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.
Kell says
Hi!
Your research has been a lifesaver! I am wondering, what about Kiwi? I didn’t see it on either the food you can’t or can eat and was wondering if it’s a safe option? Thanks
Alex says
Do you know if some people can tolerate triggers like dark chocolate? I’m wondering how much I can try to reintroduce and what is a definite no-go
Alicia says
Yes some people can! Reintroduce whatever you miss. Not all of these is a trigger for everyone. The elimination will help you see what is a trigger and what is not.
David says
I wanted to ask about Apple cider vinegar in water ,which a lot of people use to help with a lot of ailments. some list it good for headaches and migraines. Is it really bad?
Alicia says
It's not really bad, but it can be a personal migraine trigger. I have quite a few readers who report a sensitivity to vinegars outside of distilled white vinegar. The only way to really know is to eliminate it for a while and then reintroduce it.
Emma says
Hi Alicia! Thanks for all these great lists! I wanted to check if you know if gatorade or other sports drinks are allowed or not. I thought I saw somewhere they were a no-go but I can't seem to find it now! Thanks for your help!
Alicia says
Technically no. It's better to do electrolyte water or a mix in that doesn't have as much sugar.
Lisa G says
Is this diet only for headaches and Vestibular Migraines with headaches?
I have vestibular migraines, but have never had an accompanying headache.
Alicia says
No, it's for all types. I don't have headaches with my migraine attacks. You might find this post on vestibular migraine diet helpful.
Tess Marett says
I see that you recommend a good quality American cheese like Boar’s Head. But the description of the Boar’s Head American Cheese it says it’s a blend of cheddars. Is this still okay?
Alicia says
Yes, in American cheese they use a blend of really young cheeses. It's well-tolerated.
Dana says
Hi Alicia - Thank you for supporting the vestibular community. Your book is wonderful. I just bought cottage cheese to pit fruit in but than i noticed you said it can’t be live culture. Once i got home i realized it has live culture on the container. Assuming i can’t eat it?
Alicia says
Yes, you have to be careful sometimes with those if they say "live active cultures" like good culture. Daisy is the brand I recommend!
Kim Lavach says
In looking at your no-no foods, you did not list tofu. Is this form of soy also on the eliminate list? I am trying to navigate and better understand all of these food choices for my teenage daughter! Thank you!
Alicia says
Yes all forms of soy except soy oil and soy lecithin - those are the only two you dont have to eliminate. For future, tofu doesn't seem to be as common of a trigger for people like soy sauce so it may be something she can reintroduce later on. If she's vegan and trying to do the diet, I'd probably leave it in unless you notice an issue. If she's not vegan, you have so many other good options to just avoid it for a while.
Jelena says
Would fish sauce be ok? Ingredients are anchovy extract, sugar, and salt.
Alicia says
Unfortunately not allowed because of the fermentation! Sometimes I use coconut aminos instead, but it's tough to replace that flavor.
Reid Bailey says
I swear, you people view this book as a sacred text… you and your FB “support” are nothing but a cult and you the cult leader.I’ve never been a part of a more toxic FB group. I share my concerns in the group and here comes 10+ angry housewife’s talking down to me and basically calling me an idiot. The gate keeping in the migraine community truly is something else . You all have already blocked me but good frigging riddance.
Alicia says
I have zero idea what you're talking about but maybe they're being mean back because you called what has helped many people a cult? That's not a great way to start a conversation. My facebook group is literally just about sharing pictures of what we cook so unless you really hate cooking I'm not sure what is toxic about it.
Nerissa England says
Hello!
I find your information SO helpful! Thank you for sharing. I am still learning what my triggers are and trying to break food habits.
I’ve been dairy free for a while and im wondering about yogurt. You say strictly avoid, but is this just dairy based? Or would a plain oat yogurt be possible?
Is it a fermentation issue? Or a dairy issue?
Thank you!
Nerissa
Alicia says
Hey Nerissa - it's a fermentation issue when it comes to any yogurt!
Alex says
There is a CLIF nut butter bar ad on your website. He he he. They won't be finding many takers here. Thank you so for this website. I am grateful.
Alicia says
Oh no! I know the ads are based on recent search history so you must have been checking ingredients at one point haha. 🙂
Jennifer says
Thank you for your website! I just finished reading Heal Your Headache, and someone recommended your website to me. I appreciate that you have healthy recipes that are migraine friendly. Do you know why it can take several months after starting the diet to see a difference in migraines? Is the body detoxing the chemicals that cause migraines during that time, or is it something else?
Alicia says
Hey jennifer sorry I missed this. It doesn't have anything to do with detoxing, it's just sometimes it takes a while for our brains to calm down, especially if they've been in a migraine cycle for a while. Some people message me and say they feel better after a week! Others, like myself, it takes longer. So it's just tough to give a blanket timeline for everyone.
Colleen says
Hi Alicia,
I just found your website and it has been SO helpful and informative! I've suffered from migraines for 25 years and recently just started suffering from vestibular migraines (although undiagnosed, I finally understand what these new symptoms are!).
My question is incorporating the migraine diet with the ketogenic diet. I've been strictly keto for the past 3 months, but found that is when the dizzy / brain fog / low energy symptoms started happening. I feel great eating keto (controlled hunger, not controlled by food cravings, consistent weight loss), but now that I'm learning about the migraine diet think that the increase in incorporating cheeses and processed meats have put me over the edge.
Do you have any recipes for keto/paleo followers? Also, would you recommend attempting to continue with keto right now while also doing the elimination diet? From my reading, it appears that the keto diet is helpful for migraines, but any recommendation or resources would be helpful!
Thank you!
Alicia says
Hey Colleen, it's hard but I know people who do it. Often they'll start with this diet first, figure out food triggers and then move to keto. So that way you know what your triggers are before starting and if you can tolerate nuts, avocado...staples for that diet basically.
I do have a filter for paleo recipes under my recipe index.
Randy says
Is there something like good quality American cheese in Canada? Trying to find a substitute for my wife with no luck..
Alicia says
Unfortunately not - I believe some of my readers use Boursin, goat cheese, or farmer cheese depending on the recipe.