An article published in Medical Sciences assesses the potential association between sodium chloride (salt) withdrawal and migraine.
Writing in Medical Sciences, Ronald B. Brown, PhD, of the University of Waterloo in Canada, outlined evidence implicating migraine as a potential withdrawal symptom of excessive sodium chloride (salt) intake.
In the perspective article, Brown proposes that “inhibited withdrawal from highly processed food intake, rich in salt, mediates an association between increased sodium chloride intake and relief from migraine headache pain.” However, further research is warranted to better elucidate pain experienced from sodium chloride withdrawal in migraine, Brown noted.
To form this theory, Brown searched PubMed, Google and Google Scholar, Scopus, and additional resources for relevant research.
Salt meets the Diagnostic and Statistical Manual of Mental Disorders-V criteria for substance dependence, which include “health problems, cravings, unsuccessful attempts to quit or control the substance, and withdrawal in which the substance is used to relieve withdrawal symptoms.”
It also has therapeutic, toxic, and addictive effects, and in recent years food addiction research posits that this condition shares common features and neural mechanisms with drug addiction.
Numerous studies point to a potential relationship between migraine and sodium chloride intake.
Common comorbidities of migraine include hypertension, stroke, chronic kidney disease, and cardiovascular disease. Each of these conditions is also associated with excessive sodium intake. One study cited by Brown found that among 20 patients with a history of migraine, 3 described a craving for sweet or salty foods “which when taken in time, alleviated the attack.”
Furthermore, edema, or swelling due to excess fluid in the body’s tissues, has been reported during the early phases of migraine. “Fluid retention without a known medical condition, known as idiopathic edema, can amount to approximately 4 pounds of retained fluid, possibly related to large amounts of salt consumed in binge eating subsequent to strict dieting,” Brown explained.
Previous research has revealed a link between migraine and eating disorders among female migraineurs, in addition to a relationship between obesity and higher migraine prevalence.
One study found urinary sodium excretion to be higher among migraineurs compared with healthy participants. “Sodium permeability through the blood–brain barrier and blood–cerebrospinal fluid barrier [also] increases during migraine,” Brown added.
Lower sodium intake among migraineurs has been associated with reduced risks of headache. In one analysis of 266 women with migraine, high adherence to the Dietary Approaches to Stop Hypertension (DASH) was linked with 46% lower odds of severe migraine when compared with those with low diet adherence. One component of the DASH diet is reduced sodium intake.
Multiple studies have been conducted assessing whether sodium chloride could serve as a potential treatment for migraine. Using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), researchers found “found a 7% reduced odds of migraine history associated with increasing sodium dietary intake in men, and also in women with a lower body mass index (BMI).” This finding could be due to the fact that relief from withdrawal symptoms can serve as a mediating factor, Brown said.
However, in this study “researchers did not appear to consider confounding due to the relief from withdrawal symptoms from increasing sodium intake, although the researchers cautioned against the use of sodium to treat migraine,” he noted.
More research is also needed regarding medication overuse headache as a secondary headache caused by sodium withdrawal in relation to use of nonsteroidal anti-inflammatory drugs.
Although 1500 mg of sodium chloride constitutes an adequate daily amount, the average American consumes 3400 mg of sodium chloride each day, with highly processed and restaurant food providing over 70% of daily intake.
An increased risk of chronic disease has been linked with a daily intake of over 2300 mg of sodium chloride.
According to Brown, food additives have been identified as potential addictive triggers in sodium-rich foods. This hypothesis led researchers to develop the Highly Processed Food Withdrawal Scale. A version of this scale was also developed for children, for whom migraine is the most common acute and recurrent headache syndrome. Future studies can use these tools to better understand salt withdrawal among adult and pediatric migraineurs.
“Although research studies confirm a positive link between migraine headache pain and sodium chloride intake, opposite findings are controversial,” Brown concluded. “Further investigations are needed to clarify the role of sodium chloride dietary intake and withdrawal in the etiology and prevention of migraine.”
Brown RB. Sodium chloride, migraine and salt withdrawal: controversy and insights. Med Sci. Published online October 30, 2021. doi:10.3390/medsci9040067