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Is Your Diet Giving You a Migraine?

Certain foods can trigger migraine headaches.  The good news is that many of these foods can be easily avoided. Learn about common food triggers — and how to avoid them — from The Migraine Brain: Your Breakthrough Guide to Fewer Headaches, Better Health, by Carolyn Bernstein, M.D., and Elaine McArdle.

For many years, it was believed that certain foods were the cause of migraines, but significant research in recent years shows that foods have been over-implicated as migraine triggers. The more likely culprit, it seems, is low blood sugar—that is, eating certain foods that cause your blood-sugar levels to soar and plummet, the kind of inconsistency your Migraine Brain abhors.

Still, it is true that some migraineurs have a reaction to certain foods. This is very possibly due to chemical properties in certain foods, which may influence or interact with certain hormones or chemicals involved in the migraine chain reaction. (This is yet another area where more research is needed.)

It’s worthwhile to figure out if any foods trigger your Migraine Brain. If so, this does not mean you are allergic to that food. An allergic reaction is a response by your immune system to a particular irritant—food or otherwise—where your symptoms may include shortness of breath, hives on your skin, watery eyes, sneezing, or more serious consequences such as your throat closing up so you cannot breath. A migraine response has nothing to do with your immune system; it is your brain chemistry being overly sensitive to that food, resulting in the migraine chemical chain reaction.

It’s just incorrect that certain foods trigger migraines in everyone, but many websites, books, and even medical personnel continue to blame these foods, including chocolate, nuts, salami, and MSG.
So-called “migraine-free diets” touted by these books or websites claim to “cure” migraines by having you restrict your diet to certain foods. One diet recommended that you eat nothing but bananas and yogurt. Like all extreme diets, it’s not only ridiculously hard to stick to, it’s bad for your health. These extreme diets are unsound nutritionally, depriving you of the vitamins and other nutrients you need to stay healthy. And you’re wasting your time: little solid data support their
claims to eliminate migraine. The more effective approach is to eat a healthy diet, avoiding any foods that are your particular triggers.

Possible Solutions
To avoid food triggers, you must be very aware of the ingredients in the foods you eat. Read food labels. Don’t even consider eating a food that gives you a migraine simply because you don’t want to offend a tablemate or hostess! If you were deathly allergic to a certain food, you wouldn’t feel bad about turning it down. Empower yourself the same way about your migraine. If something’s going to make you sick, you don’t have to eat it.

Common Food Triggers
Aspartame. This artificial sweetener goes by the brand names of Equal and Nutrasweet, and it’s found in numerous food products including diet soft drinks. Many migraineurs have a notable problem with aspartame. I have one patient who can actually feel her trigeminal nerves begin to throb if she has more than a few sips of Diet Coke. Aspartame’s function in triggering migraines may be due to its effect on serotonin levels. I strongly recommend that all my patients avoid aspartame or at least try to figure out if it’s a trigger for them.

Aged Cheese. Aged cheeses can trigger migraines, possibly due the fact they often have high amounts of tyramine, see below. Aged cheeses include: blue, Camembert, cheddar, feta, Gouda, mozzarella, Muenster, Parmesan, provolone, Romano, Stilton, and Swiss.

Chocolate. Poor chocolate! For years, it’s been implicated in migraines. While chocolate can be a trigger for some people, it’s simply a myth that it triggers migraines in everyone. Many migraineurs have absolutely no problem with it. I actually prescribe a small piece of dark chocolate before bed for my patients who don’t have a problem, since it may help them sleep and has other health benefits.

Chocolate also contains caffeine, though, so if caffeine is a trigger for you, you may need to avoid it. Milk chocolate can also be a trigger because it contains a kind of sugar called lactose, which some people just can’t digest. Also, the high sugar content of many chocolate can- dies can wreak havoc with your blood-sugar levels, which may be the real reason it triggers migraines in some people.

MSG. Contrary to popular myth, monosodium glutamate (MSG) does not cause migraines. But it can be a migraine trigger, although not for everyone. Some migraineurs are very sensitive to MSG, a very common food additive found in a wide range of foods, from barbecue sauces to, most famously, Chinese food. If MSG is a trigger for you, read all food labels in order to avoid it. (You may be surprised at how ubiquitous it is!) At restaurants, request that your food be prepared without MSG.

Pepperoni and Other Processed Meats. Pepperoni, packaged ham, bologna, and other processed meats contain high amounts of tyramine, a migraine trigger for many people. See “Tyramine,” below.

Soy Sauce. Soy sauce is a migraine trigger for some, probably because it contains tyramine. See “Tyramine,” below.

Tyramine. Tyramine is an amino acid present in certain foods, especially aged and fermented foods, including certain cheese, meats, and even breads and fruits. Tyramine has been shown to trigger migraines, for a variety of possible reasons, including, perhaps, its interaction with serotonin, norepinephrine, or other chemicals involved in the migraine process, although there is much more research to be done. (If you are taking a monoamine oxidase inhibitor such as certain antidepressants, you should limit your intake of tyramine, which can be dangerous to you.)

There is still controversy among researchers over the migraine — tyramine connection. Many believe it is overstated. But if you have problems when you eat foods or drink alcohol with tyramine, avoid it. It’s your Migraine Brain, and you know best how to handle it. You don’t need a scientific study to back up your experience of migraine pain after you eat these foods.

In general, to avoid tyramine, stick with fresh foods, which are better for you, anyway. Aged and fermented foods, or fruits that are ripe or overly ripe, have a higher tyramine content.

ABOUT THE AUTHOR
Carolyn Bernstein, M.D., co-author of The Migraine Brain (Copyright © 2008 by Carolyn Bernstein, M.D. and Elaine McArdle), is an assistant professor of neurology at Harvard Medical School and a staff neurologist at Cambridge Health Alliance in Cambridge, Massachusetts. A board-certified neurologist, Dr. Bernstein belongs to the American Academy of Neurology. In 2006, Dr. Bernstein won the Harvard Medical School Faculty Prize for Teaching Excellence, and in 2007, she was the recipient of the Leonard Tow Award for Humanism in Medicine given by Harvard Medical School and the Arnold Gold Foundation. In 2007, she also won the National Headache Foundation’s Headache Healthcare Provider of the Year. In 2006, Dr. Bernstein opened her own headache clinic for women, the Women’s Headache Center at Cambridge Health Alliance.

Elaine McArdle , co-author of The Migraine Brain (Copyright © 2008 by Carolyn Bernstein, M.D. and Elaine McArdle),  is an award-winning journalist, lawyer with a degree from Vanderbilt Law School, and migraineur who for twenty years has been writing for newspapers and magazines, including The Boston Globe, Boston magazine, and many others.

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