Which Foods Are Potential Migraine Triggers?: Understanding Food Chemicals
Note: This is a lot information to digest (pun intended) and will probably be overwhelming. I’m starting with the necessary details; in future posts I’ll share specific food lists and ways to make an elimination diet manageable.
The classic doctor’s list of food triggers includes cheese, aged meat, chocolate, caffeine, beer, red wine, and artificial sweetener. In recent years, gluten and dairy have been added to some lists. Whatever’s on the food list, it is often presented without an explanation of why these foods should be avoided. There’s little attention paid to the fact that not everyone with food triggers will have trouble with all these foods, some may find that foods that don’t appear on the list are triggers, still others may have no food triggers at all.
Why does the food trigger list contain the foods that it does? Sometimes items are added to the list because patient report particular foods as triggers, like chocolate. Often, though, it’s because the foods contain a certain food chemical, like tyramine or MSG. (All foods are composed of naturally occurring chemicals. A “food chemical” doesn’t necessarily mean it is an additive.) However, even if the standard trigger food list is composed of items with a particular food chemical, patients are rarely told what the food chemicals are and how they’re relevant. This is integral knowledge to understand why certain foods are triggers.
Food chemicals are a good starting point for a couple of reasons. By understanding how potentially problematic foods are related to each other, it becomes easier to understand which ones are affecting you at a particular time. For example, you might be OK consuming one food that’s has MSG, but two will bring on a migraine. Looking at foods in groups also helps illustrate the “why” of food triggers. For example, tyramine is a vasoactive food that causes vasoconstriction followed by dilation, a series of events implicated in migraine attacks.1
The food chemicals that are thought to be the primary culprits to trigger migraine attacks are listed below. Some are naturally occurring, while others are added to foods. I’ve included some information on each of the food chemicals as well as links to good resources to learn about each one. A quick web search of any of the terms will also lead you to comprehensive guides.
Tyramine: Some foods, like snow peas and nuts, are naturally high in tyramine, but it’s primarily found in foods that are aged, fermented, stored for a long time, or aren’t fresh. Cheese and deli meat are often culprits.
Nitrates/nitrites: Nitrates/nitrites are found in cured meats and certain vegetables, like celery, spinach, beets and lettuce. (The link is to an article encouraging readers to eat vegetables high in nitrates, but it’s the most accessible list I could find and the information still applies.)
Sulfates/sulfites: Food additives are the primary source of sulfates/sulfites, though wine and beer are naturally high in them. To find added sulfites, look for the words sulfite, bisulfite, metabisulfite, or sulfur in the list of ingredients. Those words will usually be combined with another word or two, like sulfur dioxide or potassium bisulfite. (The beginning of the linked article addresses allergic reactions to sulphites; scroll down for food lists.)
Caffeine: Caffeine can relieve migraine symptoms if used occasionally, but it can trigger them in some people, especially if used often and/or in high doses. You know the culprits here: coffee, tea, soda, energy drinks. Be careful with any “energy drink.” Those that don’t contain caffeine usually have another stimulant, any of which can also trigger migraines. Stopping caffeine consumption can be tough, as withdrawal can cause migraine-like symptoms, including massive headaches, nausea, vomiting and irritability. Decrease the amount you drink slowly over a week or two (or more, if you drink a lot of caffeine). Also, be aware that some people have difficulty with the chemicals used to decaffeinate coffee and tea; herbal tea and decaffeinated soda shouldn’t pose a problem.
MSG: Chinese food has a reputation for being high in MSG, but it’s found in most processed foods. The trick is that it’s rarely listed as MSG. Other monikers include guar gum, maltodextrin, barley malt, calcium caseinate, yeast extract, soy protein isolate, and enzymes. Unfortunately, the list is quite long.
Artificial sweeteners: You probably know artificial sweeteners by brand name (Sweet ’n Low, Splenda, Equal), the generic names are saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, and advantame.
Histamine: Histamine doesn’t get mentioned on traditional migraine diets, but it’s gaining attention as knowledge of histamine intolerance grows. Even though the issues have historically been attributed to other food chemicals, many of items that appear on migraine food trigger lists either contain or liberate histamine in the body. Foods that are problematic in terms of histamine include aged cheese, aged meat (or even fresh meat that has been stored too long), shellfish, tomatoes, and spinach. Based on my research, I believe histamine in food and that is released as part of digestion is a significant migraine trigger. It may be the common denominator of most foods on traditional migraine food trigger lists.
Chocolate and alcohol are the two additional foods that don’t fit neatly into the traditional trigger food chemical, but chocolate is high in histamine and alcohol causes the body to release histamine. Other food chemicals in chocolate that have been considered the migraine trigger factors are tyrosine (related to tyramine) and phenylethylamine. Interestingly, some research has shown that chocolate isn’t actually a trigger for some people, but that they crave it as part of the very early stages of a migraine attack – usually so early they don’t even know a migraine is coming on.
Take a deep breath and don’t panic. I know this information is overwhelming – I’ve been overwhelmed countless times myself – and it may seem like you won’t be able to eat anything on an elimination diet. It’s a lot to learn at first and is intimidating, but the background information is an important component to ensure you take the most effective approach to an elimination diet. This will keep you from having to repeat the diet multiple times.
If you don’t uncover any food triggers by eliminating the food chemicals mentioned above, you may not have any food triggers, or you may have food triggers that aren’t covered by typical migraine diets. Those could be related to other naturally occurring food chemicals (like tannins) or you could have food allergies or intolerances. Again, I’ll address all that in a future post.
If you want to get started right away, the book “Heal Your Headache” by David Buchholz is helpful. I loathe recommending this book because the author’s tone is condescending, some of the migraine information is incorrect, the focus is on foods rather than food chemicals, and it reads as if he assumes that any patient who doesn’t improve on the diet is to blame (when, in fact, not everyone has food triggers at all). However, it is remains the most concise, straightforward guide to migraine elimination diets and includes recipes. It’s available at many libraries and can be found used for less than $5 including shipping. For minimum annoyance and misinformation, focus your reading on chapter 4, which contains the diet outline, and the appendix, full of tips and recipes. Be aware that the book does not address histamine at all.