and frequently consumed in daily life. Another common feature of these food triggers of MOH is that they are dopaminergic foods. Whereas migraine-specific food triggers were peanut butter, chocolate, cacao, coffee cream, milk powder, fish, red wine, white wine, mayonnaise, deserts with syrup, gateau and foods containing red food dye. Migraine specific triggers consisted of histaminergic foods and processed foods containing food additives. Food trigger specific to irritable bowel disease was red grape which is also dopaminergic. Tomato juice and spinach were common triggers of both MOH and irritable bowel disease. Cream cheese, custard, milk, potato, onion, garlic, bulgur wheat, bagel, citrus fruits, cabbage, canned foods, soy sauce and beer were among the shared triggers between migraine, MOH and irritable bowel disease.

This was the first study to investigate the frequency of irritable bowel disease symptoms and food triggers among medication overuse headache patients. The frequency of irritable bowel disease symptoms was higher in MOH patients compared to migraine patients. MOH specific triggers were mostly dopaminergic foods whereas migraine specific food triggers were mostly histaminergic and processed foods. It is important to raise awareness about food triggers in headache patients. Individuals with migraine and MOH must add diet diaries to their headache diaries. Migraine, MOH and irritable bowel disease patients should be aware of their food triggers and the treatment plan of these patients must include appropiate and personalized diets with the avoidance of those triggers.