What is a migraine diet?
While there is no one migraine diet, most dietitians, doctors and other health professionals in the know are talking about a low tyramine diet that is also low histamine, MSG (monosodium glutamate) and sulfites.
Many years ago, when we started our very popular and peppy private Facebook group, the title of group specifically referred to the Heal Your Headache (HYH) diet by name. We have since changed the name to Migraine Strong, but diet continues to be a significant part of the focus for people helping themselves get migraine attacks under control, as well as lessen the intensity and duration of vestibular migraine (VM) flares.
In general, diet is very popular topic as it is often a game-changer for many of us in the cranky neuron club. The Heal Your Headache diet is a type of low tyramine diet very popular in the migraine community and used synonymously with migraine diet. I will be using these terms interchangeably.
Diet has been one of my most useful tools in helping me get my life back. It cut the frequency and intensity of my attacks. It helped fade my ever-present head pain, altered vision and other symptoms.
How does the HYH diet work to help our heads?
The Bucket Theory
This migraine diet works by minimizing your most controllable trigger. We cannot control the weather or most external stress, but we can avoid foods that we know trigger us. That is the main goal of the migraine diet – minimizing triggering foods so they can then be identified.
When you eat only foods commonly considered head-friendly, you are lessening your trigger load. The simple concept of The Bucket Theory is important. When you lower your trigger load and increase your migraine threshold you reduce the severity, frequency and intensity of attacks.
Additionally, you are better able to tolerate potential triggers outside of your control like a weather front, hormonal changes or being stuck in a car with someone wearing perfume.
Some naturally-occurring food components and food additives are the culprits in the common food triggers.
A migraine diet not only avoids foods high in tyramine, but also foods high in glutamate. So, the Heal Your Headache diet is low in tyramine, histamine and other biogenic amines as well as low in glutamate and some food additives like sulfite.
Tyramine and Other Biogenic Amines like Histamine
Tyramine, histamine and highly processed foods are well documented migraine triggers and eliminating them helps many improve symptoms in many people.
Tyramine is an amino acid that is present in many common foods. In our body, it is a neuromodulator and part of “the biochemical soup.” This soup is part of what determines whether or not our nervous system gets stirred-up or is quelled (neuromodulation).
Histamine and phenylethylamine are other biogenic amines often found in the same foods. They are also naturally-occurring. In general, the ripening process and the aging process increases their concentration. So, freshly roasted chicken may be low in biogenic amines but when it’s eaten 3 days later as a leftover, it is higher in biogenic amines.
While the migraine diet is a low tyramine diet, it also happens to be “lowish” in histamine. Histamine is a known problem for some of us with migraine brain.
Many processed foods contain countless forms of hidden monosodium glutamate. Glutamate, the G in MSG, is another amino acid (glutamic acid) found in foods. In our body, it is a neurotransmitter and plays many important roles. It’s the most prevalent of all the neurotransmitters in the brain and is considered excitatory. For those of you that read a lot of our articles, you know that our migraine brains over-respond to normal stimulation. In essence, our brains are too responsive to environmental stimulation. While glutamate and its stimulating qualities are vital for our neurochemistry, some believe that imbalances in glutamate contribute to the cascade of neural activity that results in a migraine attack.
Just a Little Bit of Food Science
It’s important that you know that MSG is both a man-made food additive and a naturally-occurring component of many delicious, flavorful foods. An example of a tasty food that does not have added MSG is soy sauce. The glutamate content develops during the process of fermenting the soybeans, wheat and salt. It’s an aged, fermented brew.
When you order from “no-MSG” Asian restaurants, if they are using traditional Asian sauces and fermented products, you will be eating natural glutamate. Your body does not recognize the difference between natural glutamate and added MSG.
There is a very long list of foods additives that are high in MSG or MSG-like ingredients that may trigger migraine attacks. When following a migraine diet, it’s good to be familiar with many names of MSG. Here is a nice graphic.
The Good News
When you follow the Heal Your Headache diet you are following a low tyramine diet, that is also low in glutamate. The lengthy list of allowed foods are low in both categories. In general, those who implement this game-changing migraine diet tend to eat foods that are wholesome and less processed.
It’s hard to know exactly what is at work when you follow the HYH diet. Is it because you minimize the biogenic amines (tyramine, histamine, etc.)? Is it because MSG is minimized? Or, is it some other food component like added sulfites or food coloring that are not being consumed because you are mainly eating fresh foods that are less processed? As a registered dietitian and one who loves science, I wish I knew. Since we are all unique, the answer may be different from person to person.
Dr. Buchholz’s Version of the Migraine Diet – The Heal Your Headache Diet
A well-known headache specialist from The Johns Hopkins University School of Medicine wrote a book including a migraine diet in 2003. The book is called Heal Your Headache The 1,2,3 Program for Taking Charge of Your Pain. You are highly encouraged to buy or borrow this must-read. Seriously. It’s a MUST-READ for all of us.
Diet is one piece, but he focuses on other imperatives for us to help get ourselves better, including rebound headaches. The way he explains the migraine process and what is needed to rein it in is fascinating.
4 Steps to Success with the HYH Diet
So many triggers are beyond our control – external stress, consistent sleep, lighting, scents, hormones and sounds. Food is the most controllable. Spending time trying to figure them out often pays off bigtime.
Following these steps will have you understand how to help make the migraine diet work for you.
Step 1 – Commit to it fully (but expect to make some mistakes).
There’s never a better time than now. Pick a date and stick to it. If you wait for the perfect time, you’ll never start.
Some people are dramatically better in a few weeks. Others need a few months. Dr. Buchholz suggests giving the diet 4 months. Why so long? He knows that it often takes a few weeks for people to understand the diet and get in the groove. Then, it takes a while for your system to respond by calming.
Step 2 – Gather your resources and support
When I started, all I had was a one-page printout of the migraine diet from University of California, Berkeley, the excellent migraine handout from Johns Hopkins Headache Center and a few printouts from internet sources about the tyramine content of some foods. Even as a registered dietitian and skilled cook, pulling it together was extremely frustrating.
I highly recommend joining our Facebook group if you aren’t already in it. The migraine diet will be so much easier to do when you can share resources and ask questions about certain products and ingredient labels. There is power in community support.
The Dizzy Cook– Another excellent resource that would have helped me have more tasty and interesting meals is The Dizzy Cook. While the Heal Your Headache book is a must-read, The Dizzy Cook Cookbook by Alicia Wolf is a perfect companion as it gives you countless recipes that are different from the ones on her website. You can follow the low tyramine diet and eat delicious, varied meals. No need to be bored!
Healthcentral published and excellent article called “Let’s Talk About Migraines” that is a wonderfully rich resources for migraine info. The way they describe what migraine is is especially interesting and unique. While food trigers are mentioned, the migraine diet is not. Read it to enhanced your understanding of migraine.
Step 3 – Focus on what you CAN eat
Below is a list of many foods that you can enjoy. It’s not an exhaustive list but it is enough to give you and idea of what you can eat. There’s enough here even for those who are picky. It is so important to understand that the migraine diet is temporary. Once your symptoms are in much better control, some of your favorite foods are added back. More on this later.
Dr. Buchholz gave this wonderful interview shortly after his book was released. I highly recommend reading through his answers about the diet as it will explain a lot of nuances. Dr. B acknowledges that the his list is not going to capture 100% of the triggers out there. But he believes that his diet covers about 90% of the common food triggers.
During the interview, Dr. Buchholz said, “My approach is that you’ve got to draw the line somewhere or the list just becomes so lengthy and unwieldy that no one is ever going to begin to address it. So I normally don’t steer people away from all those items, but I would advise anyone who observes from their personal experience that something like, let’s say, strawberries seems to be a trigger for them. Well, if you’re a headache sufferer I would stay away from them.”
Step 4 – Understand the Common Triggers (you might be surprised!)
This section follows the lists of foods you can eat as the list of common triggers for the migraine diet is intimidating. Some people get discouraged before they start. It’s very important to understand where the common food triggers are.
Let’s go through the food categories where we find these substances in higher amounts. I will use the same categories as in Dr. Buchholz’s book as he groups them nicely.
Monosodium Glutamate (MSG) – Avoid Asian-style restaurants and most other restaurants that use a lot of sauces; Commercial and homemade soups using bouillon and “soup starters” that add flavor; The seasoning called Accent and other seasoned salt; Barbecue and other flavored chips and snacks, seasoned corn chips like Doritos; yellow rice and other flavored rice dishes; croutons and bread crumbs; commercial and homemade gravies made with bouillon or flavor enhancers like Gravy Master; frozen entrée; veggie burgers; protein concentrates, texturized proteins, processed and canned foods with flavorings; Low-fat and low-calorie processed foods; commercial salad dressings.
Many foods with glutamate are also high in tyramine, histamine and other potentially triggering food additives.
Check labels and be wary of labels that say “natural flavoring.” A good general rule to avoid MSG is to include mostly natural whole foods in your diet. These foods do not contain this flavor enhancer. Use herbs and spices in your cooking for flavor.
Processed Meats and Fish – Avoid aged, canned, cured, fermented, marinated, smoked, tenderized or preserved with nitrites or nitrates. Hot dogs, sausage, salami, pepperoni, bologna (and other lunch meats with nitrites), liverwurst, beef jerky, bacon, pates, smoked or pickled fish, caviar and anchovies. Avoid beef and chicken liver which are high in tyramine.
Many processed meats are high in tyramine, nitrites, nitrates and MSG not only because of additive but because they are not fresh. They often sit in the factory, transit and in the deli case for a long time before you serve them on a plate. Choose fresh meats, poultry and seafood. Be aware even fresh poultry especially turkey can be injected with artificial flavorings so read labels.
Cheese and Other Dairy Products – Aging increases tyramine, histamine and glutamate. The older the cheese is, the worse. Beware of cheese containing foods including pizza and cheese breads. Avoid yogurt, sour cream and buttermilk
Fresh or unaged cheeses like cottage cheese, ricotta, cream cheese and good quality American cheese, mozzarella and goat cheese are allowed.
Nuts- All nuts and nut butters are to be avoided as they are high in tyramine. Peanuts are legumes, not nuts, but should also be avoided.
Pumpkin seeds, sunflower seeds and sesame seeds are widely available and allowed.
Alcohol and Vinegar – Avoid red wine, champagne, beer and dark heavy drinks. Vodka seems to be best tolerated of all alcohols, but avoiding alcohol is best. Avoid vinegar except for clear, distilled vinegar.
Don’t overdo condiments (ketchup, mustard, mayonnaise) made with vinegar. Homemade salad dressings are best tolerated.
Certain Fruits and Juices – Avocados; citrus fruits (oranges, grapefruits, lemons, limes, tangerines, clementines), pineapple and their juices; Avoid bananas and dried fruits such as raisins (contain tyramine and sulfites). Avoid raspberries, red plums, papayas, passion fruit, figs and dates.
Avoid over-ripened and damaged fruits (high in tyramine and histamine). All other fresh and frozen fruits are allowed (apples, apricots, blackberries, blueberries, cantaloupe, cherries, cranberries, grapes, melon, mangoes, nectarines, peaches, pears, strawberries and watermelon).
Certain Vegetables, Especially Onions – Onions, sauerkraut, pea pods (snow peas, sugar snap peas) and certain beans (broad Italian, lima, fava, navy and lentils). Allowed: All other vegetables and beans including leeks, scallions, shallots, spring onions and garlic.
Onions, especially raw and less-cooked can be powerful triggers. The dried and minced seasoning is often tolerated as well as deeply caramelized onions in small amounts.
Fresh Yeast-risen baked products – Less than one day old homemade or commercial breads. Especially sourdough, bagels, doughnuts, pizza dough, soft pretzels, some coffee cakes made with yeast. Fresh yeast is high in tyramine and glutamate.
Baked goods made with yeast are an exception to the “fresher is better” rule. Packaged commercial breads are less likely to trigger headaches.
Sugar subsitutes- Aspartame. In general, sugar substitutes are triggers for many people. The more natural ones like stevia and others may be better choices.
“Others” – Soy products, especially if cultured (miso), fermented (tempeh) or otherwise highly processed (e.g., soy protein islolate/concentrate). Avoid soy sauce (MSG). Possibly tomatoes (and tomato-based sauces), mushrooms… whatever gives you a headache. can also be a trigger.
Soy oil and soy lecithin are safe. Vegetable oils are allowed.
Unprocessed soy like edamame is allowed.
Chocolate – Avoid all forms of milk and dark chocolate. White chocolate is ok. Chocolate is high in tyramine, histamine and other potential triggers like theobromine & phenylethylamine.
Caffeine – Avoid coffees, colas and teas with caffeine. Herbal teas are allowed.
Discussions about caffeine and migraine are typically lively. Some insist it’s a helpful and others insist it’s harmful, so who is right? Both. It’s harmful to those who are sensitive to the substance. The migraine diet specifically eliminates caffeine. You can learn about why caffeine should be avoided (temporarily) in this article.
Tips to make this a whole lot easier:
- Cook extra chicken, beef or pork and package them in individual containers and freeze them. This will keep them fresher and handy for future meals.
- Make large batches of freezable meals like soups and stews and package them in individual sizes.
- In the beginning, find some head-friendly foods that you really enjoy and make sure you have plenty on-hand so you don’t get tempted. Understand that the first few weeks may be a little repetitive until you get the hang of things.
- Prep allowed veggies and fruits all at once. You are much more likely to have what’s on your list instead of grabbing a no-no like yogurt if the food is already washed and trimmed.
- Commercial breads that are 100% HYH-friendly are often hard to find. Preferably, look for breads that are not made with malted barley flour Take the pressure off and buy the best one you can.
- Find a few pre-packaged items for “grab and go” so you have food when you are away from home longer than planned and food options are very limited. My personal favorite was Nature Valley Granola Bars, Oats N Honey. Some people choose potato chips as there are many brands that are made simply of potatoes, oil and salt.
How and When to Add Foods Back
Fast-forward – You are following the diet and have had substantial improvement. And, you are pretty sure you have achieved your “baseline.” Kudos to you for all the work you have done. It’s now time to start challenging some foods to see if they are head-friendly for you or they are triggers.
Eileen Zollinger wrote an excellent article about adding foods back at the end of the migraine diet’s run. In short, you pick one food to challenge and eat it every day for at least 5 days in a row. You do not add other new foods during this time. Pay attention to your response (or lack there of). It’s necessary to eat the new food for several days to see if quantity is troublesome or if it’s a problem mixed with other small triggers like weather or fragrance exposure.
The Migraine Diet is Temporary
It’s not forever. This way of eating works by removing the common culprits and seeing if your body responds. From personal and professional experience, most people find relief. Some get a little better and some get substantially better.
I’m a firm believer that we should all “eat the rainbow” and enjoy nature’s bounty. Varied diets are important for our overall health. Do not be intimidated by the diet. Seek guidance and support. Do not get stuck on the diet either. If you get wonderful relief, figure out how to enjoy some of your favorites again.
If you do not find significant relief, there are still options for you from a diet and lifestyle approach. It’s also important to know that diet is just one piece of the Treatment Pie. Migraine is complex. It’s a high-maintenance condition for those with high-frequency episodic attacks, vestibular migraine and chronic migraine.
Education, hope and support at key.
The above article is not medical advice. Please do your own research including discussion with your health professionals before making changes to your diet.
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