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"Let food be thy medicine and medicine be thy food." Hippocrates 

November 12, 2013, the American College of Cardiology/American Task Force on Practice Guidelines published the AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. These guidelines include lifestyle recommendations for diet.

Because recent studies have shown a correlation between migraine, cardiovascular disease, and hypertension, along with an increased risk of stroke, these guidelines are important for us to know. But, before we get to them, let's refresh our knowledge and take a brief look at the definitions of cardiovascular disease and hypertension.


The American Heart Association (AHA) defines cardiovascular disease as heart and blood vessel disease. Also called heart disease, many of the disorders involved are related to atherosclerosis. Atherosclerosis develops when plaque builds up in our arterial walls. Plaque consists of fat, cholesterol, calcium and other substances found in our blood. Accumulation of plaque is believed to narrow our arteries and make it difficult for blood to flow through. Eventually, an area of plaque can rupture and cause a blood clot to form. If the clot is large enough, it blocks the flow of blood.

Heart Attack

When a clot forms and blocks a blood vessel in the heart, it is called a heart attack. If the clot completely blocks off a vessel, the portion of heart muscle supplied by that artery starts to die. A large amount of damage to the heart muscle can affect the pumping action of the heart. This can lead to heart failure. Without treatment, the bodys' need for oxygen and nutrients may be compromised.   


If blood flow to the brain is blocked, an ischemic stroke can occur. In this case, the portion of the brain supplied by the vessel involved will begin to die. A hemorrhagic stroke happens when a blood vessel in the brain breaks (ruptures). According to the National Stoke Association, hypertension is the most important risk factor for stroke.

It is important to know that although brain cells that die from lack of oxygen cannot be replaced, injured brain cells can be repaired with rehabilitation. In this way, functions like speech, memory and motor power can improve.


To understand hypertension, we need to take a brief look at the physiology of blood pressure. Blood pressure is the force of blood pushing against our arterial walls. For a person over 18, an optimal blood pressure is considered to be 120/80 or lower. The top, or systolic, number is a measurement of the force our blood exerts on our arterial walls when our heart pumps. The bottom, or diastolic, number is the force our blood exerts on our arterial walls when it rests between beats.

Hypertension, or high blood pressure (stage one hypertension) is a measurement of 140/90 or higher. High blood pressure makes our hearts work harder to pump blood through our bodies. This can cause our blood vessel walls to thicken and deteriorate. Besides stroke, it can lead to a number of other problems like heart attack, heart failure, and kidney failure.

Relationship between cardiovascular disease, hypertension and migraine

Although more research is necessary, endothelial dysfunction and hypercoagualability, as well as pathological reactivity, have been reported as important findings in people with migraine. We should know that endothelial cells form the inner lining of our blood vessels and provide an anticoagulant barrier between our vessel walls and our blood. In addition, these cells react with physical and chemical stimuli in our circulation and help regulate homeostasis, vasomotor tone, and immune and inflammatory responses. Injury of these cells results in many pathologic states including atherosclerosis, loss of membrane function and clot formation.

Dietary Recommendations to Reduce Cardiovascular Risk

Keeping all of these things in mind, let's take a look at the dietary recommendations to reduce cardiovascular risk. Overall, dietary patterns, rather than individual dietary components, are emphasized as foods are typically consumed in combinations rather than individually. Two dietary patterns, along with their relationship to health outcomes, that have been identified based on expert evidence are the DASH (Dietary approaches to stop hypertension) and Mediterranean (Med)  patterns

That said, let's examine the diet recommendations for lowering low-density lipoprotein (LDL) cholesterol, and the diet recommendations to lower blood pressure.

Diet recommendations for lowering (LDL) cholesterol are:

  • Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.
  • Adapt this dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other conditions including diabetes mellitus (type 2 diabetes). *For those of us with migraine, we would add migraine disease here.
  • Achieve this pattern by following plans such as the DASH* dietary pattern, the USDA* (US Department of Agriculture)) Food Pattern, or the AHA* (American Heart Association) Diet.

 *The DASH diet is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts; and low in sweets, sugar-sweetened beverages, and red meats. It is also low in saturated fat, total fat, and cholesterol and rich in potassium, magnesium, calcium, protein, and fiber.

*The USDA diet suggests choosing a variety of foods from the five major groups: grains, vegetables, fruits, protein foods, and dairy products and limiting oils, solid fats, and added sugars.

*The AHA diet suggests an overall healthy dietary pattern that includes a variety of fruits and vegetables, whole-grain products, low-fat dairy products, skinless poultry and fish, nuts and legumes, and nontropical vegetable oils. As well, saturated fat, trans fat, sodium, red meat (the leanest cuts possible), sweets and sugar-sweetened beverages should be limited.

Diet recommendations for lowering BP are the same as those for lowering LDL cholesterol with the addition of lower sodium intake:

  • Choose foods with less sodium and prepare foods with little or no salt.
  • Consume no more than 2,400 mg/day of sodium.
  • Further reduction of sodium intake to 1,500 mg/day is desirable since it is associated with an even greater reduction in BP.
  • If you can't meet these goals at the moment, reducing sodium intake by at least 100 mg/day can lower BP.

*Most of the sodium we consume is in processed foods. Therefore, it seems best to avoid them.

Maintaining a healthy diet is one of the most difficult, but important, things we can do to help decrease the frequency of our migraine attacks and reduce our risk for the development of cardiovascular disease, hypertension, and stroke (if we have a family history of these disorders, our risk is even greater). If you find the task of selecting foods suitable for your needs overwhelming, have a number of comorbid diseases, or have poor renal or liver function, you might want to ask your doctor for a referral to a nutritionist to help plan your diet and recommend appropriate supplements to avoid nutritional deficiencies and further organ damage. 


American Heart Association. (2011)."What is Cardiovascular Disease?" 

Eckel, H.,E., et al. (2013, November 12). "2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation.

National Stroke Association. (2013). "High Blood Pressure (Hypertension)".

Mancia, G., et al (2011). "Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study)." Journal of Hypertension, Vol 29, No 2. Lippincott Williams & Wilkins. DOI:10.1097/HJH.0b013e3283410404  

Schurks, M., S., et al. (2009). "Migraine and cardiovascular disease: systematic review and meta-analysis."  BMJ. 2009;339:b3914.

Sumpio, B., E., Riley, J.,T., and Dardik A. (2002). " Cells in focus:endothelial cell." Int. J. Biochem Cell Biol. Dec;34(12): 1508-12. 

Sharron is a health and wellness author. A person with migraines herself, her most recent book is "Migraine: Identify Your Triggers, Break Your Dependence On Medication, Take Back Your Life-an integrative self-care plan for wellness: San Francisco: Conari Press, 2013

Follow Sharron on twitter @murraysharron her Facebook page: Sharron Murray MS, RN and her website 

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health care professional.

Updated February 4th, 2016

Copyright 2013, Sharron E. Murray





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