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.”
The following are 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.
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!
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. 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.
Looking for a good place to start? Check out this easy 5 day meal plan with a grocery list included! It covers all your breakfast, lunch, snack, and dinner needs!
Thanks for all the helpful information Alicia, and for helping the people here directly which is very kind.
I have a couple of questions about identifying triggers if you don’t mind.
When you cut out so many foods and have to wait months to see results, how do you identify what actually made the difference? There are many things recommended to avoid that have other excellent health benefits (e.g. probiotic yogurts) so I would be hesitant to eliminate them unless I knew the results would be clear (or increase consumption of foods I consider unhealthy). I follow a high fat, moderate protein, low carb diet which (through experience) works wonders for me.
Additionally, for many people like me who have VM but rarely (or never) get migraines or any symptoms that are very stable & consistent, I don’t know how I’d distinguish an improvement from the diet from an improvement with time or “good” days/weeks/months or other measures (supplements, “pacing” i.e. working and exercising more moderately…etc.)
Thanks
Robert
Hey Robert – All good questions! Not everyone has to wait months to see results. I’ve had some people tell me they saw them within two weeks. It’s very individual. That being said, you will be able to identify what’s a trigger (or if you even have food triggers) as you reintroduce each food. For instance, I used to eat yogurt daily but when I eliminated it for 2 months, I had a vertigo attack within an hour after eating it. This was different from my 24/7 dizziness I had at the time. As I continued to test it as a trigger, it always made me more dizzy within that day. My symptoms would increase, etc. It’s suggested to test triggers 3-5 days in a row to see if symptoms kick up. If they do, you can make a note and try it again later. Over time, it becomes really clear what they are. I’ve been able to add a lot of foods back in, but yogurt isn’t one of them. Actually eating a diet without additives with lots of fresh veggies and fruit has been great for my gut. Before the diet, I relied heavily on probiotics, followed FODMAP, and had terrible IBS symptoms. Now I wonder if it was migraine related as that’s all cleared up for me once my VM was controlled. If it’s a concern though, there are a few migraine safe probiotics without histamine releasing strains. The diet you’re on also works well for migraine. I have many friends on keto as a preventative diet and they have a lot of success with it. Sometimes they like to start with HYH to discover any potential triggers that they rely on for LCHF and then transition. I don’t believe one is better than the other – it’s more about what people think they can stick with.
I think this goes back to the first question. It’s more about noticing a difference when you try to reintroduce foods. The idea is to wait till you’re in a good place with your symptoms and you feel it’s well controlled. Then it’s easier to discover if you have any potential food triggers because you’ll definitely notice an increase in symptoms. If your symptoms are still 24/7, it can be difficult to distinguish exactly what’s bothering you. I strongly believe that everything works together – diet, meds, supplements, exercise, etc. Having all the pieces together increases your overall threshold so you’re more resistant to triggers you can’t control like weather or stress. Some food triggers continue to be a bit blurry for me. I can have them when other triggers are low, but if I’m stressed or there’s bad weather it seems to throw me over. I hope that explains it a little bit!
Hi Alicia,
My PCP recommends adding a probiotic to my diet. Can you suggest any migraine safe probiotics without histamine releasing strains? Thanks a latte~
Like Robert, I haven’t had migraine headaches for a long time (20 years in my case) which is why I found the diagnosis of Vestibular Migraine so puzzling at first. Eventually, uneven deafness and tinnitus had taken me to a Vestibular Consultant who joined all the dots for me. What I hadn’t realised was that many other symptoms which I had thought were ‘age related’ were part of the same picture too, like dizziness, a ‘fuzzy’ head and stiff neck, and the mysterious vertigo attacks over the years.
Although none of these symptoms are extreme these days, what drove me to try the diet was largely curiosity.. to find out just how much better I COULD be, and which of these symptoms might disappear with time. Three months in, my head is clear, my neck is comfortable and I feel just more alive in general! My deafness and tinnitus remain the same. Who knows whether that too will improve with time, or whether the damage is irreversible.
My feeling about the food lists is, like Robert, I was reluctant at first to give up foods which I think are very nutritious, like yoghurt, nuts and avocados! Two weeks in, I had a whole avocado mashed on a couple of slices of sourdough bread, and the effects brought it home to me that maybe in my case, some things were not to be! I considered my diet to be spot on before, but curiosity drove me on. What I’ve discovered already is it’s fairly easy to find alternative sources of nutrition; it’s excellent practice anyway to avoid additives; it makes me much more conscious of what food I select; and it makes me even more connected with cooking and food preparation than before. So it’s a win win!
Ps. My suspicion is that my symptoms now would be far more severe if I hadn’t been very food aware in the first place. I have known about the common migraine triggers for years of course.. red wine, cheese, chocolate etc. But I think what has ‘saved’ me is habitually cooking meals from whole natural foods, so at least I’ve always avoided additives. Looking back, stress is a major factor too that pushes you over the top and into the worst of it, and my horrendous migraine headaches and vertigo attacks have been during periods of high stress.
Could not agree more with you! I think stress is what triggered mine to be chronic as well, but cooking gave me a lot of joy that I was missing. It helps to know exactly what’s in your food too!
I totally agree! I love knowing exactly what I am eating.. and it’s great to discover new recipes and ideas, and know that they’re the right foods for VM.. thank you so much Alicia, I love your website!!
Alicia,
Is there a way to do this diet without TOTALLY eliminating everything at once? I work full-time, have a 2 year old daughter, and am just finding this diet EXHAUSTING. I do not even have an official diagnosis yet, but after a stressful few months (mom diagnosed with a chronic illness, bad car accident/whiplash, lots of stress) I woke up one day in April dizzy and it hasn’t stopped since. I am waiting to get into neuro and a vestibular DPT who tests for disorders (but can’t until August) but my ENT is confident VM is what I have (and my symptoms do all align). I cut caffeine a while ago as well as artificial sweeteners (as they were a big trigger for my regular migraines- which I don’t get often). I think hormones might be my biggest trigger because I seem worse around my period time. Overall, I am just not feeling well, in the craziness of getting a diagnosis, while trying to keep my job (which I like and itself isn’t stressful) and raise my family. Will this only be effective if I go all-in or can it work to just cut a few things (like chocolate, cheese, nuts) for 6 weeks and then reintroduce then start another series of foods to test out? We also eat out a good bit (being on a busy schedule) so I am trying so hard to navigate that. This weekend, I picked simple grilled meats (asked for no seasoning) with a side salad (no cheese) but did do dressing.
Thanks for your help!
Hey Brooke, Did you get my comment with all the recipes on the foods allowed post? I typed out a lot of info so I hope you did. That may help. Unfortunately it’s really meant to do everything all at once. You may be incorporating other food triggers that could be messing with your testing of the ones you decide to eliminate. And really, there’s not meant to be a timeline, you just do it until you feel like you’re in a good place or have reached a “baseline” that you’re happy with – for some thats 1 attack a week, for others it could be 1 every 2 weeks.
That being said, it may help you to ease into it. I’m not sure I would expect any crazy results, but you could do what you did above with the ordering. Eating whole foods rather than packaged foods could make a difference without the full elimination. I find if people are more episodic than chronic, they can expect better, faster results without going all in. If you have symptoms 24/7, it may be hard to get the results you’re looking for this way.
Brooke – one more thing. Join the recipe chat if you can. I have a thread going for you. Lots of moms who are amazing at doing the diet with young kids and full time jobs! https://www.facebook.com/groups/dizzycookrecipechat/
Hi Alicia, I’m starting week three on the HYH diet, and I have some very specific food questions. Are the following okay in early stages of this diet: lemon zest, orange zest, plantain, seaweed.
Thank you so much your wonderful work for all us migraineurs!
Hi Alicia, I’m starting week three on the HYH diet, and I have some very specific food questions. Are the following okay in early stages of this diet: lemon zest, orange zest, plantain, seaweed.
Thank you so much your wonderful work for all us migraineurs! (My symptoms are, as you say, 24/7 as of now!
Hey Deborah,
Yay week 3! Unfortunately none of those are allowed in the beginning. I will say that zest is a great place to start when you go to reintroduce citrus fruits once you’re feeling better. 🙂
Hi Alicia
I just got a referral for a neurologist. Just to check if there’s nothing else besides my migraines.
I prefer natural medicine and natural treatment.
I would like to know if it’s ok Peanut butter and almond milk? Thanks Ro
Hi Rosana, Unfortunately peanut butter and almond milk are supposed to be eliminated.
Hello August 23 2019 Hi I am working with my doctor to figure out if I have vestibular (spelling) migraines also just saw a neurologist and then he is referring me to a ears nose and throat doctor. I am currently pre diabetic and following the Dash Diet I also have a stiff neck and ringing in the ears sometimes. I want to help myself because I and tired of feeling sick and tired all the time. I am willing to change my diet to do so. I do see that a lot of the foods that I thought was ok to eat and some of my favorites are no’s to eat. I am going to try and get the books to help me its a bit overwhelming. I do believe that stress for me is a trigger I have had a lot lately in my life along with not realizing that certain foods cause flair ups. I want to feel better and I am willing to ask for help to do it thank you Lori
Hey Lori, I understand your frustration! Asking for help is a wonderful step to take. Most of the recipes on here are all about using fresh foods and ingredients so it should fit fine, you may just have to find a work around for the desserts. There are some sugar substitutes like monk fruit and stevia which are allowed on the diet. I suggest finding a great registered dietician in your area that can help you incorporate both diets!
Best ideas for candies that I can suck on when I have a bit of nausea that are HYH safe ?
Try Gin Gins or Simply Mints (they have gum too)
Hi Alicia, I just got diagnosed on Friday, I have been suffering for years with painful stiff neck, tinnitus, and Vertigo, now I feel overwhelmed with what I can eat. I love to drink tea, I have changed to decaf is that ok,? I hate coffee so that’s not a problem. Is it ok to drink wine, or Gin? Is tonic water ok? Is shop bought Mayonnaise ok? and pasta sauces which contain tomatoes? Sorry so many questions. Help.
I recommend even avoiding decaf teas. If you really want you can try naturally decaffeinated only but I find it still triggers my symptoms. You may be different. Natural decaf teas are like green rooibos and chamomile, not just any decaf tea!
If you’re chronic I would not recommend drinking alcohol until you’re in a steady place where your attacks have decreased. If you do have a celebration or something, I recommend trying a wine wand from PureWine to filter sulfites and amines. You can read more about that in this post.
You can have the mayo I recommend in Pantry staples or make your own. I also explain pasta sauce in the pantry staples too.
What about tonic water, due to the quinine?
Re: Baking breads at home.
The simplest recipes are often the best ones to make, and I’ll let you guys in on a secret. The milk these recipes call for? The only purpose they serve is to give a tougher crust. That’s it. Eliminate the milk if it bothers you, it does not affect the flavor of the bread at all, and you still have a perfectly good loaf of bread to use.
Personally, I’m also allergic to the casein protein in the dairy, and the way my body reacts? Migraines! Lucky me. Even with the elimination of dairy, I still have migraines. I’ll be trying the HYH diet very soon, I’m working with my husband (he does the grocery shopping and cooking) so that together we can conquer this monster in my head!
Hi Alicia,
I’m so glad that I found your blog! I was diagnosed back in March after over 5 years of trying to get answers. I had all of the same symptoms as you but my vertigo had gone from severe (from 1999 – 2013, which I was told was positional vertigo; to more random and less severe – but with all of the other symptoms of VM thrown in which one Dr. thought might be Stage 2 Meniere’s) – I was also unable to read for over 5 years, and I used to read daily, but just tracking the words, and turning pages triggered symptoms. To me that was more frustrating than nearly every other symptom, even the “bat to the back of the head” level of migraine that I’d developed over the years before I saw him, and randomly falling over.
I bought the book like my new Dr. suggested and like you struggled badly for a while, just walking into a store made me want to cry. I have a son with autism who only eats specific foods, and I have to make different parts to every meal I cook. I’m not as overwhelmed now, but still frustrated some days trying to figure out what to make and because until today I hadn’t found a salad dressing that I could use and dry salads are not very good.
I’ve made progress with the severity of the migraine pain, especially the pain in the back of my head/neck – but the vestibular symptoms, imbalance, vision issues, ear pressure/tinnitus are almost always present. Different days are different levels.
I signed up for your Facebook Dizzy Cook Recipe Chat page and look forward to connecting with other people and getting meal plan/recipe ideas.
Hey Debbi, I’m so glad you found the site and hope some of your VM issues improve with these tips. I know how hard it is to have the daily issues. Just be patient with yourself as it does take some time to have those vestibular symptoms go.
And if we can help you in the chat please let us know! Maybe we can accommodate some things for both you and your son. 🙂
Hi Alicia! My husband is just beginning the HYH diet after two years of vestibular migraines. He’s tried quite literally EVERYTHING! So here’s hoping this works!
Quick question – do you know if any of the boats head nitrate free and msg free lunch meats are safe?
Sorry! I meant boars head ^
Hey Holly! I don’t know if you ever watch the migraine world summit, but one of my favorite doctors that they have speak (Dr Dodick) said it would literally take someone a lifetime to try everything possible! That always made me feel so much better to know that even though one doctor may say you’re out of options, many experts see a plethora of combinations that haven’t been tried and that could be successful. Make sure you check out the timolol post too!
So I know a lot of people who do well with those, but I wouldn’t include them in the initial elimination. The reason is you don’t know exactly when they were cooked, so the build of tyramine can be high. This is why I recommend people get the “naked” rotisserie chickens without seasonings (just salt and pepper) that you can find at Whole Foods and Sprouts. At least you know those are usually cooked that day and they make great lunch meat. Or if you have a local butcher that does freshly roasted turkey, that would be an option too.