The Migraine Food Trigger You’ve Probably Never Heard Of
I went from having a migraine attack every time I ate (no exaggeration) to having only a few a week. The explanation of how I did it is long and involved.
The trouble with histamine
Here’s the at-a-glance summary and the details follow. Please don’t stop reading at the word “histamine” if you don’t have allergies – this has nothing to do with allergies!
- Histamine can be a migraine trigger, even if a person has absolutely no allergies.
- Some foods contain histamine.
- Histamine is also always released as part of the digestive process.
- A digestive enzyme called diamine oxidase (DAO) processes histamine, both what’s in food and what’s released as part of digestion.
- Some people do not produce enough DAO.
- Taking DAO as a supplement before eating and/or eating a low-histamine diet can reduce the frequency, severity and/or duration of a person’s migraine attacks.
What is dietary histamine?
In most people’s minds, histamine is inextricably intertwined with allergies, but it does a lot more in the body than allergic and immunological responses. For example, histamine is a fundamental part of digestion. It’s what tells your stomach to start producing gastric acid, which is key to digestion. Histamine is also contained in or released by numerous foods, like tomatoes, citrus, chocolate, spinach and aged meats and cheeses.1 The phrase “histamine intolerance” is often used to describe people who have trouble with dietary histamine.
What is diamine oxidase?
Diamine oxidase (DAO) is an enzyme that’s present in your body, primarily in your kidneys and digestive tract.2 DAO allows your digestive tract to process the histamine that’s released as part of digestion or is in contained in or released by certain foods. At least, this is what’s supposed to happen. (More on this in a minute.)
Is histamine a known migraine trigger?
Histamine has been suspected to play a role in migraine for many people since the 1950s. Recent research also supports the idea that histamine can be a trigger.3,4 I began to unravel histamine’s role as a trigger for me after the first prescription migraine preventive to give me any relief was an antihistamine called cyproheptadine (Periactin).
If histamine is problematic for you – and it can be even if you’ve tested negative to every possible allergen (food and otherwise) and have no allergy symptoms at all – the histamine that’s part of digestion or is in certain foods could be a migraine trigger.
Eliminating histamine from your diet
The best place to start is to trying to find out if dietary histamine is a trigger for you is to eliminate foods that contain histamine from your diet. Keep in mind that you do not necessarily have to eliminate all these foods permanently, but you need to establish what your baseline is like without them. (If you search online, you’ll find many conflicting lists of foods that contain or liberate histamine. You’ll drive yourself wild trying to follow all the lists, so I recommend starting with only the one I shared. It’s the most reliable list and I trust the science behind it.)
What if an elimination diet isn’t enough?
For many people, avoiding histamine in foods is sufficient for their bodies to deal with the histamine that’s released as part of digestion. For others, it’s not. This is the category I fall into. It doesn’t matter what I eat, whether it contains histamine, tyramine or is the least potentially triggering food ever, I get a migraine.
What is DAO deficiency?
Yes, you read that right: the very act of eating is a migraine trigger for me. That’s because my body is unable to process even the amounts of histamine that are released as a necessary part of the digestive process. With a lot of sleuthing, I’ve discovered that I appear to produce such small amounts of DAO, that I can’t process even my own body’s histamine release. Add histamine-containing foods and my migraine severity skyrockets.
Is it related to migraine?
About 25% of the population has a DAO deficiency and one study found that 87% of participants with migraine did not produce sufficient DAO.5 In a study tested a low-histamine diet for chronic headaches (migraine or not). On the low-histamine diet, 73.3% of patients "improved considerably," according to the researchers, and eight had no headaches at all.6 There are also anecdotal reports from migraineurs who have the same experience. I much prefer science to anecdote, but the science for this is in the very early stages.
Can you supplement DAO?
Fortunately, there is a digestive enzyme that is made with DAO from pig kidneys. (Pigs are currently the only source for supplemental DAO.) You can take DAO up to 15 minutes before eating and it will degrade the excess histamine in your digestive tract. It has shown to be highly effective a recent study.7
Several different companies sell DAO supplements. Histame has the fewest additives, but is also the lowest dose at 4,000 HDU (histamine digesting units) per capsule. All the others, including HistDAO, Histamine Block and DAOsin contain 10,000 per capsule. I started with Histame, but the dose was insufficient. I now take HistDAO. I've found that one capsule is sufficient for about 400 calories.
Is it safe?
I can’t point you to hard data on the safety of DAO. My naturopath and a leading dietician on the subject have both assured me that it is very safe and does not remain in the body. They tell me that DAO, like food, gets processed and eliminated quickly. It is rare that I take something without definitive proof of it’s safety, but I feel so much better taking DAO that I’m sticking with it.
Can you check your levels?
There is a blood test to check your DAO levels, but most practitioners consider the test to be a waste of money. The levels of DAO in your blood do not necessarily reflect the amount in your digestive tract. Also, there’s no known range of “normal” levels of DAO in a person’s blood. Without knowing the range, there’s nothing to compare a number to. Ultimately, the test is unnecessary because trying a DAO supplement is likely to give you all the information you need.
Want to learn more?
You can learn tons more about migraine, histamine and DAO on my blog, The Daily Headache. That link takes you directly to the histamine page, which I continue to update. Be sure to read “Histamine Intolerance & DAO: Anwers to Your Questions,” which responds to some of the numerous questions I’ve been asked.
The American Journal of Clinical Nutrition published a comprehensive article on histamine and histamine intolerance (the full text is available for free). It might take some time to wade through, but it is worth the effort.
There’s not much about histamine and migraine online, but there’s good basic information on histamine intolerance. Use “histamine intolerance” as your search term to find general information.
Why am I sharing this?
Writing about an unproven treatment for which there’s little data isn’t my style, but I couldn’t keep this information to myself. Taking DAO has literally changed my life in so many positive ways. I hope that reading my story will help someone else find the missing piece of their migraine puzzle.
*This document includes some foods that contain tyramine, but it is not an exhaustive list.
How much has your migraine disease changed or evolved over time?