Abstract text (incl. figure legends and references)

Background: Migraine is the most common disabling primary headache globally. Although the pathogenesis of migraine headache is not fully understood, the possible role of inflammation and disturbed immune system has been proposed; thus, adherence to a dietary pattern that follows the Alternative Healthy Eating Index (AHEI) might reduce the risk of migraine. The current study aimed to investigate the association between the AHEI and odds of migraine headaches.

Methods: This case-control research was conducted on a total of 501 patients with migraine headaches (94.2% were women) and 576 sex-matched healthy controls (94.4% were women). A valid and reliable semi-quantitative food frequency questionnaire was used to record participants' dietary intakes. AHEI-2010 score was measured based on the dietary records, and regression models were used to determine the association between AHEI and migraine headaches odds.

Results: In the multivariable-adjusted model, the odds of migraine headaches was 76% lower for the patients in the last tertile of the AHEI score (aOR: 0.24, 95%CI: 0.16, 0.35, P for trend < 0.001). In the both base and adjusted models, odds of migraine headaches was significantly lower in patients in the last tertile of Whole grains (aOR: 0.60, 95%CI: 0.43, 0.82, P for trend: 0.001), Legumes (aOR: 0.30, 95%CI: 0.25, 0.48, P for trend < 0.001) and PUFA (aOR: 0.12, 95%CI: 0.08, 0.18, P for trend < 0.001). Patients in the last tertile of Fruits (aOR: 1.77, 95%CI: 1.27, 2.45, P for trend < 0.001), and sodium (aOR: 2.57, 95%CI: 1.82, 3.64, P for trend < 0.001), had a higher odds of migraine headaches in the both base and adjusted models

Conclusion: Following a dietary pattern, which is in adherence to the healthy eating index, may be protective against migraine headaches.