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You Are What You Eat: The Conundrum of Migraine and Food
Medical Review by Headache Specialist Dr. Jessica Kiarashi
Living with unpredictable Migraine attacks is frustrating enough. Add to it the mysteries of finding the best Migraine diet and avoiding reported Migraine food triggers, and you have a recipe for extra stress.
Food should be nourishing and enjoyable, not anxiety-inducing. But we’ve been there: overwhelmed by information and lists of foods and drinks we dare not eat. Or else.
This comprehensive guide is designed to take some of the stress out of figuring out Migraine triggers and making healthy food choices. You deserve to enjoy your life and every bite of your food!
In this guide, you will find evidence-based info to empower you to:
- Prevent Migraine attacks with evidence-based nutrition and hydration
- Identify and avoid your individual Migraine food triggers, instead of all of them
- Identify Migraine ‘safe’ foods you can enjoy without stress
First, a few caveats. Identifying your best diet and own Migraine food triggers is not an exact science, but more of a trial and error process. Every person with Migraine is unique, and clinical research on Migraine nutrition is fairly limited.
Let’s walk through what we do know to help you navigate Migraine and diet more effectively.
Migraine Food Triggers
The list of Migraine food triggers commonly reported by patients is long, but the list of solid, clinical evidence is short. One research theory proposes some people might develop Migraine attacks due to the way the body processes certain chemicals such as tyramine, nitrate, caffeine, and sodium (National Headache Foundation. Low Tyramine Diet. ‘>2)
- Food additives like aspartame (diet drinks), MSG (i.e. soy sauce), nitrates (i.e. processed meats), sulfites (i.e. red wine) and yeast extract (i.e. canned soup)
- Alcohol like red wine, beer, and hard drinks including Scotch and Whiskey
- Caffeine-containing products
- Certain dairy products like aged cheeses, yogurts, sour cream and buttermilk
- Aged, smoked, fermented, pickled or salted meats and fish, like hot dogs, bacon, and herring
- Certain fresh fruits like citrus, banana, avocado, and dried fruits like raisins
- Beans, nuts, and soy like fava or lima beans, nut butters, and tofu
- Certain vegetables like onions and tomatoes
What We Know About Tyramine and Migraine
Tyramine, typically found in aged or fermented food, is a widely reported Migraine food trigger. It’s a naturally occurring chemical that tends to increase as food ripens or ages.
Foods with high levels of tyramine include:
- Cheddar cheese, blue cheese and other aged cheeses
- Pepperoni, salami, and other cured meats
- Smoked fish
- Sauerkraut, kimchi, pickles and other fermented or pickled foods
- Beers on tap or home brews
- Dried fruit
- Fava beans, broad beans, snow peas
Some researchers suspect that some people develop Chronic Migraine when they’re unable to properly process tyramine (National Headache Foundation. Does Caffeine Trigger or Treat Headaches? ‘>4):
- Chocolate and cocoa
- Sports and energy drinks, including those that include taurine
- Gum and candies
- Prescription and non-prescription medications like pain relievers, cold medicines and diuretics
If you are trying to cut back on caffeine, don’t quit cold turkey. Gradually reduce your caffeine intake until you no longer feel the negative effects.
How Sugar Affects Migraine
Ever feel like those sugary, yet delicious, desserts are causing you Migraine pain? Unfortunately, for some people, excessive sugar intake or low blood sugar (hypoglycemia) can trigger their Migraine.
If you are prone to sugar crashes or have them regularly, there may be something you can do about it. Be sure to eat good high protein and fiber meals throughout the day and eat often. Foods high in carbohydrates and sugars tend to lead to a blood sugar crash that can trigger an attack.
It’s known as reactive hypoglycemia, and it’s one of the least-known migraine triggers.
All About Migraine and Salt
Sodium intake and Migraine is a tricky topic for a few reasons. While too much sodium isn’t good for anyone, high or low sodium levels within the body can be a trigger for some Migraine attacks.
High salt meals can trigger Migraine attacks in some people. But some Migraine warriors find that their attacks are triggered by dehydration and having too little salt. One study found that when people consumed more sodium, reports of Migraine actually decreased (Headache. 2016 Oct;56(9):1543-1552. doi: 10.1111/head.12953. https://www.ncbi.nlm.nih.gov/pubmed/27699780‘>6).
To understanding how gluten affects you and your Migraine, you may need to undergo IgG antibody testing (https://www.migrainetrust.org/about-migraine/trigger-factors/hypoglycaemia/‘>8).
You can avoid a blood sugar crash and the impending pain by eating nourishing meals throughout the day. Avoid skipping meals.
Getting dehydrated is a surefire way to invite a Migraine attack. Not drinking enough water, sweating, vomiting, and diarrhea are all causes of dehydration.
Learn to recognize signs that your body is dehydrated. It’s a little more complicated than just feeling thirsty. One study reported that headaches and moodiness were reported in women when they lost 1.4% of their body weight in fluid (https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201‘>10).
Some people misinterpret their cravings as Migraine food triggers.
“For example, many people identify chocolate as a trigger, but really it may be that early in the attack they are craving chocolate, they eat it, and then they feel that headache and painful part of the attack after eating it,” Dr. Andrew Charles of UCLA told Migraine Again.
“So they identify chocolate as the trigger when it’s actually the chocolate craving that’s the indication that they’ve already started their headache,” Dr. Charles explains.
A headache diary or app can highlight the connection between certain food cravings and the start of a Migraine attack.
How to Identify Food Triggers
Not everyone has the same Migraine food triggers. Triggers can also be additive, meaning: a specific food may push you over the threshold into an attack only when you’re exposed to other triggers at the same time, like poor sleep or extra stress.
To identify your personal food triggers, use a headache diary or app, such as Migraine Buddy or N-1 Headache (formerly Curelator Headache), for 60-90 days.
How to Keep a Food Diary
When keeping a food diary, it is important to write down everything you ate and when, along with any symptoms experienced. It is also important to jot down compounding factors like the details of your menstrual flow (if applicable), major weather events, outside stressors, and sleep patterns.
Mobile apps take the guesswork out since they often factor in weather in your area and perceived sleep patterns, saving you the effort of adding that data yourself. Because triggers are additive, you might be able to enjoy a triggering food one day, and find it problematic if consumed on a high-stress day when a storm is brewing outside.
Once you have a clearer picture of your own Migraine food triggers, you can choose to avoid them. There’s no need to avoid the whole laundry list of potential foods.
Migraine Again founder Paula K. Dumas gave up aged cheese for nearly 15 years before discovering it wasn’t necessary at all. For her, it wasn’t one of her personal migraine food triggers.
Is Food Sensitivity Testing Worth It?
If your Migraine triggers are attributable to food, or if the possibility exists, you may want to consider speaking with your doctor about food sensitivity or allergy testing.
Food sensitivity is not the same as food allergies. Testing for food sensitives is done through an IgG antibody test, which is different from a test to detect allergies. The science behind food sensitivity and IgG testing is promising but it’s still new, says Amy Sutton from Harvard University (11).
Comparing Popular Migraine Diets
What Is An Elimination Diet and Should I Try One?
An elimination diet consists of removing a long list of foods from your diet that may be triggering a Migraine attack.
Elimination diets are a hot topic of debate within the Migraine community. Despite little proof of efficacy, the American Migraine Foundation explains that an elimination diet can be considered to reduce Migraine triggers. But they should be done under medical guidance so that medical and nutritional support is provided (https://headaches.org/2007/10/25/low-tyramine-diet-for-migraine/‘>13):
- Fermented sausages, meats that are improperly stored or not-fresh, processed meats and tofu/tempeh.
- Aged cheeses
- Vegetables like raw onions, fava or broad beans, sauerkraut, and fermented soy products
- Citrus based fruits like orange, grapefruit, tangerine, pineapple, lemon, and lime
- Caffeine-containing drinks
- Alcoholic beverages, including wine and beer
Some foods on the low tyramine diet should be consumed cautiously, like nitrate or nitrite-containing foods/beverages, concentrated yeast extracts, and food additives such as monosodium glutamate (MSG), sulfites, and aspartame.
The Heal Your Headache Diet
Heal Your Headache was written by John Hopkins neurologist David Buchholz, MD. The book seeks to offer a holistic guide to Migraine management, avoiding quick fixes and helping you raise your Migraine threshold.
A portion of the book outlines an aggressive elimination diet, based on 30 years of Dr. Buccholz’s clinical experience. There are no clinical studies at this time supporting its use, and it can be a difficult diet to stick to. It remains controversial among people with Migraine and the doctors who treat them.
Even so, the internet is full of people who have found relief after using the Heal Your Headache diet plan.
The ketogenic diet, or “keto” diet, is all the rage these days for weight loss. There are some theories that it can help Migraine, too.
The ketogenic diet aims to put your body into a state of ketosis, where your body uses fat as energy instead of carbohydrates. (Remember how sugar crashes can trigger attacks?)
Ketosis happens when you eat a large amount of fats, moderate amounts of protein, and very few carbs. In ketosis, your liver produces substances called ketones (Headache: The Journal of Head and Face Pain, 54: 246-259. doi:10.1111/head.12293 https://onlinelibrary.wiley.com/doi/full/10.1111/head.12293‘>15). During a Migraine attack, vasodilation of the blood vessels in the brain causes head pain.
Some people have an intolerance to histamine that triggers a Migraine attack when histamine levels increase. Histamine intolerance is caused by a low level of amine oxidase, an enzyme responsible for breaking down histamine (The American Journal of Clinical Nutrition, Volume 85, Issue 5, May 2007, Pages 1185–1196, https://doi.org/10.1093/ajcn/85.5.1185‘>17).
A low histamine diet can offer relief in individuals sensitive to it. The low-histamine diet is similar to the low tyramine diet.
Foods high in histamine to be avoided include (https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/the-truth-behind-the-most-popular-diet-trends-of-the-moment/art-20390062‘>19):
- Fresh fruits and vegetables
- Unprocessed foods
- Whole grains
- Dark chocolate
- Red wine
Some of these choices, however, may be a trigger. The best diet for you is based on your individual food triggers.
- Fatty fish like salmon, sardines, mackerel, herring, cod, white fish, tuna, anchovies
- Seeds especially hemp seeds, chia seeds, flaxseeds
- Egg yolks
Migraine-Friendly Foods and Recipes
Sometimes it’s easier to focus on what you can eat rather than what you can’t.
One of our most popular articles, The 10 Best Nutrient-Rich Foods that Help Migraine, dives into the essential foods to add to your diet. Most of them have vitamins and minerals that have been shown to help prevent attacks.
Migraine friendly foods that help fight off attacks include:
- Dark chocolate
- Olive oil
- Chia seeds
Many people with Migraine are magnesium deficient. Magnesium is known as the ‘relaxation mineral’ and it’s important for reducing tension throughout your body.
Many factors can contribute to magnesium deficiency like stress, low dietary intake, excessive magnesium excretion, inherited conditions, and absorption problems (21). Increasing dietary magnesium is essential for people who are fighting Migraine.
While adding magnesium-rich foods like greens to your diet, you may also want to consider limiting coffee, sodas, salt, sugars, and alcohol.
More foods rich in magnesium include:
- Pumpkin seeds
- Sunflower seeds
- Swiss chard
- Wheat germ