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.
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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 3-4 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. My standard recommendation is to not let them go past 2-3 days during elimination.
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. These two foods are high in natural glutamate.
If you haven’t eliminated them and are not feeling better after 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 histamine.
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! Most of the recipes on this website (unless specifically called out as a reintroduction recipe), and all the recipes in my cookbook The Dizzy Cook, fit this diet.
If the Heal Your Headache migraine elimination diet ever seems too extreme for you, or you have other restrictions like gluten and dairy free, I highly recommend looking into my Mediterranean Migraine Diet, which focuses on the right foods to include for migraine disorders rather than elimination.
The Migraine Threshold
While Buchholz is very clear that diet alone will not eliminate your migraine attacks, 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 4 months depending on how you are feeling.
Sometimes it can take longer than 4 months to see a large difference, so don't expect to see changes overnight. 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.
When to Stop a Migraine Elimination Diet
It's important to remember that a migraine diet like Heal Your Headache is meant to be temporary. It is not meant to go longer than 4-6 months on it without reintroducing foods, or slightly longer if you're seeing amazing results. If you're not seeing any results (slight changes still count!) after 4 months, it's my recommendation to revisit your treatment plan with your physician outside of a migraine diet. A migraine elimination diet does not work for everyone because not everyone will have food triggers. It needs to be combined with proper medications, supplements, and other treatments for maximum effectiveness.
By eliminating too many foods and not eating enough variety, gut health issues can present themselves over time. If you eat a varied diet while on HYH, this shouldn't be an issue. To do this, it's important to always include a protein, fiber, and healthy fat in a well-balanced meal. Include lots of fruits, vegetables, and healthy proteins from the allowed foods throughout the day.
If you begin to feel that everything is a food trigger, this can indicate gut imbalance and a dietitian is needed to help navigate this. I also recommend the help of a dietitian if you struggle with variety, food aversions, and additional intolerances.
Migraine Diet Information
How to Start A Migraine Elimination Diet
Foods ALLOWED on the Migraine Diet
Vestibular Migraine Prevention Diet
Pantry Staples for Heal Your Headache
How to Find Migraine Food Triggers
FREE 5 Day Meal Plan
Migraine Diet Recipes
I also highly recommend purchasing the Heal Your Headache book before you begin which really dives into the details.
Ann B. says
Hi Alicia,
Cultured wheat flour seems to be popping up in my favorite store-bought baked goods, that are otherwise fine. It is apparently wheat flour fermented with a bacterium, and is a natural preservative.
With the fermentation process, I'm presuming it's on the "no" list. Any ideas? I suspect it is a big trigger for me. Thanks, and thanks for your wonderful books! Ann
Sarah says
I am new to this diet and only started doing research on it this past week. So I had a question about cocoa butter in white chocolate. I noticed some of the white chocolate you recommended has cocoa butter listed as an ingredient. I was hoping to learn more about why that's okay to consume vs cacao? I am trying to make sense of everything in my head. Thanks!
Alicia says
Hey! Cocoa butter has cocoa solids removed, which is generally the part people find troublesome with chocolate.
Annie says
Are pectin and maltodextrin forms of MSG as well? In doing my own research, I haven’t found anything definitive with some things contradicting others, so I was hoping someone here might know.
Sabrina says
Hi Alicia,
I wanted to make your sloppy joe's recipe, but I just realized the buns I bought the first ingredient says enriched wheat flour (flour, malted barley flour, reduced iron, niacin, thiamin mononitrate, riboflavin, folic acid). I just read your bit about breads, even if a day old, malted barley flour should be avoided. That's also the first ingredient (enriched wheat flour) listed on the English muffins I've been eating for the past 6 months. In fact, it's the first ingredient in almost all store bought breads and it's hard to find anything without malted barley flour.
Lacee Knowlton says
I am so so happy I found your website! Your advice is in line with my son’s pediatricians advice. Do you have any knowledge about abdominal migraines? My son has this. Eliminating all trigger foods has helped
R says
Hi Lacee,
I suffer from abdominal migraines. Beans and eggplant are huge triggers for me. When my migraines are extreme, most food is intolerable. I feel for your son! Does he vomit or struggle with nausea?
Doug says
Alicia:
Buchholz says onion and Garlic are OK but they are incredible triggers for me? What say you?
Alicia says
Onions are an elimination food but garlic is ok. However, I have a few readers who cannot tolerate it or people who also need low FODMAP foods. They generally do better with garlic infused olive oils for the flavor. Anything can be a food trigger, especially if you've tested it a few times. The list is really just a starting point of common ones to help you figure these things out.
Stephanie Ingram says
I am gluten and dairy free and I’m having a hard time finding a butter that I can use. Any thoughts?
Alicia says
I used to recommend Earth Balance Pressed Oils but they do not make them anymore. Ghee would be your best option, if tolerated. Otherwise you'd have to use oils.
geo says
Goat butter, if you are dairy free from a lactose intolerance issue
Pearly says
There’s a county crock plant based butter with olive oil . Super delicious!
Sharita Jordan-Cole says
I'm so excited to find you. Were best friends in case you didn't know. I've ordered the books from Amazon and can't wait to get them. I have a cold and just wondering what meds you use? I'm brand new to this mirgraines and dizzness so I'm trying to take control. I'm Five weeks in but it seems like years. Thanks so much!
Alicia says
Hey Sharita - I usually use my acute meds during a cold, along with whatever my neurologist recommends based on my symptoms. But really finding a good acute med will help. Sometimes we have to do a steroid course after.
Lois says
Hello please could you help with hemiplegic migraine. Lights and other sensory things are triggers.
I have so far found that
Tomatoes
Coleslaw
Vinegars
MSG
Are all food triggers
Thanks
Kiana says
Hello. Can I eat Muenster cheese?
Alicia says
It's not a part of the elimination phase but you can reintroduce it later on. Please see the foods allowed list for options in elimination.
dea says
Hello The Dizzy Cook
I trust you and yours are well. Happy preparations for the holiday.
I wonder your thoughts regarding collagen powders. I bought a lot before diagnosed with VM and they expire soon. Are they allowed on a Migraine elimination diet?
To be honest even before I got the diagnosis of VM I had stopped using them often because the first sip of the smoothie would trigger a headache, at the time I had no idea what was happening to me.
Thanks and happy holidays
Anonymous says
so pretty much starve for the rest of your life. mo thanks. I'll deal with the migraines
Alicia says
Sorry to hear that. If you look at my recipes you'll see none of us are starving and have improved quite a bit.
Natalie says
I’ve been on the full elimination diet for over a year and definitely have not starved. My headaches per month have significantly decreased and we have Alicia to thank for all of her hard work to help us. Thank you Alicia!
JR says
Sounds like food eliminations may be tough for you, but there is no need for rude comments. Many of us have put a lot of time and effort into finding our specific migraine triggers with this guide. I can assure you that we are thriving, not starving. Be a better human with your internet comments.
Beverly Cecil says
Hi Alicia ... I’m curious about oils ... is grape seed oil ok to have ? I just read how they extract the seed out of the grape to process for oil and they use a chemical which they say gets burned off . But wanted to ask what you thought .
Thank you , make it a great day !
Anonymous says
If I make homemade yeast bread, do I need to wait / let it sit 24 hours before freezing it?