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.
Sarah H says
Hi Alicia! I am about a month into the diet. I have had high frequency migraines for several years, and have had debilitating chronic daily migraines for the past 3 months. I am so grateful for all your resources! I am wondering if you could clarify something. Ive been looking for pre-packaged foods and I have been able to find some without the MSG or sulfites- but I noticed that many posts about the HYH diet say to "avoid additives". Is that just referring to the additives that are specifically referenced, or is it saying to avoid all additives? Thank you!
Alicia says
Hey Sarah, so I usually went by this rule - I would avoid everything on the list pretty strictly, but if I needed cream cheese and all had gums but only one had locust bean gum (as opposed to xanthan and carrageenan, etc) then I would choose that one. So it's really just being more mindful of choices. Like if a cracker has 50 ingredients and they're all ok, but you can find another one with just 4, then choose the one with fewer. It's just being more mindful of what you eat and putting as few additives as you can into your diet.
Sarah Hitchcock says
Thank you for your time! Thats definitely a more useful way of framing it. I have a few other questions.
Is onion powder okay in small amounts? Like in cajun or taco seasoning (msg free)..
What are the rules exactly with raw chicken in fridge for more than a day? I see it is recommended to freeze immediately. I find this is especially difficult for me right now with my intractable migraines- I never know when i'll be able to cook, and I need to be prepared when I do get a break. This also makes it difficult to avoid cooked leftovers. Let me know your thoughts!
Alicia says
No, not till you're ready to reintroduce. There are some brands that make it without though. I have suggestions in pantry staples.
Raw chicken I'll typically leave 2-3 days and then freeze if I can't use it if I intend to eat it right away. If you're leaving 2-3 days and then want it for leftovers 2-3 days, that's just going to have more tyramine build up. It really just depends on how sensitive you are. I'd say most can tolerate 2-3 days though. But over that is just highly individual. So I'll try to meal prep some stuff on good days in case I don't want to cook on attack days. Or I'll keep everything in the freezer and pull it out to defrost overnight for the next day.
K says
Just reading this particular page again and it's been updated so much since I originally read it back in Feb-Mar of 2018 looking for a pulled pork recipe. ! I had no idea about the Creme Fraiche!! I was wondering that too. You are such a god-send to the MAV/Migraine community for this site. With everything you do and how you reach out to everyone it shines a light into everyone's darkness. Thanks so much again for everything. I really hope all is well with you!
-K
Erika says
I've loved your blog so far and I am about to try the HYH diet for myself to hopefully help with my chronic headaches! Your articles have been a huge resource so far. But since I 'm used to baking a lot, I'm noticing a lot of my labels state "May Contain Traces Of" no-no foods like nuts or soy....should I consider these items as a definite no, or just use with caution? Example baking power/soda, cornstarch, etc.
Erika says
Also wondering about avocado OIL, which is not specifically listed in your posts that I've seen. Avocados are a NO but "cooking oils" are a YES. Ive seen avocado oil as an ingredient in pantry foods you've promoted, but I originally thought it should be avoided.
Alicia says
Oils are usually highly refined and don't present an issue with tyramine the same way eating an avocado would. I do find a few people are sensitive, but most do well with it. Soybean oil is similar!
Alicia says
Oh no! Don't worry about those. That's just for people with extreme food allergies. Just worry about what is actually in the main ingredient list.
Sharifa Bahri says
I have a question, is hummus okay?
Alicia says
It depends. You'd have to use a recipe without lemon. I have one on my site (search for artichoke hummus) and one in my cookbook as well.
Sharifa Bahri says
Omg, thank you so much for your prompt response!
I am working on a plan to start the diet, and I noticed the tea being a trigger. Are you referring to only black tea with caffeine? Are green teas and herbal teas included in the trigger list? I usually have a cup of green tea with my breakfast.
Ps. I really appreciate the work you’re doing here. I know it is a hard work, so I want to say it is changing lives. I so appreciate it. ❤️
Alicia says
Hey Sharifa, Yes so green tea still contains a lot of caffeine, which is a big part of what you want to avoid. Some people still struggle with decaf teas, like myself. Natural decaf is the best way to go - so all peppermint, ginger, or rooibos will be your best bet.
Thank you for such a kind comment too. 🙂 It is hard work!!
Lucy Annable says
So basically, you can't eat anything !! id starve if I followed this diet 🙁
Alicia says
Well, I've had this food blog for 3 years and can assure you that no one has emailed me that they have starved! Maybe you can peruse some of the recipes or look at the list of foods allowed for a more positive approach.
Jeff says
What about soy lecithin? I’m seeing a number of things where this is the only real question mark.
Alicia says
It's ok! Soy protein is really the big one to avoid.
jo says
Hi I assume apple cider vinegar is not permitted?
Alicia says
Unfortunately not.
Michelle says
Will this work with hormonal migraines? I only get migraines right before my period.
Jackie says
I get them too. Since I started this diet, I went 8 weeks before I got a migraine (which I believe was weather induced). Before the diet I would get a migraine every three weeks like clock work which I assumed were hormone related. . So, it seems to be doing something.
Alicia says
Wow, so happy you're already seeing results!!! Stick with it! It gets better. 🙂
Jennifer says
Alicia, can you have rice wine vinegar? Is sour cream ok?
Alicia says
Hi Jennifer - neither are ok on this diet unfortunately.
Suzanne says
It's interesting to see how different people are. I've had migraines for over 50 years and still counting, though I now have many fewer, less intense attacks. I'm fine with caffeine, chocolate, dairy products, wine, aged cheeses, and all dairy products, I can eat green peas and string beans in any quantity, Avocados are no problem at all. I can eat many other foods on Dr. Buchholz's last. For me, major triggers are all nuts, coconut, all dry legumes (especially soy), baker's yeast, mushrooms, and bananas. My fish and seafood allergy triggers migraines . as well as severe vomiting and diarrhea.. Over the years, I've done many rounds of exclusion diets, sensitivity testing, spent 8 months in a chronic migraine clinic, done acupuncture, tried herbs, minerals, and vitamins, Bach flower remedies.,,I've worked out, often very painfully, what works for me.
Rachael Carlson says
I'm diving into the diet and wondering about seasoned rice wine vinegar.
Alicia says
Any other vinegars besides distilled white vinegar are not allowed unfortunately.
Suzanne says
Again, your experience may be different. I have no reaction to balsam, red wine, or apple cider vinegars.
Jenna says
Hello!
I'm starting this diet soon. Wondering if your book has a decent amount of vegan recipes?
Thanks!
Alicia says
It has over 70 vegetarian recipes, but I do use a fair amount of cheese and butter. You can easily sub oils for the butter and leave out the cheese. There's also a lot of info outside of recipes - try it and if you hate it you can return through Amazon very easily. This diet is fairly restrictive as a vegan so I highly recommend working with a registered dietician to help make sure you're getting enough good nutrients. You don't want to end up feeling worse because you've limited so much!
Rajee kumar says
My daughter has been having multiple migraines per week for many years and is looking to get on this diet. We are lacto-ovo vegetarians and I am putting together recipes to help her.
This is a great resource and I am going to get this book.
My question she is planning to eliminate tomatoes and lemons initially - I was wondering about tamarind to see if I can safely use it instead?
Alicia says
Hey Rajee, Tamarind is fine!! Also lemongrass and sumac are great for tart flavors as well. I highly recommend my cookbook because it's got over 70 recipes (out of 90+) that will fit a lacto-ovo veg diet, so I think it will help as well.
Rebecca says
I’ve recently been diagnosed with VM and found your wonderful website while trying to learn more about VM. I’ve started the diet based on your lists but was curious what you do when you’re not at home. I was out all day today and didn’t know what was safe to get for lunch. Do you have any suggestions? 3+ months is a long time to only eat at home 🙂 Thanks!
Alicia says
Hey Rebecca a few options are
- Plain burgers (seasoned with salt and pepper which you can ask for) and American cheese, lettuce, tomato. I find most buns are ok and if they do have malted barley, it really won't bother you for a quick meal one time.
- A lot of things are ok at chipotle, you can get rice without lime if you ask for it. Most of their meat is fine as is their red salsa. Ingredients are posted online if you ever want to look up something.
- Grilled fish or meat (again ask about seasonings) in restaurants (Not like chickfila which manages to put msg in their grilled chicken)
- Salads where I bring my own dressing or use olive oil, salt and pepper.
- Breakfast tacos with eggs
- Plain oatmeal from Starbucks
If you're in a bind, it's just better to try to follow it as best you can without starving yourself. Not eating can bring on an attack anyway and one or two small cheats shouldn't hurt.
Dave says
This may be a stupid question - is there a preferred means of cooking for this diet? Is steaming better than roasting etc.? (my preference is roasting vegetables in the oven... just want to check that's ok!!)
Thanks!
Alicia says
Hey Dave - there is none. You can roast, grill, saute, boil, air-fry, steam...whatever you want!
Jamison Travis says
Wow! I just found your sight. Makes perfect sense. I have BPPV and VM. I am gluten and dairy free, don’t eat red meat, wild caught fish but an occasional chicken. I looked at your suggestion of CogniMag and I am allergic to strawberries. Any other suggestion? What about Coco Aminos? Any suggestions for dairy free ice cream? Thank you so much for sharing!
Alicia says
Hey Jamison,
Coconut aminos are ok cause they come from the sap of a coconut blossom instead of the actual coconut. Some brands are fermented, so you just want to watch for that. I believe Oatly makes a good dairy free oat milk ice cream. If you end up tolerating coconut well, they have so many good coconut milk ice creams. I also really love sorbets - there's a recipe in my cookbook for watermelon sorbet that's really easy.