When I first began researching migraine and the migraine diet more in depth, I found everyone kept recommending the Heal Your Headache migraine diet from this book, Heal Your Headache – The 123 Program for Taking on Your Pain. I finally ordered it on Amazon and it was 10x more helpful than the majority of doctor visits I had experienced over the past year. Dr. David Buchholz from Johns Hopkins University School of Medicine is the author and he is endorsed by many of the top migraine doctors like Robert B. Daroff from the American Headache Society and Ronald J. Tusa from the Dizziness and Balance Center at Emory University. In the book he gives a plethora of helpful information you won’t necessarily get from your personal physician. This isn’t just a book about headaches, it’s a thorough overview of all types of migraine. It will show you how to find and avoid your potential triggers, including foods that trigger migraine attacks.
About Heal Your Headache
There are 3 sections to the book – avoiding the quick fix, reducing your triggers, raising your threshold. “Avoiding the quick fix” is about the standard migraine “abortives” that are widely available such as triptans (Imitrex, Relpax, Zomig), caffeine containing analgesics (Excedrin, Vanquish, Midol, etc.), and opioids and how they can cause rebound if used several times a month, perpetuating the migraine cycle.
“Raising Your Threshold” is about incorporating a daily preventative if you cannot get enough relief from the elimination diet and eliminating rebound migraines. “Reducing Your Triggers” focuses on the Heal Your Headache, or HYH diet, and how eliminating certain trigger foods can help to lower your overall threshold. By lowering your migraine threshold with the diet, you can experience unavoidable migraine triggers such as stress, bright lights, loud noises, and weather changes without them always triggering a migraine. This is the section I will focus most on because, as Dr. Buchholz states clearly, “If your goal is to control your headaches (or migraines) – and take as little medication as possible – the diet is the most valuable tool you have”.
The Heal Your Headache Migraine Diet
The Heal Your Headache migraine diet is tough to follow in the beginning because you must “strictly avoid all potential dietary triggers”. I even cried in the first two weeks because I was so upset and frustrated. I believe once you focus on all the things you cannot have, which usually lasts for about a month, you begin to focus on what you can have all the great substitutions that are available. Plus it may take a few months to truly notice a difference, which adds to the initial frustration. I remember a month or two in thinking this diet was silly and I was going to try a little bit of yogurt. After all, I had eaten it almost every day for years before being diagnosed with vestibular migraine. What would it really do if I just had a dollop of tzatziki with my lamb? A few minutes after trying the yogurt, I felt like everything was moving at the dinner table. My vestibular migraine was back in full force and triggered almost immediately by the yogurt. Sure enough from then on, I stayed on the diet!
The Importance of High Tyramine and Histamine
Lets talk about the triggers. Some of these you hear as common triggers – caffeine, red wine, chocolate, but some are lesser known like lemons and nuts! This list was compiled based on years of research from Dr. Buchholz patients. Most contain some form of tyramine (aged or fermented foods) or histamine (citrus, nuts, aged cheese). According to WebMD “tyramine can cause nerve cells in your brain to release the chemical norepinephrine. Having higher levels of tyramine in your system — along with an unusual level of brain chemicals — can cause changes in the brain that lead to headaches.”
Histamines, according to MBG Health,“cause your blood vessels to swell, or dilate, so that your white blood cells can quickly find and attack the infection or problem. The histamine buildup is what gives you a headache and leaves you feeling flushed, itchy and miserable. This is part of the body’s natural immune response, but if you don’t break down histamine properly, you could develop what we call histamine intolerance.”
Triggers according to the Heal Your Headache Migraine Diet:
Caffeine – coffee, tea, sodas. Unfortunately decaf coffee and tea should be avoided as well since most contain chemical triggers and are not fully decaffeinated . The best substitute you can find are CO2 or Swiss Water Processed decaf coffees which are naturally processed and 99.9% caffeine free.
Chocolate – this includes organic dark, cacao nibs…anything you might think is “healthy chocolate”. White chocolate is allowed as long as it does not contain additives. It’s not actually chocolate!
Carob is considered “questionable” according to Dr Buccholz.
Monosodium Glutamate (MSG) – I know you think you don’t eat MSG. It’s not on any of your labels! What you may not know is that it’s actually considered a natural flavoring. It can be labeled as hydrolyzed vegetable protein, autolyzed yeast, hydrolyzed yeast, carrageenan, yeast extract, soy extracts, and protein isolate. See the chart for all the names.
Processed Meats and Fish- Canned, aged, cured, fermented, smoked, tenderized, marinated meats and fish. Most contain nitrates or nitrites as preservatives. These include hot dogs, ham, jerky, sausage, pepperoni, most deli meats, smoked or pickled fish, bacon, and anchovies. Beef or chicken livers also contain a high amount of tyramine.
Aged Cheese and Dairy Products – “The more aged, the worse” according to Buchholz. This includes gouda, parmesan, cheddar, brie, manchego, swiss, blue…all the good stuff. However, there are some fresh cheeses you can still have as long as they don’t have additives. FRESH mozzarella (not aged or smoked), ricotta (beware of carrageenan here), cream cheese, cottage cheese, boursin, and good quality American cheese. Yogurt and buttermilk should also be eliminated. Organic milk and cream, hemp milk, rice milk, and oat milk are all OK. Watch for additives in these. Carrageenan is a definite no, but gellan gum is allowable if there is no cleaner alternative. Update – I’ve seen a lot of people using sour cream and creme fraiche. Don’t do it! Creme fraiche is usually part buttermilk that’s fermented with cream.
Nuts – All kinds must go, including nut butters. Peanuts, which are legumes but fit well in this area, are also to be eliminated. Good substitutes that are allowed are sunflower seeds and sunbutter, tahini (sesame seed butter), and pumpkin seeds. All seeds are allowed on the HYH diet.
Buchholz includes coconut under nuts, but coconut can technically be classified as a drupe fruit, nut, or seed! The other confusing part is coconut is allowed on another, more strict migraine diet, The Charleston Diet, from the Charleston Headache and Neuroscience Center. From what I have seen, it seems many on HYH can tolerate coconut. Because of this, and because it doesn’t seem to be a huge trigger for many, I will include it in some recipes. If you are just beginning the diet or if you find it is a trigger for you, you should definitely eliminate it.
Alcohol and Vinegars (except distilled white) – “Especially red wine, champagne, and dark or heavy liquors” says Buchholz. Vodka is best tolerated as well as clear distilled liquors and organic white wines, but these should be eliminated at the beginning of the diet until a steady place is found. This has to do mostly with the aging processes and fermentation, however some wines do contain added chemicals that appear to affect migraines even more than sulfites. Clear, distilled white vinegar is allowed, but other vinegars, like balsamic, are not.
Certain Fruits and Juices – Citrus fruit such as lemons, limes, grapefruit, and oranges etc. Bananas, pineapple, raspberries, red plums, papaya, passion fruit, figs, dates, and avocados should all be eliminated. Raisins and dried fruits with sulfites must be avoided. Once you are feeling better you can incorporate organic dried fruits that have no added sulfites (check labels).
Onions, Pea Pods, and Certain Beans – Broad italian, lima, fava, navy, and lentils should be eliminated due to high tyramine. Garlic, spring/green onions, shallots, and leeks are allowed and good substitutes for all onions. Sauerkraut and kimchi, since they are fermented, are off limits.
Fresh Yeast-Risen Baked Goods – This includes all baked breads less than one day old, especially sourdough due to the fermentation. Bagels, donuts, pizza dough, pretzels, muffins, etc. You can bake or buy all of these things and let them sit 24 hours for them to be safe to eat. Even if not a day old, look for additives like “malted barley flour” as that should be avoided because of glutamic acid. Pre-made naan is great for making pizzas, but watch for yogurt in it.
* There is no indication in Heal Your Headache that gluten is a definite trigger. If you would like to eliminate gluten because you think it may be a problem for you personally – go for it! I personally tried Gluten Free after my first few months of HYH to see if it would make an impact on my symptoms, but had a lot of success before I added it. Just be wary of additives. Sometimes I find gluten free foods actually contain more migraine trigger ingredients than fresh breads from your local baker.
Aspartame (Nutrasweet)– Saccharin (Sweet N Low) can sometimes trigger. Sucralose (splenda) and stevia (Truvia) should be ok, but would avoid if you can at first.
Soy products – Miso, tempeh, soy protein isolate, soy sauce. Soy milk and flour are less risky, but should be avoided in the beginning, and soy oil is safe.
Leftovers that have been in the fridge a couple of days – This one is based on the build up of tyramine that can occur in “safe” foods over time. I find that this is highly specific to the individual. I can usually tolerate foods that have been left in the fridge a max of 2-3 days, but I have also seen people who cannot even tolerate crockpot meals or broth that has been simmered for several hours. If you do have leftovers, it’s a good idea to freeze them right away and then thaw as needed.
Other potential triggers include tomatoes and mushrooms…or a number of other things that are completely individual – While mushrooms and tomatoes aren’t on the “no” list, they could be triggers for you based on them being a more common trigger for others. If you haven’t eliminated them and are not feeling better after 2-3 months, consider adding them to the “no” foods from the HYH diet. I will cook with these in recipes, but I will also try to give you substitutes or allow you to eliminate them if possible. I’ve also seen people with seemingly random triggers such as cinnamon, spinach, strawberries, or shellfish. These could potentially indicate a higher intolerance to histamine, in which case you could further eliminate more foods high in histamines.
Foods You CAN Eat on the Heal Your Headache Diet
Before you start feeling depressed that you can’t eat anything you love, please read this post about things you CAN eat. There’s actually quite a bit!
The Migraine Threshold
While Buchholz is very clear that diet alone will not eliminate your migraines, myself as well as many others have had great success with raising our overall thresholds for developing a migraine by following the diet closely. You should eliminate all the “no” foods for at least 3-4 months depending on how you are feeling. Sometimes this takes more than 4 months, so don’t give yourself a set timeline. If you begin to feel better and notice your migraines are under control, you can begin to introduce some of your favorite “no” foods. I would personally begin with the things you are REALLY craving (I’m looking at you, avocados).
The idea is to test the potential trigger food for 4-5 days in a row to see if a migraine presents itself. This can be tricky because one day your threshold for a migraine could be much lower due to stress, weather, hormones, etc. and you could instantly get a migraine, whereas on good days where your threshold is higher, you could eat the trigger food and get by with it, not even realizing it’s a trigger. Also some trigger foods can produce a migraine as much as 24-48 hours later, allowing you to blame incorrect foods for the migraine. This is why it’s a good idea to keep a journal of what you ate and any outside triggers that occurred that day and test potential trigger foods on several different days.
More Posts to Get You Started:
How to Start A Migraine Elimination Diet
Foods ALLOWED on the Migraine Diet
Vestibular Migraine Prevention Diet
Pantry Staples for Heal Your Headache
FREE 5 Day Meal Plan
I also highly recommend purchasing the Heal Your Headache book before you begin which really dives into the details.
If we fall off the migraine diet, does all the work get undone ? So if I didn’t follow the migraine diet over Thanksgiving does that mean my “clock” gets reset ?
I’d honestly say it depends on how much you consumed that wouldn’t be migraine friendly and how much you pushed it with other triggers too (lighting, exciting, etc). Only you can really gauge that yourself how you feel from before on the migraine diet, throughout Thanksgiving consuming non-migraine friendly foods and triggers, to thereafter… Migraine diet you can simply just jump back onto it, but you still have to be conscientious of triggers because your mind is technically spiked a bit from the Thanksgiving triggers.
Imagine a glass of water, you have that glass low on the migraine diet + looking out for triggers.
Thanksgiving either overflowed the glass with the triggers or you’re close to overflowing.
Only you can gauge where you are currently.
It depends on how long you go for. One day won’t undo all your work, although you may get an attack from it (or even get away with it!). This post might help with some clarity,
Hello! So is the gelatin that is used to make marshmallows bad? I saw gelatin on the Glutamate/MSG list.
Thanks for any help.
Yes this wouldn’t be allowed. You can have marshmallow fluff which doesn’t contain it, but check the ingredients as always
Hello again!
Sorry for ask another question -do you know if is it okay to use/cook with a Traeger/pellet smoker?
I just started the HYH diet (I likely have vestibular migraines and Meniere’s) and I wanted to thank you for explaining it so clearly and for making it easier for us to get started. Thanks to you I stocked up on safe foods that have made all the difference. It’s only been five days but I swear I already feel a little better. I ordered the HYH book and your cookbook too and am so excited to try your recipes. Thanks for this site, it is a true public service 🙂
PS. I ordered your book from Amazon before I visited your site, I wish I had done it the other way around to order directly from you…
Hi Alicia! I am SO grateful for finding your website. It’s finally given me hope for overcoming my migraines. Thank you so much for doing all this.
I’m pretty new to the diet, and just wanted to double check: when you talk about leftovers, does that include only foods that have been cooked? Or does that also include uncooked foods that were purchased and/or opened a while ago and are still in our fridge (like my fresh mozerella ball that I purchased a month ago, and then opened a few days ago and am still eating). What about fresh things like veggies that haven’t been cooked but that we haven’t used that have sat in our fridges for 2-3 weeks but are still alright (I’m the queen of leftovers and am super frugal so I’m struggling with this no leftovers idea if you can’t tell!). Thanks for your advice!
Its more for things that build up bacteria quickly so like meat and fish. If it’s uncooked, use before the sell by date. If it’s cooked, eat within 2-3 days. It’s better to not let veggies and fruit sit for a long time – you don’t want them overly ripe, but if they’re still good it should be ok. It’s hard to give an exact timeline because everyone is different in what they can tolerate.
This book helped me. In it, I realized that chocolate was a problem. I was getting them every Saturday. After reading this book, I realized that my TGIF. chocolate bar was showing up the next day. I also cannot have onions or garlic unless they are cooked. I guess the cooking takes out whatever it is that I can’t tolerate.