ABSTRACT:

Background: Dietary factors may influence migraine burden, but the relationship between Mediterranean diet (MD) adherence and migraine chronicity remains unclear. This study aimed to investigate whether higher MD adherence is associated with a less severe migraine phenotype, particularly lower odds of chronic migraine (CM) and fewer monthly headache days. Methods: This retrospective observational study included 448 patients diagnosed with migraine who were classified as having episodic migraine (EM) or CM. MD adherence was assessed using the validated Turkish version of the 14-item Mediterranean Diet Adherence Screener (MEDAS). Participants were categorized as having poor adherence (scores 0–5) or at least moderate adherence (scores 6–14). Demographic characteristics, migraine features, comorbidities, medication overuse, daily water intake, caffeine intake, sweetened carbonated beverage intake, and dietary behaviours were retrieved from patient files. Logistic regression models were used to evaluate the association between MD adherence and CM. Negative binomial regression was used for monthly headache days. Results: Of 448 patients, 256 had EM and 192 had CM. Patients with CM had lower MEDAS scores than those with EM and were less likely to have moderate-to-high MD adherence. Higher MD adherence was independently associated with lower odds of CM after adjustment for age, sex, BMI, disease duration, comorbidities, medication overuse, water intake, caffeine intake, and broader dietary behaviours (OR = 0.360, 95% CI: 0.193–0.674, p = 0.001). This association persisted after excluding patients with medication overuse, after multiple imputation, and when MEDAS was analysed continuously. Higher MD adherence was also associated with fewer monthly headache days in unadjusted and clinically adjusted models; however, this association was attenuated after full adjustment for caffeine intake and other dietary behaviours. Conclusions: Higher MD adherence was independently associated with lower odds of CM, even after adjustment for medication overuse and lifestyle-related dietary factors. The association with monthly headache days appeared more sensitive to broader dietary behaviours. These findings support the role of MD adherence as a potentially relevant lifestyle marker of migraine chronicity and warrant prospective studies that use detailed dietary assessment.