The humble headache has a lot to answer for. The ubiquitous “not tonight darling, I’ve got a headache” remains unchallenged as the most common intimate evening ambush yet it seems women, or indeed men, are not faking it after all.

According to the World Health Organisation, in developed countries Tension Type Headache (TTH) alone affects two-thirds of adult males and over 80% of females whilst migraine prevalence suggests that 3,000 migraine attacks occur every day for each million of the general population. Less well recognized is the toll of chronic daily headache: up to one adult in 20 has headache every or nearly every day. That’s a lot of headaches.

The commonality of the headache is all pervasive, it is the norm to pop over the counter medication and get on with things - an approach that treats the symptom rather than the cause.

However, it is the much maligned migraine sufferer that demands most sympathy. The fact is that migraine cannot be understood with adjectives alone. Much like a nurse said to me when I was in thought I was in labour with my first baby, “dear, you’ll know when you are in real labour. It is nigh on impossible for those who suffer with the odd headache to understand the real pain that migraine sufferers can experience.

A migraine headache can last hours to days and can occur as often as daily or as infrequently as yearly. Other neurological symptoms such as weakness, marching numbness, clumsiness, language problems and confusion may occur in a minority of migraine patients with or without headache. The latter symptoms can often be difficult to differentiate from stroke and in fact, stroke can result from migraine. Migraine headache associated with neurological symptoms is now an accepted stroke risk factor.

On a social level, According to the World Health Organisation, migraine sufferers have a reduced capacity for social and work activity and depression is three times more common in people with migraine or severe headaches than in healthy individuals.

Those who suffer regularly with migraine attacks are well used to being on high alert for early warning signs such as light sensitivity (photophobia), sound sensitivity (sonophobia) or loss of vision yet studies show that taking care over a menu could be much more effective.

Although the etiology of migraine remains relatively obscure, it is understood that migraine neurological symptoms have been attributed, at least in part, to spreading depression of electrical activity along the cerebral cortex, thought to be linked to reduced cellular production of energy (ATP) within the brain cell.

This provided a clue as to a simple, cheap nutritional treatment that has proven to reduce the both the intensity and frequency of migraine headaches by at least 50 percent.

Assistance comes in the form of vitamin B2, a water-soluble vitamin otherwise known as riboflavin, which is known to improve cellular energy production.  Thus, its role in the migraine conundrum is to shore up the deficit of mitochondrial energy that plays a role in development of migraines.

In a 3-month, randomized trial published by the periodical Neurology, 55 patients with migraine were given either riboflavin or a placebo. Riboflavin was superior to placebo in reducing attack frequency and headache days. Only 15 percent of the subjects taking a placebo improved, but 59 percent of the riboflavin group experienced at least a 50 percent improvement.

Riboflavin, and indeed many of the other B vitamins, is found in tasty and readily available health foods such as wheatgerm and bee pollen, both of which can be taken by the teaspoon or sprinkled on food.

Similar to riboflavin, coenzyme Q10 improves mitochondrial energy metabolism and therefore also has produced similarly good results in migraine sufferers in double blind, randomized, placebo-controlled trials. The downside is that the effects appear to take up to three months to take hold.

For those prone to headaches, supplements are not a get out of jail free card. The fact is, a romantic meal, complete with cheese board, wine and a cup of java is likely to kick off a number of triggers before the night is out.

Orange cheeses containing tyramine (e.g. cheddar cheese), preservatives, monosodium glutamate, peanuts and alcohol are only a few of the many common known precipitants of migraines. A food diary can help determine which of these applies or a straightforward food allergy test can help to clarify things.

Ending a romantic meal with caffeine and you’ll ignite a true love / hate relationship. Although caffeine can actually abort an existing migraine headache in the long-term regular caffeine can aggravate the chronic headache problem. A gradual reduction in caffeine consumption is always preferable to going cold turkey since, yes; you’ve guessed it - that can cause a headache too!