The crime scene: allostatic load
We are designed to withstand to stress. Think of the proverb “The wind does not break a tree which bends” or any of its variations. Scientifically, this process is known as allostasis or “maintaining stability through change.” However, too many changes can result in allostatic load, a physiological condition in which the body’s allostatic systems become overstimulated or unable to respond normally to change.
What does this have to do with migraines? I think it has something to do with the state of your individual allostasis in combination with the potential for certain inputs to send it into overdrive. We have more control over some of these inputs than others: you can’t control the weather, but you can control what you eat.
The suspects: excitatory inputs
Any investigation into food triggers and migraine disease will be messy at best. But when I look at the foods commonly reported with migraines, they all have in common what I am calling “excitatory inputs,” components of foods that have the potential to activate an excitatory physiological response. The way I see it, if your allostatic systems are already overstimulated, then these foods might just be enough to push you over the edge.
The Primary Suspects: tyramine and glutamate
Tyramine is produced in the conversion of tyrosine, an amino acid present in many proteins, into the neurotransmitters dopamine, norepinephrine (noradrenaline), epinephrine (adrenaline). Excess tyramine in the body is mopped up by Monoamine Oxidase (MAO). Low tyramine diets are required for conditions associated with decreased levels of MAO, which include people with Familial Dysautonomia, a serious genetic neurological disorder that effects the autonomic nervous system, and people taking MAOIs (Monoamine Oxidase Inhibitors). For these groups, elevated levels of tyramine can result in a “hypertensive crisis” with symptoms including headache, nausea, vomiting, fast heartbeat and, in extreme cases brain hemmorhage. Low tyramine diets are also sometimes recommended for people with headaches.
The guidelines can be overwhelming. The most important thing to remember is freshness: the tyramine content of food increases over time and at higher temperatures as tyrosine breaks down. (If you want to get really geeky about it, check out the USDA’s National Nutrient Database for Standard Reference which lists the tyrosine content of many foods, then try to estimate how long it might take to convert the tyrosine.)
THE FRESHNESS SCALE
some alcohols and vinegars (distillation may remove some of the triggers–the rule of thumb is the clearer the better)
aged meats (charcuterie, salumi and deli meats)
nuts, peanuts and dried beans
overly ripe fruit
out-of-season and non-local fruits (depending on where you live, this may include bananas, oranges, pineapples, tomatoes)
spoiled food (The Danger Zone: 1-4 hours at 40-135°F/5-55°C)
foods naturally high in tyramine: fresh legumes (snowpeas, pea pods, edamame)
Additive-free, freshly canned and frozen fruits and vegetables (thank you, Clarence Birdseye)
Many migrainers report that monosodium glutamate is a trigger. As a chef, this is a tough one for me. I’m a big fan of umami, which is essentially glutamate, which also happens to be the most abundant excitatory neurotransmitter. So here’s where I stand: I support the development of umami as a natural part of the cooking process, but I don’t support artificially adding glutamate to foods.
Spot Clean Food tip: Always be on the lookout for processed and cross-contaminated foods. A trigger may be hiding where you least suspect it.
Wanted for Questioning: aspartame, nitrates, sulfites, tannins, caffeine
If you are eating a clean diet of whole foods, most of these excitatory inputs should not be an issue, but let’s cover them anyway.
I don’t really want to get into the great aspartame debate, but I will say this: aspartame is aspartic acid and phenylalanine dipeptide, and phenalynine is a precursor to tyrosine which is a precursor to tyramine.
Nitrates, sulfites and tannins
Another great subject of debate, particularly regarding red wine. These substances are used as preservatives and could be considered accomplices under the freshness guideline. Tannins also evoke a somatosensory response, the feeling of astringency, which makes me wonder if it may be implicated in activating the trigeminal nerve (like an ice cream headache).
Caffeine has been reported to both trigger and help alleviate migraine attacks. It’s a complicated little chemical. It is a stimulant that blocks adenosine, the amino acid responsible for sleepiness. It is also a vasoconstrictor, which may be why it seems to help with some types of headaches or certain phases of a migraine attack, but can also cause a withdrawal or bounce-back headache. I think it all depends on your load, and your drinking habits, to determine how much is too much.
The one that hasn’t been ruled out: Chocolate
Chocolate is commonly reported as a migraine trigger, but is it the caffeine, the tannins, the theobromine? There is even some evidence that it may be a food craving in the prodrome stage of a migraine and not an actual trigger. Cross-contamination, particularly with peanuts and tree nuts, may also be a contributing factor.
The mystery of migraines and food triggers remains unsolved. I sincerely hope the investigations continue, but I’m not going to get too excited about it. I have other things to worry about, like what’s for dinner.
McEwan, Bruce, and Teresa Seeman. “Allostatic Load and Allostasis.” MacArthur SES & Health Network, Aug. 2009. Web. 30 July 2012. <http://www.macses.ucsf.edu/research/allostatic/allostatic.php>.
Low Tyramine Diets
Buchholz, David. Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain. New York: Workman Pub., 2002. Print.
The Low Tyramine Diet for Migraine, National Headache Foundation
Meal Ideas and Menus: Avoiding High-tyramine Foods Made Easy, Vanderbilt University Medical Center
Tyramine Free Food List, The Familial Dysautonomia NOW Foundation
National Nutrient Database for Standard Reference, United States Department of Agriculture (tyrosine)