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.
Thank you very much for all the useful information you have posted here. I am suffering badly from migraines and although I’m taking medication I’m still getting two a week. It’s better than one every two days but I think I need to try the diet. I’m just finding it challenging as I eat low carb for diabetes and when I have a headache, it all feels overwhelming.
Were you ever able to tolerate avocados?
I’m in a little bit of denial this week. Like several others who have let comments, my VM started about 2 years ago while I was under a great deal of stress. I actually, which sounds similar to you, encountered two problems at the same time; VM and SIBO/IBS. I’ve done a lot of work on my IBS and am in a much healthier place with that now but the VM comes and goes. Like others also mentioned, which I find curious, when the VM first started I also got tinnitus which is still with me today, 2 years later.
I think what I’m having the most trouble with right now is caffeine. I quit caffeine for a few months; once the VM was manageable I started back with decaf coffee. I was able to drink regular decaf coffee without many flare ups for about a month. I then started drinking regular coffee, intermittently, and was still okay for another month. Finally after about 3 months the VM came back with a vengeance and I’ve thrown my hands up in disbelief. It was at this time that I first learned of the HYH diet, and came across your website.
I’m having a very hard time finding motivation without caffeine. I went about two weeks without and tried a cup of decaf today; needless to say I’m feeling sluggish and tired afterwards which is not the response I was hoping for. It did taste delicious though.
Sorry for the long post but I wanted to know if you were ever able to tolerate avocados, almonds, or Swiss Water processed Decaf? Thank you!
Hey Brad,
Yes! I do eat avocados often now. At first when I reintroduced them, they proved to be a low grade trigger. As I continued to heal, I can tolerate them just fine now. I still try to be careful though if I have a lot of outside triggers going on – stress, messed up sleep schedule, travel, etc.
Almonds I can do in very small amounts, but I can no longer drink almond milk. To be honest, I don’t miss them that much. I think oat milk is much better and prefer seeds now. I think you’ll do well with Swiss Water Processed Decaf. Here’s a post on coffee and VM.
I could never reintroduce caffeine and just stick with SWP. Even regular decaf makes me dizzy. I do miss caffeine, but I also like not being dizzy!! A few ways I get some energy and mental clarity.
– Magnesium Threonate – people tell me this is like having a cup of coffee for them. It’s helped with my brain fog immensely. Take in the morning.
– B vitamins, like B2.
– A little bit of exercise.
– Sparkling water – I’m not sure why, but this sometimes helps wake me up in the afternoons.
Usually between these 3 things I can get enough energy to not miss caffeine too much. I wish you the best!
Thank you Alicia, that gives me hope 🙂
And thank you for creating this site and sharing. Similar to you I waited for 10 months to see Dr Beh. In the interim, someone I met in a group referred me to a Neurologist in Southlake who also focuses on headaches/migraines. He was a life saver and got me started on my wellness journey. I eventually got into see Dr Beh and am thankful to be in this area where we have access to these doctors; that said the wellness journey does not end with the doctor so I really appreciate you creating this space to share your journey that will no doubt help others who are struggling and looking for answers.
Hi Alicia,
I notice Brad mentions tinnitus. Uneven loss of hearing plus tinnitus has been my most persistent symptom apart from dizziness. And it doesn’t seem to have improved. Do you have any experience of this or have you heard of others with this difficulty, or anyone for whom this has improved over time?
Also, I wondered if you have tried Craniosacral Therapy?
How does your diet work for people with hemiplegic migraines ? My son gets about currently get 15 a month
Hey Lisa – This diet actually works for all types of migraine. I’m sure that’s terrifying for both you and him, so I would say it’s definitely worth your time to read the book and see if he will make the effort to give the diet a try. 🙂
Thank you for your time and efforts. I got diagnosed with VM about five months ago, researched the HYH and started cold turkey. I quit coffee after years of drinking strong coffee, reorganized my kitchen, continued my regular exercise and added yoga, and after four months of following the HYH diet have not had any migraines and only a few dizzy times. No medications. Your recipes are great, really creative and fun to boot. I do have a question or two that I cannot find the answers to anywhere. Red cabbage? Black licorice (no artificial or natural flavoring in the ingredients)? Caramel? Thanks again and I will be getting your upcoming recipe book on amazon! Can’t wait! Thanks again. Terri
Red cabbage is definitely ok! Licorice is ok as long as no gelatin. Caramel is usually ok too! You can make Jenn’s salted caramel cookies. 🙂
I am so thrilled to hear about your improvement. That’s amazing progress in just 4 months and I imagine you’re about ready to reintroduce some foods too??
Hi , just found your page. I have been having vistabular migtanes for 2 months I get a break for half the day then they are back. I have seen allot of Dr. Before they put a label on it. I have cut all food out but I wonder how long does it take for my head to stop getting dizzy from the foods I have consumed in the past?
Hey Natasha – it may take more than just a diet change for you to not feel dizzy all the time (see some of my posts on supplements and FAQ). That being said, it took me about 4 months to even notice a difference and about 6 months till I was comfortable with reintroducing foods again. I know people who have felt better after 2 months and others who it took a whole year…it really just depends on you!
Thoughts on almond flour, or a all purpose flour substitute?
I bake with gluten-free flours and flour mixes with things like rice, oat, quinoa, and millet. Tapioca starch/flour helps stick things together. I’m not eating eggs so I use a chia egg substitute instead. I also use corn flour (masa) in Mexican dishes and corn bread.
Hey Geof – it depends on what you’re using it for. Almond flour itself isn’t allowed on this diet, but you can use lots of gluten free flour subs like cassava, oat flour, rice flour, etc.
Would Skyr or Quark cheeses be okay on HYH or do they fall under aged cheeses?
Hi Alicia, Thanks so much for all of this incredible information you’ve compiled – it’s so appreciated!! I’m wondering if you can clarify when you can and cannot eat yeast on the HYH diet. In the list of “nos”, it says “yeast extract, yeast food, autolyzed yeast, nutritional yeast” are names for glutamate/MSG but then it also says you can have yeast-risen baked goods a day after they are made. So if a cracker has “yeast” listed in its ingredients, would you say it’s safe to eat, as long as it doesn’t have any other trigger ingredients? Again, thank you so so much for your help. I’m at the beginning of trying to get my migraines under control in a preventative way and your blog has been an amazing resource.
Yes! Yeast by itself is fine. It just can’t have yeast extract or any of those names. Plus if it’s a cracker, it’s definitely not freshly baked so no worries there. I’m so glad it’s been helpful for you! 🙂
I can’t find any reason about why gelatin isn’t allowed, pure grass fed gelatin would not have MSG in it. My biggest food trigger for migraines is sugar/corn and I use homemade gummies to help with that. It’s hard to combine low histamine AIP (which has helped) with this diet because vinegar also is opposite – can use ACV small amounts but not distilled because corn is inflammatory. Liver also helps my histamine reactions so not sure if it’s worth removing that. I just added back in pecans and walnuts to help increase magnesium (i get joint pain from ALL grains/pseudo grains so having trouble keeping magnesium up even with good supplements). Muscle symptoms, and jerking is down but head pain is increased so who knows? Why does diet have to be so hard?
Gelatin is high in glutamate, so that’s where it can react like MSG would in someone who is sensitive to MSG. It sounds like you already know your triggers so I’m not sure this diet would be helpful for you. It’s really for people to be able to discover their triggers and then add back in these foods, not to just avoid them forever. I believe that’s how AIP is too…these diets are too restrictive to live this way forever. I wouldn’t try to combine diets, just stick with whatever one is working for you. 🙂
Hi Alicia!
Great blog!
I recently finished reading the book and started the diet. Is it possible to eat quinoa on the diet?
How possible is it to make the diet as a vegan?
Do you think the author of the book meant that we actually add foods to the diet after things get better? Because it’s not so clear in the book. It encourages a lot of caution in this process and eventually, once you return foods containing tyramine, you add triggers to the system.
Thank you,
Shelly
Hey Shelley,
Yes! I highly recommend you check out the foods allowed list – should be helpful.
Also here’s a post on doing the diet as a vegetarian, but also has some vegan tips too. I do have a great vegan mayo on here that is worth trying! The post gives you some tips for protein rich veggie sources.
That being said, this diet is a lot more doable as a vegetarian than a vegan, but if you make sure you’re getting the right amount of essential nutrients and protein, it can be done. I also have a good dietician that’s familiar with migraine I can recommend.
And yes, he says to add back in the things you miss the most. There are some items I never missed that I just never tried to add back, like a lot of fermented or processed meats. I also never added back in MSG and read my labels more carefully now. But healthy things like lemons or limes and nuts should at least be given a try to see if they’re really triggers or not. It’s a fairly restrictive diet, and that allows for more food freedom. No sense in eliminating things forever that are not your personal triggers!
Hello, I am wondering if you have done any reasearch about why there are so many different migraine elemition diets and why each one contradicts the other? I have been given a strict diet from migraine.com titled comprehensive migraine elemition diet. It is the most limiting bit does label each food with the “amine” trigger, which is very helpful.
Hey Danielle, Yes, there are quite a few contradictions. I think this is mainly because everyone likes to have their “own” diet that they can say they came up with rather than crediting someone else. Plus triggers are highly subjective. Personally I don’t like the migraine.com diet. To me, it’s far too restrictive (which is saying a lot for migraine diets!), and half the items on it have no reference as to where they came up with how to label it (I review all the references they post at the end). Some contradict the SIGHI histamine list. Others have no research behind why they say it has tyramine and I can’t even find them on other tyramine lists. They list the Heal Your Headache diet as a source, but their list is completely different. So it’s confusing. If they had accurate sourcing info on the post, I’d be more open to it.
But if you’re find with eliminating an extreme amount of foods and can do it in a healthy way, then do what works best for you. 🙂
Thanks so much, I have been doing this extreme diet for 2 months now, Dr. want me to do it for 3 then start adding back foods one at a time. I am finding success and learning by mistakes but I agree with you they do not explain enough. I am he kind of person who needs to know who, what, when, where and why. 😉
Wow such a long time! At least you are finding success! I’ve had a few people on that diet who transitioned to this one as they still wanted to see improvement, but wanted more food freedom.
You may want to start with your doctor and ask him why he prefers that diet over Heal Your Headache/Johns Hopkins Migraine diet. I don’t hear of many doctors recommending that diet so he probably has a plan. And it’s a good way to be to ask questions!! Unfortunately there aren’t many studies when it comes to migraine and diet, but the few out there have shown promise for a low tyramine diet like HYH for treating migraine in children and for keto.