Food Triggers & Migraine

Have you been given the dreaded list of migraine food triggers? It’s like… a mile long and includes everything you have ever loved?

Yeah, me too. Rolled my eyes, put it in a file, never touched it again.

But now I am older and wiser…

  • I know that diet can play a major role in migraine.
  • There are many “common” migraine trigger foods and food chemicals.
  • But I also know that every person with migraine has different triggers and that there is no universal diet trigger. In fact, a lot of people don’t have any diet triggers!

I’m going to walk you through common food triggers, why they may trigger attacks, and tell you how to determine your triggers.

Common triggers

There are many lists of “common migraine triggers”. Here is what we’ll be covering today:

  • Aged foods
  • Alcohol
  • Artificial sweeteners
  • Caffeine
  • Citrus
  • Food additives
  • Histamine

Aged Foods

When foods like wine, cheese, or smoked meats are made, they go through an aging process, producing a food chemical called tyramine. This naturally occurs in other foods such as tomato, eggplant, and avocado.

Tyramine stimulates nerve cells to release norepinephrine, increasing heart rate and blood pressure. This causes vasoconstriction, the narrowing of blood vessels, which is what is thought to trigger the attack.

If you believe you may be sensitive to tyramine, refrigerated leftovers are something to be wary of. If the leftovers are going to be saved for longer than a day or two, it is better to store them in the freezer to delay the aging process.

Common food sources: wine, aged cheese, beer, some beans, smoked or pickled meats, soy sauce, tomato, eggplant, avocado, raisins

Alcohol

Alcohol is one of the most commonly reported migraine food triggers. This could be from the tyramine (described above), dehydration, histamine, or sulfites (both described below).

[Click here] for an article from the American Migraine Foundation all about alcohol as a migraine trigger! They discuss how red wine is the drink most frequently reported as a trigger, but many other alcoholic beverages are equally (if not more) reactive, which I found very interesting.

Artificial Sweeteners

These have been highly studied to determine that they are safe to consume. Artificial sweeteners are a low-calorie alternative to sugar used in processed foods.

Aspartame is the most frequently reported migraine trigger. There isn’t solid evidence supporting this, but it is thought that it may inhibit the release of important substances like serotonin and dopamine. ([Click here] for the review discussing this.)

Caffeine 

A change in caffeine consumption is typically the trigger for attacks. I’ve written an [entire article] about caffeine, including how it impacts our brains and how to taper off without withdrawal symptoms.

Citrus

It is still unclear why, but citrus fruits like orange, lemon, and grapefruit are commonly reported as migraine triggers.

Citrus contains a chemical called synephrine, a mild stimulant that increases blood pressure and narrows blood vessels. This could potentially be the mechanism behind citrus triggering migraine attacks.

Other potential ways citrus may act as a trigger is that it also contains histamine (described below), and when consumed alone can cause a blood sugar spike. Unstable blood sugar is a migraine trigger, which is why skipping meals is so problematic for migraine.

Food Additives (MSG, Nitrate, Nitrite, Sulfite)

MSG, nitrate, nitrite, and sulfite are the commonly reported food additives that trigger migraine attacks.

MSG:

Monosodium glutamate is a flavor enhancer commonly used in spices to enhance the umami flavor. It is thought to cause “Chinese Restaurant Syndrome” (an obviously problematic name…), described by symptoms like dehydration, headaches, or numbness, but studies cannot confirm this relationship.

You could be sensitive to this additive, but it isn’t necessary to avoid it otherwise.

Listed on ingredient labels as “natural flavors”, hydrolyzed protein, sodium caseinate, calcium caseinate, yeast extract, glutamic acid, and more.

Common food sources: flavored nuts, processed foods, seaweed, bouillon or stock, soy sauce

Nitrates & Nitrites:

These are used to cure meat products, extending their shelf life, or may be naturally occurring in some vegetables.

When broken down to nitric oxide in the blood, this lowers blood pressure and expands blood vessels (the opposite of many of the substances discussed on this list), which is believed to be the way they trigger attacks. 

Some interesting research has been done on how our oral bacteria may be playing a role with sensitivity to nitrates and nitrites. [Click here] for more information, but essentially, people with migraine may have higher levels of nitrate-reducing bacteria in our mouths.

Common food sources: bacon, hot dog, bologna, other cured meat and seafood, spinach, beet, radish, celery, collard greens

Sulfites:

This is a common food preservative that is reported as a common trigger due to their presence in wine, particularly red wine.

It is actually quite unlikely that sulfites trigger attacks, allegedly less than 1% of people are sensitive to it, and those people have asthmatic symptoms instead of head pain. This doesn’t mean that it’s impossible for sulfites to be one of your triggers, it just means it is unlikely!

Common food sources: wine, dried fruits, syrups, condiments

Histamine

Building up an excessive amount of histamine is what is thought to trigger attacks, as a symptom of “histamine intolerance”. Other symptoms include flushing of the skin, cold hands and feet, stuffy nose, or poor temperature regulation (often feeling too hot or cold).

Histamine is involved with our immune system, releasing when the body senses a threat. It expands blood vessels to aid white blood cells in traveling to find the threat. Elevated histamine can occur from allergic reactions (which are frequently treated with antihistamines!) or medications and foods we ingest.

You may be wondering if antihistamines can help alleviate attacks, or even prevent them. Antihistamines available today act on receptors named H1 and H2, which is likely not helpful for migraine. There are other receptors (H3 and H4) that may be more promising, but we don’t have much information on this yet. [link to article

Common food sources: alcohol, pickled foods, aged cheese, nuts, beans, legumes, chocolate, citrus, processed snack foods, and much more! (There are both foods with high levels of histamine and foods that cause a release of histamine.)

How to find your triggers

Keeping records of both your diet and your migraine attacks is the best way to find patterns. However… This can get tricky for many reasons:

  • Food triggers can have a delay of up to 3 days before bringing on an attack
  • It’s difficult to distinguish between what foods are triggering you and what you’re craving during the prodromal, pre-pain phase of an attack
  • Triggers in general are inconsistent because our threshold varies from day to day

You could try a targeted elimination diet with the help of a dietitian [work with me] or work to strengthen your threshold in other ways, making food triggers less “powerful”.

Do you have any known food triggers? I’d love to hear from you. 

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