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It is believed that chocolate is a trigger for migraine, yet there is inconsistent support for this. In one small double-blind, parallel-group study of 12 patients who believed that chocolate could provoke their attacks, chocolate ingestion was more likely than placebo to trigger a typical migraine episode, with the median time until the onset of the attack of 22 hours (Gibb et al 1991). Three other double-blind placebo-controlled trials suggest that chocolate on its own rarely precipitates migraine (Marcus et al 1997, Moffett et al 1974), with the results of one trial suggesting that chocolate was no more likely to provoke headache than was carob in typical migraine, tension-type, or combined headache sufferers (Marcus et al 1997).

Allergy to cocoa has been documented (Taibjee et al 2004) and it has been suggested that workers employed in the processing of cocoa and flour may be at a high risk for the development of allergic sensitisation and respiratory impairment (Zuskin et al 1998). One case report of cocoa aspiration causing severe aspiration pneumonitis in a 4-year-old has been documented (Lopatka et al 2004).

There is no evidence that chocolate contributes to acne (Ravenscroft 2005).

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