Diet for People with Headache Disease

The first step in the nutritional management of diet-triggered headaches is eating a well-balanced diet. It is especially important to eat three meals a day with a snack at night or 6 small meals spread through out the day.  You should include a good protein source at each meal/snack (i.e. milk, meat, fish) and should avoid eating high sugar foods by themselves, especially when excessively hungry. These actions will help to prevent the “hunger headache.”

If you are taking an MAOI drug (i.e Nardil, Parmate) you need to follow a low-tyramine diet.

Individual Food Sensitivities:

People with headache disease vary in their sensitivity to specific foods. Reactions to foods may take anywhere from ½ hour to 72 hours to develop, making them often very difficult to pinpoint. For that reason, it is recommended that you keep a food diary, with columns for time, food(s) eaten and the amounts, and any headache symptoms. You should start with a conservative diet (generally, one that does not include any of the foods in the following lists). You can introduce one new food every three days and determine any patterns/changes in migraine symptoms. This can be quite helpful and is well worth the time and effort.

Please be aware that migraine triggers can have an additive effect. For instance, being overtired is a migraine trigger for many people, so is skipping a meal. If you haven’t gotten enough sleep, then rush through the morning and skip breakfast, you will be much more likely to get amigraine (and that migraineheadache will take up much more time than what you saved in the morning) than if you had missed some sleep but eaten breakfast.

For women only: Many females with migraine diseases are much more sensitive to migraine triggers when they are premenstrual. Foods that may not bother you the week after your period may trigger head pain or migraine the week before your period.

Possible Culprits:

Everyone is unique but there are categories of foods that are more likely to be triggers for migraine than others. They are grouped by similarities of sensitivities (for example, people who find red wine to be a migraine trigger often find chocolate to also trigger migraine).

Caffeine and Similar Compounds

First, caffeine is a stimulant that can alter the effectiveness of many migraine treatment medications. For that reason, caffeine intake should be limited and preferably, consistent. Please note that we are not encouraging anyone who does not use caffeine to start! No more than a 2-serving equivalent of caffeine should be consumed per day (total of <200 mg. caffeine per day). Please see the end of this guide for common sources of caffeine and their content. Because chocolate (except white chocolate) contains caffeine and other chemicals that mimic caffeine’s effects, one serving (1/2 oz. chocolate equivalent) counts as one serving of caffeine.

Secondly, stopping your caffeine intake abruptly can cause caffeine-withdrawal headaches. In some individuals, A Sunday morning migraine may be caused by sleeping later than the time of the usual morning cup of coffee or tea. Others may even wake up in the middle of the night with a caffeine-withdrawal headache because of the drop off in blood levels after consuming caffeine virtually all day long. There is a lot of individual variation in sensitivity and some people do best completely avoiding caffeine.

Food Temperatures

Consuming extremely hot or cold foods may trigger migraine in some individuals (i.e. the “ice-cream headache”). You may need to eat these foods slowly or avoid extremes of food temperatures entirely.

Tyramine Sensitivity

Tyramine is natural by-product of protein breakdown. Its content in food increases as food, especially high protein foods, age. Because it is a naturally-occurring substance and is not added to food, tyramine is not listed on food labels. People taking MAOI medications need to follow a careful, low tyramine diet but other people with migraine may be experience tyramine-induced head pain or migraine.
Foods high in tyramine often are high protein foods that have not been properly stored (the warmer the temperature the faster tyramine accumulates.) All food, especially high protein foods, should be prepared and eaten fresh. Be cautious of leftovers that you want to store for more than 2 or 3 days. Refer to the diet for MAOI users for more details.

Alcohol

Some people get migraine from consuming any alcohol. Others react mostly to red wine (especially Chianti), which is due to a sensitivity to the chemicals, not alcohol, in red wine. People who are sensitive to red wine are often also sensitive to chocolate.

In all cases, please speak with your Physician and/or Pharmacist regarding alcohol intake, as many medications react with alcohol.

Others

The following is a list of some other foods and food ingredients, which people have reported headache sensitivity. This is not an all-inclusive list. You may have sensitivities to foods not listed. You may also have no problems with any or all of the following items:

  • Sulfites
  • Raw onions
  • MSG (Monosodium Glutamate)
  • Aspartame
  • Aged cheeses
  • Citrus fruits and juices (usually, ½ cup per day is not a problem)
  • Nitrates and nitrites added to food (note: not the thiamine mononitrate added to bread – that is just a chemical name for Vitamin B1)

Please note that sensitivities are often quantity related and are more likely to be problematic when consumed on an empty stomach – for instance, processed soups containing hydrolyzed yeast (contains some tyramine) and MSG in a variety of foods.

Caffeine Content of Selected Beverages:

Carbonated beverages 12 oz. (regular and sugar-free): 0 – 50 mg.
(Colas, unless marked caffeine free, and Mountain Dew are ~ 50 mg)
Coffee 6 oz.: 100 mg.
(That means a 12 oz. mug is 200 mg.)
Tea 6 oz.: 30-60 mg.
(Caffeine increases with length of brew)
Decaffeinated Tea and Coffee 6 oz.: ~ 2 mg.

Headache Sufferer’s Diet resource:  Saint Joseph Hospital, & Diamond Headache Clinic

Additional Notes:
Some people who get migraine headache may experience subtle warning signals 4 to 72 hours before the actual onset of the migraine or aura. These symptoms may include food cravings. While chocolate may trigger migraine in some people there is good evidence to suggest that a patient with migraine may experience a craving for chocolate up to several days before the onset of the migraine. If they eat the chocolate and a migraine occurs, it is natural to assume that the chocolate actually caused the headache. But in reality, both the chocolate cravings and the migraine are caused by the same root problem and the chocolate is not at fault.

What You Need to Know This Cold and Flu Season
Military Migraine Topic Sheet