Low-tyramine diet essentials
Some headache specialists recommend patients adhere to a low-tyramine diet as part of an overall migraine-prevention strategy. If your doctor has recommended this, hopefully he or she also gave you a list of foods and additives high in tyramine. I received similar instructions from my first headache specialist. Since then, my latest doctor has focused more on sleep hygiene, regular meals, hydration, and stress management as prevention strategies. New research has shown that food is less of a reliable trigger than these other lifestyle factors. However, some people continue to be food-sensitive. Even though the current focus is on other behavioral triggers, I continue to maintain a low-tyramine diet. It's a habit I started a long time ago. Over time I have learned that I just feel better when I limit the amount of tyramine in my diet.
What is tyramine and why is it harmful?
Tyramine is a naturally-occurring substance that is created from the breakdown of the amino acid tyrosine. Tyrosine breaks down as foods age and spoil. Tyramine is also created when foods are fermented or aged. Foods that are stored for a long time, even if they do not appear spoiled, can contain high levels of tyramine. Leftovers and foods thawed at room temperature can also contain high levels of tyramine.1,3Cooking does not destroy it. It can't be completely avoided, but it can be limited.
Tyramine can be problematic because of the way our body responds to high concentrations of it. When anyone consumes tyramine, the adrenal glands secrete catcholamines ("fight or flight" hormone), dopamine, norepinephrine, and epinephrine. This produces a boost of energy. In sensitive individuals, it can cause increases in blood pressure, heart palpitations, nausea, vomiting, and headaches.3 Migraineurs are extra-sensitive to all kinds of environmental changes. For some of us, that includes the food we eat, especially foods high in tyramine.
If you think that you have food triggers, a low-tyramine diet is often a good place to start. Just remember to consult your doctor before making any dietary changes.
Here is a sample list of foods to avoid, use with caution, and "safe" foods. It was compiled from several different lists. There was quite a bit of variation among the lists. Some foods forbidden on one list were allowed in moderation on others. That's why it is best to discuss the actual implementation of a low-tyramine diet with your doctor and maybe even a dietician. Also, just because a food is low in tyramine does not mean it won't be a migraine trigger. If you see one of your triggers on the "safe" list, then be smart and avoid it anyway.
Foods high in tyramine1,2,3
Foods to use in moderation or with caution1,2,3
- Citrus fruits
- Parmesan cheese
- Processed cheese
- Wine or beer
- Fresh fruits and vegetables
- Dairy products and dairy substitutes
- Soft cheeses (American, Cottage, Ricotta, Cream, Mozzarella, etc.)
- Baked goods*
- Cooked and dry cereal
- Beans, peas, and lentils*
- Fresh, frozen, or canned beef, poultry, and fish
- Nuts and seeds
- Cooking oils*
- Salad dressings*
*Except those with ingredients on the "avoid" list
Shopping and food preparation tips:
- Eat fresh produce within two days of purchase.3
- Eat canned or frozen foods right after opening.3
- Avoid preparing leftovers for storage in the refrigerator. If you prepare large quantities for later use, freeze or can in portion sizes. Thaw, reheat, and consume on the same day.
- Find out what day produce is delivered to the grocery store and shop that day. Better yet, buy from a farmer's market or grow your own.
- Read all labels!3
Can you tell when a migraine attack is coming?