Chronic Migraines, Food Triggers, and The Curious Case of Too Much Tyramine
Most people never get the chance to learn about metabolic sensitivities. In this client case study, I share a story of insightful investigation to help someone with chronic migraines.
Welcome to ZigZag Nutrition.
This is my newsletter that I started almost 3 years ago now (wow) to give us a chance to explore all things health and wellness with the freedom to learn the true fundamentals of health and healing.
offers us that chance in the age of unimaginable censorship across most modern media.I’ve been writing for over a decade now and have always had an inkling of a call to try to encourage, educate, empower, and inspire others. You can expect all of that here.
looks at complex topics across holistic health, integrative & functional medicine, offering insights about our broken healthcare system, natural & alternative health, health optimization, nutritional psychiatry, and data-driven tools to inform and elicit change behavior like never before. (and more).Some of my community’s favorite posts are linked above if you want to take a look around. Today, I’m going to share a fascinating case study of one of my clients who has battled chronic migraine for over 20yrs and how I helped her identify potential triggers no doctor had ever considered before.
Let’s Dive In!
Migraines are a major headache. Nobody likes them. And if there’s ever something we can do to help treat and prevent migraines for people then it would help a lot of people avoid unnecessary suffering and debilitating loss of life, work, and relationships.
That’s what we’re about here. Taking care of people better than they are taken care of anywhere else. While most people are dismissed with migraine headaches and sent out the door of the physician’s office with worse than mediocre medication management for their migraines, there has to be a better way to practice medicine.
There has to be a better way to help people heal. And there is.
Migraine affects an estimated more than 10% of people worldwide and is about 3 times more common in women than in men.
Migraines can occur for many different reasons, but the wide variability of potential migraine triggers are often never fully explored with the help of a holistic and comprehensive assessment.
There is more to this puzzle than what meets the eye…
For example, studies show that people with migraine are more likely to have low levels of vitamin B12, vitamin D, and magnesium and that supplementation with these and other nutrients, like CoQ10, may help reduce migraine occurrence and severity.
Personally, some of the more common interactions I see with migraine headaches come down to food. In fact, there are many related interactions between food and migraines or headaches. There are a dozen or so common food and beverage triggers that people may experience, including chocolate, caffeine, wine, processed meats, gluten, dairy, sugar, and more.
Deeper still exists the many potential food and nutrient interactions that are influencing headaches and migraines… which brings us to our story today.
Tyramine Intolerance
Tyramine intolerance is a type of food sensitivity, where eating foods high in tyramine will bring on unpleasant symptoms.
Perhaps you’ve never heard of Tyramine (“teer-uh-meen”) ?
In this context, tyramine is a compound which occurs naturally in cheese, fermented foods, some meats, and other foods and can influence blood pressure by way of provoking vasoconstriction. More significantly, crossing over a certain tyramine threshold of intake can cause dangerously high blood pressure in people taking a monoamine oxidase inhibitor medication.
Tyramine occurs widely in plants and animals, and is metabolized by various enzymes, including monoamine oxidases. In foods, it often is produced by the decarboxylation of tyrosine during fermentation or decay. Foods that are fermented, cured, pickled, aged, or spoiled have high amounts of tyramine. Tyramine levels go up when foods are at room temperature or go past their freshness date.
Specific foods containing considerable amounts of tyramine include:
strong or aged cheeses: cheddar, Swiss, Parmesan, Stilton, Gorgonzola or blue cheeses, Camembert, feta, Muenster
citrus fruits, such as lemon, lime, clementine, orange, tangelo, etc
meats that are cured, smoked, or processed, such as salami, pepperoni, dry sausages, hot dogs, bologna, bacon, corned beef, pickled or smoked fish, caviar, aged chicken livers, soups or gravies made from meat extract
pickled or fermented foods: sauerkraut, kimchi, tofu (especially stinky tofu), pickles, miso soup, bean curd, tempeh, sourdough breads
condiments: soy, shrimp, fish, miso, teriyaki, and bouillon-based sauces
drinks: beer (especially tap or home-brewed), vermouth, red wine, sherry, liqueurs
beans, vegetables, and fruits: fermented or pickled vegetables, overripe fruits
Just imagine if you suffered a migraine headache lasting anywhere from 1-hour to a whole week whenever you consumed one of the following foods:
Apples or Pears
Citrus Fruits – lemon, lime, oranges, pineapple
Bananas (sometimes)
Dark chocolate
Yogurt (usually Greek yogurt, but for some reason Oikos triple Zero is okay)
Salmon (generally stay away from fish)
Sourdough bread
Rye bread
Fermented foods
Certain lettuce – spring mix, sometimes raw kale
Some alcohol: white wine, beer
Some cheese: blue cheese, swiss
Almonds & Almond Milk, sometimes Cashews
Raisins
Any form of leftovers if older than 6-8 hours
Marinara/pizza sauce
Tomatoes
Vinegar/Apple cider vinegar/kombucha
Anything “smoked”
Ginger, Coconut, Cilantro
Trail mix that has dried fruit
Cheesecake
Spicy foods
This was my client, suffering for decades without anyone ever discovering a root cause for her chronic migraine headaches. In my opinion, this is not proper medicine. Instead, what she was dealt was chronic pain management strategies without a true remedy to the problem.
Real doctors tend to be real teachers at heart.
When we lack the process or capacity to teach and reach our patients and clients as physicians, we are acting outside the bounds of our original philosophical foundations for practicing medicine.
For people with tyramine induced migraine headaches, they need to monitor their intake for all of these foods (and more).
With the help of high-level knowledge, consistent communication and proper feedback between the client and I, we were able to tailor a nutrition program that made sense for her needs while reducing overall intake and frequency of tyramine in her diet.
What’s also important to note from my perspective is that now she has this awareness and empowerment to lead with her wellness journey for the rest of her life. If she will need future considerations for different medications or travel opportunities, she will be able to take into consideration how to best communicate (and advocate) on her own behalf to set herself up for success to prevent adverse events as much as possible.
Now, she has additional tools and information she needs to live her best life possible. This is the kind of “docere” we need from physicians to their patients and vice versa. The practice of medicine is a two-way street, interlaced with experiential anecdotes and background education to lead us towards informed decision making.
Doctors can learn from patients just as much as what patients can learn from doctors.
In the case of tyramine intolerance, one professional experience of this condition will open the eyes and mind of any clinician to consider “there’s more to this puzzle than what meets the eye...” when they encounter their next patient suffering with migraine headaches.
Imagine the patient walks in the physician’s office with all sorts of weird and seemingly random symptoms from tachycardia to hot flashes, clammy hands and feet, night sweats and cold chills. You might think this could be any number of conditions.
Interestingly enough, some of the symptoms related to tyramine intolerance/sensitivity include the following: Increased blood pressure, increased heart rate, severe headaches, hot feeling, and redness of the skin, sweating, chills, clamminess, migraine headaches, lightheadedness and hives.
If any of this sounds like you or you suffer from chronic migraines, I would strongly encourage you to work with a functional medicine provider or someone well-versed in complex considerations who will actually help you do a deep dive to find your root cause. What we should NOT do for patients is simply scoff at their common symptoms of headaches and migraines.
Patients deserve better. Physicians can and must practice better.
Equally insightful is to know that not everyone has a tyramine issue. There are all sorts of other reasons why someone might suffer from chronic migraines.
Other people are particularly sensitive to artificial flavors or artificial sweeteners like commonly consumed aspartame, certain preservatives, MSG, and more.
Furthermore, there are often secondary and tertiary effects related to the onset of migraine. One of those common correlates is an individual’s blood pressure.
For example, under high stress, low sleep, or all sorts of other conditions, someone’s blood pressure can notice significant changes.
Elevations in blood pressure can impact migraine onset and can lead to worsened symptoms. Managing blood pressure, stress, sleep, and hydration can help someone gain better control over their migraines to complement food and dietary interventions.
The Big Idea:
You deserve the chance not to assume your pain and discomfort with chronic symptoms. You can find healing. You don’t need to assume the state of suffering.
You can dig deeper. You can ask more questions. You can grow to become the best expert for your own health.
It does take time. It takes both attention and intention. But you can do it.
That’s guaranteed.
If any of what I’ve mentioned today around migraine headaches or the role that tyramine may play in your health and wellness seems like something worth your time to delve into more, I highly recommend you reach out to a qualified medical professional to help guide you in your care.
If you notice that any particular foods do tend to provoke your headaches or migraines or if you notice any correlation between your headaches and your environment (car, work, gym, certain room in your home), again I strongly recommend you reach out to a qualified medical professional to help guide you in your care.
In the meantime, here’s how you can help lead yourself towards health & healing…
First, keep a headache/migraine journal for 1-3 months. Take note of the time and date the headache starts. Then answer these questions:
Where do you notice the migraine pain?
For women, where does the migraine episode fall in your menstrual cycle?
What have you eaten recently?
Have you been exposed to other common headache triggers, such as a change in altitude, change in temperature, strong smells, bright lights, loud noises, changes in sleep habits, or unusual stress?
Headaches may not start for 24 hours after you eat certain trigger foods. That’s why including the foods you've eaten during the past day or two may help you figure out if tyramine is part of the problem.
If you think your migraines might be related to food, what I want you to do first is to try to identify if these correlated factors are true and valid and worth further investigation. Consider if they are more affected by food or the environment you are in. Are there any common foods of concern or certain types of sauces or restaurant foods you know you need to stay away from?
If you can find a qualified nutrition professional to help you manage your diet and symptoms of migraines that would be a great next step.
If you believe this curious case of tyramine could be your case as well, please mention this to your doctor or whoever manages your medications as it relates to your overall care. And let me tell you why this is very important…
Some medications are what we call MAO inhibitors and they may possibly be playing a negative effect on your migraine symptoms. Because of its chemical structure, tyramine is called a monoamine.
Anti-depression medications are often MAO inhibitors as an example.
The reason why this is important is because MAO is the enzyme the body needs to use to break down tyramine in the body. If this enzyme is reduced or simply there is not a lot to go around, then the body can build up the presence of tyramine molecules and provoke your migraine symptoms.
Scientists made the connection after anti-depression drugs that inhibit MAO went on the market in the 1950s. People taking the drugs began to get headaches and high blood pressure when they ate foods containing tyramine.
So now you know. And you can even share this wisdom with a friend.
ZigZag Nutrition represents the pursuit we share as we strive to live this life as best as we can, learning and growing, flexing and adapting along the way to better align ourselves to the most nutritious life and lifestyle that meets our needs and nourishes our body, mind, and spirit - together.