Do you have food migraine?

Would you like to find out which foods you can tolerate? Doing so needs a bit of dedication, good-will from your family and friends, maybe some advice from your doctor and the willpower to eat only those things you can eat without problems.

Many migraineurs have a feeling that they get an attack because of 'something they ate'. Chocolate, red wine and cheese are classic triggers of migraine. Many years of scientific research have now given us a bit better understanding of what we really get sick from.

Since the beginning of the 70's there have been 140 scientific papers about migraine being caused by food, and, in all, over 100 foods and additives were listed as possible triggers of migraine. At first sight, it looks nearly impossible to find something that hasn't been blamed, at some time or other, as a possible cause of migraine. There have been so many foods blamed that there really aren't many left that haven't been (see Table 1).

Table 1 Foods named in the literature as causing migraine

Additives Alcohol Amines Apples Aubergines Bananas Beef Beer Benzoic acid Butter Cabbage Cacao Caffein Cane sugar Champignons Cheese Chicken Chocolate

Coffee Colouring additives Cottage cheese Eggs Egg powder Fish cakes Fruit Gluten Goat's cheese Hazelnuts High fat food items Hung meat Ice cream Lemons Lactobacillus Maize Meat extracts Milk

Milk protein Nicotine Nitrates Oil Oranges Orange juice Pork meat Powder milk Preserving agents Red wine Restaurant food Rice Salami Salt Saurkraut Sheep cheese Shell fish Sodium glutamate

Sourkraut Soy beans Strawberries Sucrose Sugar Sweets Tatrazin (colouring agent) Tea Tobacco Tomates Wheat Wheat flour White wine Vitamin C Yeast Yeast extracts Yoghurt

Overwhelming, isn't it? But all is not lost. We can use our modern knowledge of chemistry to group these foods in such a way that the list is a little less alarming.

Many of the foods in the table contain tyramine - more or less all of those that have been fermented, have been matured or have been through some process or other involving micro-organisms. Tyramine may be the biogenic amine that is responsible for most migraine attacks. It is formed when the amino acid tyrosine is broken down by bacteria. Typical members of this group of food are cheese from un-pasteurised milk, sour bread, salami, pickled herrings, smoked fish and meat, beer, wine and spirits, and some yoghurts.

Another important group are foods containing phenyl-ethyl-amine - the 'chocolate, red wine and citrus concentrate' group. It is less obvious, but these products, too, have been through a microbiological processing, and the amino acid phenylalanine is decomposed into phenyl-ethyl-amine. Chocolate is fermented immediately after harvest to bring out the best flavours, most red wines are left to ferment in big containers as ‘must’ (before the yeast is added), and at least some brands of citrus concentrate is filtered by bacteria to remove a bitter taste.

Many popular texts suggest that caffeine (or caffeine withdrawal) may cause migraine. However, the scientific documentation for this is not very good.

Finally there are various food additives, e.g. monosodium glutamate (MSG), artificial sweeteners, food colourings and nitrate, that are suspected to cause migraine.

If you are susceptible and eat just one thing a day that gives you migraine, you have a pretty serious problem. So the point is to exclude ALL the food items that may cause migraine, then introduce one new food item at a time in order to identify exactly what YOU do not tolerate.

We have tried to make a list of foods that, with our modern knowledge of chemistry, shouldn't be migraine triggers. Some of the recommended foods have in the past been blamed as migraine triggers. But the older studies especially can contain some errors because at that time there were no good theories about how migraine is actually triggered.

Table 2. Foods that don't contain tyramine, phenylethylamine, caffeine and artificial sweetener

Breakfast	Lunch	Dinner	Snacks
Milk Oats Butter Sugar Salt Crackers Crispbread	Egg Tomatoes, pealed Cucumber, pealed Sweet pepper, red/green/yellow, no skin Onion Salt and pepper, black or white	Potatoes Celeriac, pealed Carrots, pealed Chicken, turkey, lamb, pork, fresh, not minced Fish, fresh, white types Rice Lentils, green/red/brown* Beans* Chickpeas* Salt and pepper Fruit, pealed Maizena, rice flour, wheat flour Green peas without pods, frozen are fine	Mineral water without citrus taste Fruit, pealed Dried fruit (raisins, abricots…)

* You may find internet sites where dried lentils, beans and chick peas are listed as rich in tyramine. The origin for this information seems to be an article from 1987 where the authors speculate that this is the case.

The list is long enough that it's possible to get enough balance and variation in your diet that it should be possible to stick to it for at least a week. That's long enough to find out if you're feeling better. If you are, it may be something you normally eat that causes your migraine. After a week on the diet, it's time to introduce one new thing that might be a trigger for migraine. Have a look at Table 4, and try to identify which biogenic amine might most likely be your trigger. Then you can choose to introduce food items from the group you think might be your ‘problem’. If a migraine starts a few hours after you've eaten the 'new' thing, foods from that group are likely to be your triggers, and you should avoid them in the future.

If you feel fine after eating the 'new' food, that can go in the list of foods that don't give you problems.

WARNING: If you're on any kind of diet or have any medical condition that means that you have to be careful with your food, you should talk to your doctor before you begin to experiment with your diet.

As the content of tyramine and phenyl-ethyl-amine may vary between brands and also between production batches of one brand (particularly for tinned or smoked fish), you may need to make several tests with different foods from the same group before you can be sure that you have tyramine or phenyl-ethyl-amine migraine. You may even have both! Admittedly the list of things in the diet is a bit boring from a purely culinary viewpoint. But with a bit of imagination, the ingredients can be made into quite a few different things, e.g. vegetable or chicken soup, stews (any sort apart from beef), all sorts of white fish, chicken or turkey dishes. For dessert, stewed fruit with milk or cream.

Table 3. Traps that should be avoided while you experiment with food migraine

• All things containing citrus concentrate
• Sweets (all types, most of them contain citrus flavouring)
• Bought cakes which may contain chocolate or citrus concentrate
• Bought jams and jellies (both red and yellow types), too, may contain citrus concentrate
• Any kind of dressing or sauce
• Fruit with its peel still on, all the way from strawberries and grapes to apples and pears (home-grown and organic should be OK)
• Unpeeled vegetables with their surfaces as they were when bought (e.g. cauliflower, tomatoes, cucumbers)
• Coffee and tea (contain caffeine)
• Fruit or herb teas (may contain citrus concentrate)
• Any kind of soft drink, apart from bottled water that you're sure has no added flavour
  (there's caffeine in all colas and citrus concentrate in most of the others)
• Any kind of bought 'fruit juice' - from real red to synthetic yellow
• Any kind of alcohol
• Sour dough bread
• Vitamin-C pills with orange flavour (the white ones may be OK)
• All types of restaurant and fast food (you've no idea what they've put into it).

If a diet consisting of the things on the first list (table 1) doesn't keep you free of migraine, you probably don't get migraine from food, or at least not from food alone. There must be some other factor or factors causing your migraine.

That's information you can use. If food isn't one of your triggers, you can eat ad libitum again, and be sure that at least your diet isn't the cause of your migraine.

Can you be sure that you have food migraine?

If you're migraine-free a few days after starting and sticking to the very restricted choice of foods in Table 2, it's very probable that your migraine is caused by something you eat. But it's not absolutely certain. You could have started your diet just at the time when a hormone migraine or a stress migraine would have disappeared anyway. It's therefore especially important for women to be sure that your experiments with food aren't carried out just around the time of menstruation, when most hormone-induced migraines happen. It's also important not to start your diet during a time with a lot of stress. It would be unfortunate to conclude that you had to avoid many of life's culinary enjoyments because of some short-lived stress.

A good, solid migraine attack from eating foods with either tyramine or phenyl-ethyl-amine shows that you react to eating either one or the other. From then on, the game is to avoid eating foods containing the biogenic amine that triggers your migraine

Table 4. Main products with large amounts of tyramine and/or phenyl-ethyl-amine

• Tyramine Phenyl-ethyl-amine
• Cheese (all types made from unpasteurised milk, matured cheeses contain most)
• Yoghurt
• Tofu
• Soy sauce
• Smoked meat and fish, e.g. kippers and bacon
• Pickled herrings
• Bananas (if going brown)
• Nuts
• All bread and cakes made with sour dough
• Alcoholic drinks (including wine and beer)
• Chocolate
• Citrus concentrate – i.e. in juices and sweets
• Red wine in particular, also many white wines and beers
• Many ready-made dishes (often contain citrus concentrate)
• Fruit and vegetables that might be surface-treated

Monosodium glutamate

If you don't react to the foods in either of the two lists (tyramine and phenylethylamine), it could be that your migraines are triggered by MSG (monosodium glutamate). It's found in many pre-prepared foods and 'sauces', as well as in much Chinese and other oriental foods. Read the contents lists carefully and choose something containing MSG. If MSG is your bugbear, there's a good chance that you'll get a migraine attack. However, soy sauce and tofu are also frequently used in oriental cuisine and contain large amounts of tyramine, so you cannot conclude that migraine after Chinese food is caused by MSG.

Caffeine

There has been discussion that caffeine can cause migraine - especially if you consume less caffeine than normal for a while. Introduce coffee, tea or coke to your diet to see if they cause migraine. The theory states that the migraine should occur again when you stop using caffeine, that is when you stop drinking coffee, tea or coke.

Artificial sweeteners

There have been reports from migraineurs that at least some artificial sweeteners may trigger migraine. Artificial sweeteners are found in many 'light' products, in many kinds of sweets (chewing gum in particular) and in some tooth-pastes.

Surface treatment

If you are a 'phenylethylamine-migraineur' you may also react to some of the surface treatments that are used on fruit and vegetables. Organic fruit and vegetables should not be surface treated and locally-produced fruit and vegetables are often not surface-treated. Fruit and vegetables produced for distant markets may have been covered in various protective layers. Surface treatments cannot be washed off, and they're still there even after foods have been boiled or stewed. Just a square centimeter of surface-treated tomato skin may cause migraine. Peel everything that can be peeled, unless you're sure it's newly harvested locally. Then surface treatments won't be your problem.

Variations between brands

If you've discovered that you can eat a product without getting migraine, e.g. one brand of salad dressing or coffee, it's wise to stay with that brand for a while. A different brand of the same type of food may have been through different processes or contain different additives, so there can be differences in biogenic amine content between brands. It is therefore sensible to regard every new brand as a 'new' food.

Some tips

Pineapple juice doesn't contain phenylethylamine - and is therefore an alternative to manufactured orange juice, which does. Juice freshly squeezed from oranges doesn’t.

Green/red/yellow peppers can be peeled especially after being put under the grill for a couple of minutes.

Tomatoes are easy to peel if you dip them in boiling water for a minute or two.

Herbs and ground spices are generally dried when we buy them. This means that they have not been exposed to fermentation or maturation, and are safe for migraineurs, so can be used freely to make migraine-friendly food interesting.

Recipes

Some ideas as to what can be made using only the 'sure' foods. You're sure to have many other, much more interesting ideas.

Chilli con carne (using chicken instead of beef)

Boil the dried beans as recommended on the package, or use tinned beans. Cut chicken meat into small pieces and fry them in oil, together with chopped onion and chilli-powder, until they are golden. Add peeled and chopped tomatoes. Boil rice and mix together. Add salt and pepper and some cream if liked.

Omelette with tomato, onion and peppers

Fry chopped onion, then add beaten eggs to make an omelette as normal. Then add peeled and chopped tomatoes and peppers.

Stewed fruit (e.g. apples) with milk

Peel the fruit and bring it to boil with a little water. Add sugar to taste and simmer to a consistency that you like. Some vanilla essence or real vanilla pods can give an interesting addition. Serve with cold or warm milk.

Rice with onion and fish

Boil a portion of rice. Fry sliced onion in a little oil. Simmer the fish in salted water or milk until it flakes. Mix the rice, onion and fish. Melt some butter, add flour and the salted water or milk from the fish, and cook till it thickens. Then add to the rice and fish mix. Add salt and pepper to taste, and some paprika to give the dish some colour. Decorate with slices of peeled tomato or peeled slices of red/green/yellow pepper. Frozen peas are also a good addition to this.

Vegetable soup

A filling soup can be made from lentils (red ones cook quicker), carrots, potatoes and onions. First boil the lentils, then add peeled and chopped carrots, onions and potatoes and salt and pepper to taste. Simmer until all the ingredients are cooked. Herbs and spices can be added to taste.

Pork chops with potatoes and frozen peas

Boil the potatoes, and fry the chops as normal in some oil or margarine (NB some margarines can contain citrus concentrate, which contains phenylethylamine, and so triggers migraine). Thaw and warm the peas as on the package. The family won't recognize this meal as being especially 'migraine-friendly'.