Assessment of Chocolate, Cheese, and Caffeine as Migraine Triggers: A Systematic Review and Meta-Analysis of Patient-Reported Trigger Rates.

BACKGROUND: Migraine is a common neurological disorder affecting approximately 14%-15% of the global population and is a leading cause of years lived with disability. Dietary factors, including chocolate, caffeine, and cheese, are frequently reported as migraine triggers; however, their prevalence and contribution to migraine attacks remain inconsistent across studies. This systematic review and meta-analysis aimed to estimate the pooled prevalence of chocolate, caffeine, and cheese as patient-reported migraine triggers. METHODS: This systematic review and meta-analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported following the PRISMA 2020 Statement and MOOSE guidelines. A systematic search of PubMed, MEDLINE (via Ovid), Ovid, and Scopus was conducted from database inception to November 11, 2024. Observational studies reporting quantitative data on chocolate, caffeine, or cheese as migraine triggers were included. Data were synthesized using a random-effects meta-analysis of proportions in Jamovi (Version 2.3). RESULTS: Eight studies included, but seven only contributed to the quantitative meta-analysis. The pooled prevalence of patient-reported migraine triggers was 13.9% for chocolate (95% CI: 7.0%-21.0%), 8.0% for cheese (95% CI: 3.0%-12.0%), and 12.0% for caffeine (95% CI: 6.0%-19.0%) (all p < 0.001). Substantial heterogeneity was observed across all analyses (I2 > 95%). Four studies were rated as good quality and four as fair quality using the NHLBI Quality Assessment Tool. CONCLUSIONS: Chocolate, caffeine, and cheese are commonly reported migraine triggers; however, their effects vary considerably among individuals. Given the substantial heterogeneity and reliance on observational, self-reported data, routine avoidance of these foods cannot be universally recommended. Instead, individualized trigger identification, supported by headache diaries, should guide dietary management. Further well-designed prospective studies are needed to clarify causal relationships.