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.
Anonymous says
Should barley be avoided entirely? Or just 'malted' barley, and other forms of malt?
Alex says
Hi! Forgive me if this was answered before, but what is it in chocolate that is a potential trigger?
Suzanne says
How about Costco blueberry muffins? And any recommendations for a trip to the ballpark? I know hot dogs and pizza are out. (Love your cookbook. It’s been so helpful!)
Alicia says
It's tough to say without knowing ingredients - sorry! I'd probably bring my own snacks.
Jamie says
Do sourdough pretzels trigger? Thank you so much for all of your help! I have been given some hope from you. Still super unbalanced after 6 months on the HYH diet but hanging in there.
Alicia says
Unfortunately sourdough is an elimination item in the beginning, but I find lots of people can reintroduce eventually! If you're still not feeling better after 6 months, I'd probably re-evaluate your plan with your neurologist. You should at least be seeing some benefit right now and may need to change meds or add some things. I can help if you want to work through some ideas, I have private consults on thedizzycookshop.com
Mindy says
Hi! I’m new to VM and am working on changing my diet. I have been making sourdough bread for years now and am not seeing anything about sourdough on here. Maybe I’m blind. Is sourdough okay?
Alicia says
Sourdough is an elimination food unfortunately. If you use "control f" on a desktop computer it can help you search for "sourdough" - it's a long post!
Dawn says
Hi
Can you tell me if fresh fish is allowed please. I know you say that canned is not but does that include fresh fish like fresh cod, salmon, trout etc?
Also, can I eat organic sourdough bread if it is over a day old?
Thank you
Stephanie says
Dear Alicia,
I have just found your site. I am grateful for the research and work you have completed and shared to help so many people that have suffered from migraines like you.
I was shocked to find out that live active cultures could be a trigger to migraines. We make our own plain yogurt. I had a serving almost daily. I thought I was eating the healthiest version of live active cultures. Little did I know it was likely a trigger to my migraines. Since this news also rules out taking prebiotics and probiotics, do you have any suggestions to keep a healthy gut for those of us that cannot have live active cultures?
Alicia says
Hey Stephanie - Yes, i have some recommendations in my post on my vestibular migraine treatment under supplements. Especially if you're histamine sensitive!
Shelly says
Is mustard like Koops Arizona Heat ok to eat or is it out because of the vinegar? Also, I thought I saw on your site that Triscuts were ok but I can’t find that info now. Thanks for your great info!
Alicia says
It's hard to say without seeing ingredients, but if things just say "vinegar" they're usually fine. Might be in the snacks or pantry staples post.
Diana says
Hi Alicia,
Thank you for providing such valuable information. May I clarify a few things: you mentioned red plums are not ok, but what about black or yellow plums? What about canned fish with just water and salt? What’s your take on salted fish, fresh pickles with just salt and vinegar, and what about coconut aminos, and MCT oil? Thank you so much for clarification!
Alicia says
All plums are out in the elimination phase.
Fish packed in water is ok. Fresh pickles are fine - I have a recipe for them.
Coconut aminos are ok, I use it in recipes so I recommend reading the posts for info on those.
Anonymous says
Hi, I was wondering your opinion if a product with these ingredients fits into the hyh diet?
Ingredients: Whole grain oat flour, corn flour, sugar, whole wheat flour, calcium carbonate, salt, baking soda, tocopherols (to preserve freshness), reduced iron, niacinamide, annatto (color), thiamine mononitrate, pyridoxine hydrochloride, riboflavin, folic acid.
Alicia says
Yes, it does.
Anonymous says
Thank you. I wasn't sure, especially about the annatto.
Autumn says
I kind of feel like I'm stuck in between a rock and a hard place. I have multiple health conditions and I'm doing a sugar detox right now, so I feel empowered to change my diet for my health. But I already researched what I should eat for my ADHD and depression (I don't make dopamine), and nuts, nut butters, legumes, and soy products all help with the production of phenylalanine, a precursor to dopamine. 😅
Alicia says
Hey - I looked this up and although I don't know much about it, it seems like meat, fish, eggs, cheese, wheat, oats quinoa, barley, and seeds all help with this as well via Healthline. So I wouldn't be too worried about giving up nuts and soy for a short period of time. If you do have a lot of other restrictions though I would recommend working with a dietician to help make sure you're not getting overly restrictive. I have a few I can recommend if you email me.
Dawn Fitch says
Your sight has been AMAZING! The only place I go for migraine info. I’ve been having vestibular migraines for months. I’ve eliminated a lot. Is sugar a trigger? All sugary things? I find that when I feel better I go out for a bit of sun and fun and the next day, I’m right back in the bed. I know when I felt better I did have dairy all times, but was wondering could the sun just be the trigger?
Alicia says
Hey Dawn, it can be for some people but most people do fine with it. Moderation is key as well as watching your blood sugar fluctuations. I think sometimes when people blame sugar they're eating like 6 cookies on an empty stomach vs. 1 cookie with a full meal.
Sun and heat are definitely triggers for many, and you may want to make sure you're getting enough hydration. Try to not fall into the trap of blaming food and eliminating too much when there are a lot of other factors to consider that may help more!
Charity says
I have been trying to follow this diet quite strictly for 9 months. I have seen a reduction in the severity of my migraines but still get mild headaches several times a week. I can't figure it out! I am also on a daily preventative and try really hard to limit my use of ANY meds, especially triptans, which used to be my go-to. I am following this diet for myself as well as my 8 year old daughter, who started complaining of headaches/migraines in the last year or so (which is about the age I started having them). I honestly don't really miss the things I am avoiding (because they equal headaches in my mind!), but it's definitely hard for eating with other people/away from home, hard for my daughter, and hard for cooking for a big family (we have 6 kids). I keep hoping I can add things back in, but I never get to the point of "satisfactory headache control for at least 4 months." Plus, don't most women find headaches always vary based on their monthly cycle?
Anyway, I noticed you mentioned a couple of things that I have been wondering about...
1) soy - the author of the book says he's unsure if it is an issue, yet you say to avoid it. What is your reasoning?
2) malted barley flour - I have changed my flour type to one that doesn't contain malted barley flour (I use Gold Medal, which is twice as expensive as what I used to buy, so I keep wondering if it's worth it!!
3) "natural flavor" - I know he said, and you agree, to avoid savory products with this in the label, but I have been trying to avoid ALL products with this listed, including some bizarre things like canned fruit, canned tomatoes and chili's, mayo/other condiments,
flavored oatmeal, and certain ice creams. Do you think it's only relevant for savory products, like chips, meats, etc?
4) day old breads - I do make sure not to consume YEAST risen breads before 24 hours out of the oven, but why are muffins included in the list? I only know of muffins made with baking powder. That isn't in the same category as yeast, is it?
Thanks for summarizing his book here. I wish I had found this months ago! It's refreshing to hear about people who are benefiting from this book/diet because I sometimes feel like a crazy person...and the book is about 20 years old, so I often wonder if some of the info is outdated.
K says
I tried going dairy free and it made a huge difference! Esp in headaches and dizzyness! I use oat milk/ cream and oat flour. Maybe that might help? I noticed any cheese or milk/half and half cause headaches 10 mins later with some dizziness. It took 9 months to figure this out.
Joanne Raphael says
Are any deli meat migraine safe? Such as boar's head?
Alicia says
No, they would be considered "old meat" unless you find a deli that roasts their meats fresh in house.
Heather says
Thank you for such a handy and practical list of foods to avoid and foods that are safe. I recently had a migraine attack and didn't realize that raspberries were on the no list until I double checked your website again. Thanks for being a life saver. I had gone 5 months without a single headache before I switched up my diet again.
Alicia says
I hope taking them out helps you, but sometimes migraine attacks happen no matter what we eat so I would definitely give it a full reintroduction trial when you're ready! It sounds like you were there before!