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The Connection Between Tyramine & Migraine

Tyramine is one of the primary substances that migraine diets attempt to eliminate. Tyramine occurs naturally in many foods and increases in potency when the protein in food ages. It is though to trigger migraine by dilating then constricting blood vessels in the brain, setting off a chain reaction that leads to a migraine episode.

It is important to avoid foods that contain tyramine, but also to eat food that is as fresh as possible to avoid the additional tyramine that develops as food sits. This is the most daunting part of the diet for me. Foods (especially high-protein foods like meat) should be cooked within a couple days of being purchased and leftovers should be frozen within 48 hours. To eliminate as much tyramine as possible, I cook or freeze ingredients within 24 hours of purchasing them and freeze leftovers within 24 hours of preparation. Frozen vegetables are an easy way to do this and they are usually picked and frozen at their nutritional peak.

Additional information:

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Migraine Diet: Five Months and Counting

Remember that extreme migraine diet I mentioned in January then never spoke of again? Normally, my silence would indicate that it was a passing fad that I gave up on quickly. This time it is because talking about the diet — really even thinking about it — makes me unhappy. The only way I’ve been able to stick to it was to put my head down and plow ahead as blindly as possible, eating because my body needs fuel, but not getting much pleasure from food.

You may have guessed that I haven’t noticed much of a difference in the frequency or severity of migraine attacks. If limiting my food choices had caused the migraine attacks to decrease in severity or frequency, I’d gladly eat sawdust for the rest of my life. Instead, the migraines are still so frequent that I’m afraid to add food back in because I won’t be able to tell if a food triggered the migraine or if it was bound to happen anyway.

The Diet
I don’t do much halfheartedly and this diet is no exception. I’ve cut out all food on the tannins and tyramine lists — both those that are high in the substances and those that are on the OK-in-moderation list. The older a food is, the higher the tyramine content, so I try to cook food the day I buy it, then freeze it. Grocery shopping takes a lot of energy, so this is more often the goal than the reality.

I’ve also cut out everything in Heal Your Headache, the unofficial migraine diet handbook, including monosodium glutamate, aspartame, caffeine, fresh yeast, beta-phenylethylamine (in chocolate), nitrates/nitrites and sulfites. Again, I’m avoiding anything that has been anecdotally implicated in migraine and anything the author says may be a problem for some people.

To make my diet even less interesting, I ditched dairy in April and gluten in early May.

The Results
I began the diet the second week of January, but it was a couple weeks before I eliminated all the potential triggers. Other than constant hunger and an increased vegetable intake, I didn’t notice any changes after starting the diet. However, I confounded variables — February 7 is the magic day I increased my magnesium dose to 700 mg, which kicked off the biggest decrease in frequency and severity of my migraines that I’ve ever had. I continued to increase the magnesium over the next few months and am now at 1,167 mg a day. I attributed all the improvement to magnesium, but food restrictions may have also played a role.

Reintroducing Foods
Here’s the hard part. Actually, the diet had been really hard — here’s the tricky part: The migraines are still so frequent that I’m afraid to add food back in because I won’t be able to tell if a food triggered the migraine or if it was bound to happen anyway. Sources vary on how long it can take for a food to trigger a migraine attack, but many say it can take up to three days. Three days? I usually have three migraine attacks in three days, how in the world can I connect an attack with a food?

So far I’ve tested peaches (tannins) and bread (yeast, gluten and (in the malted barley flour added to some wheat flour) tannins). Twice after eating peaches there’s been no discernible difference, once, six hours after eating the peach, I had my first level 9 migraine since December. Within two hours of eating bread last Sunday, I had my first level 8 migraine since late March and was out of whack the whole week, during which I had a migraine every day. However, I already had a migraine coming on when I ate the bread (yes, I know that was a mistake).

Conclusions
Ha! Like I’m anywhere close to a conclusion. I was much more cynical about the diet when I drafted this post, which was before I began reintroducing foods. After last week’s migraine attacks and with traveling to a wedding this weekend, I’m afraid to deviate from the diet at all. Then there’s a basket of triggers on the horizon as Phoenix is on the verge of the summer monsoon season, which means wind, clouds and thunderstorms. I’m having trouble imagining testing any more foods until September, but I can’t imagine I’ll wait that long.

In addition to the fear of food I’ve developed by being on this diet, I’m concerned that the diet is not nutritionally adequate, that worrying about the diet itself is increasing my overall stress, and that my reluctance to eat bland food is disrupting my eating schedule and increasing my vulnerability to migraine attacks. In other words, I wonder if the mere fact of being on the diet is causing more problems than it is solving. I’m stuck in fear, fear of migraine attacks and fear of food. This can’t be healthy.

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Extreme Migraine Diet: Eliminating Tyramine & Tannins

After purposefully not making any resolutions for 2012 (I’ve decided to embrace my flaws instead of constantly trying to fix myself), I find myself on the second day of the new year plotting the most extreme migraine diet I’ve ever done. The diet will be guided, in part, by Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain, a book whose author’s attitude I find offensive. I have long thought food triggers for migraine are overrated and I’ve never had relief with long-term migraine diets, yet I’m cross-checking lists of triggers and wondering if bland will be the flavor of the next four months. Desperation is powerful motivation.

I’m using Heal Your Headache as a basic starting point and also avoiding other foods that are high in tyramine (including those that are listed as OK in moderation) or tannins. Science hasn’t found a clear correlation between particular foods (or particular chemicals in foods) and migraine, so I’m relying on anecdotal evidence I’ve heard and read over the years. That’s right, there’s not much logic to my diet plan, just the stories from people who read this blog and the overwhelmingly positive reviews on Amazon. Have I mentioned that I am desperate?

I’ve included some links to previous posts I’ve written about food triggers, but I had to stop looking at them for fear that I would discourage myself from trying again. Instead, I’m telling myself that maybe this time will be different. Maybe I’ll be more disciplined, maybe I’ll get enough cooking help from family that I’ll have adequate nutrition, maybe climate was a factor in previous attempts and I’ll be more successful in the relatively steady barometric pressure of Phoenix. Maybe, maybe, maybe it will be different this time.

Please, migraine gods, let it be different this time.

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The Migraine Diet: Judith Warner & “Heal Your Headache”

It almost bores me to write about migraine and headache diets: Nearly every news article says you should do them, but many headache specialists say that only about 25% of people benefit from them. I vacillate between thinking food triggers are bunk and not eating to avoid migraine and headache triggers.

What I’m absolutely sure of is that Heal Your Headache: The 1-2-3 Approach for Taking Charge of Your Pain is a simplified — and usually ineffective — approach to headache and migraine treatment. (Not to mention it is also terribly offensive.)

I’m not the only writer with migraine with these conclusions. The latest is The Migraine Diet by New York Times blogger Judith Warner. The following excerpts don’t do justice to Warner’s eloquent examination.

Fortunately, no one seems to have noticed that I wrote last week’s column with one eye closed. I also had the lights in my office off, the shades drawn and the thermostat turned up to about 85 degrees.

All this because I had a migraine. In fact, I was on day six of a migraine that would, by day seven, have me dissolving into tears . . .

I was suffering like this because I was Taking Control of my life. I’d recently read “Heal Your Headache,” by the Johns Hopkins University neurologist David Buchholz. And now I was following his “1-2-3 Program for Taking Charge of Your Pain.”

I stopped drinking caffeine and alcohol and stopped eating chocolate, cheese, M.S.G., nuts, vinegar, citrus fruits, bananas, raspberries, avocados, onions, fresh bagels and donuts, pizza, yogurt, sour cream, ice cream, aspartame and all aged, cured, fermented, marinated, smoked, tenderized or nitrate-preserved meats.

For a couple of weeks, I was ravenously hungry, cranky, spaced out and vaguely, deprivedly resentful. But I felt, headache-wise, somewhat improved. I had six or nine migraines, but they were less severe. And, once I got used to it, I came to almost enjoy being on my diet, exploring my capacity for hunger and self-abnegation, obsessing over what foods I could eat, and how, and when. At the very least, the diet made my friends happy. Renouncing food, renouncing pills, is so often, in our time, seen as the right and righteous, pure and wholesome thing to do.

And then the headaches returned, with a vengeance.

Funny that Warner’s post was soon followed by MSN article Discover the 3-step System to Heal Headaches: Neurologist David Buchholz Shares Practical Advice on Preventing Pain, which is nothing more than an excerpt from Buchholz’s book.

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Blaming the Patient

Commenting on Food Triggers & Unrealistic Expectations, Kate responded to a part of Heal Your Headache that I skipped over. A part that makes my blood boil and fills me with shame for having put the book in my recommended list.

“Diets aside, I have a HUGE problem with Buchholz’s book. It’s Chapter Nine: ‘When Treatment Fails.’ In this chapter he speaks of ‘hidden agendas’ for treatment failure, such as ‘…when we reap the rewards from being in the sick role. When we’re sick, others give us their attention, concern, affection, sympathy, help, forgiveness, and permission to be excused from work and other responsibilities. As a neurologist friend of mine has noted, we all like having our pillows fluffed.’

“He states that ‘we all struggle with our identities,’ and suggests that the title of ‘headache patient’ gives us at least ‘SOME identity’ and ‘distinguishes’ us. Can you even imagine this??

“He goes on to put forth reasons that headaches are ‘hard to let go of,’ producing patients who ‘don’t try hard enough.’

“This is an outrage. And he is being touted as a ‘headache expert,’ was given an hour on Larry King Live, and patients everywhere are being given his book to read. And I wonder how many DOCTORS without enough headache training are using his book as a guide??

“Even worse, in the same chapter is a section entitled ‘The Trap of Disability Status.’ He states that no doctor should support long-term disability claims based on headache complaints. ‘The patient who walks out of a doctor’s office with a signed disability form is grateful and content, in contrast to the one who departs angrily with an unsigned form.’

“He states that he understands that we are suffering, but that we are suffering because we have never had PROPER treatment, such as his ‘1-2-3 Plan’ (which I can’t say has much in it that I haven’t heard before). He writes: ‘Disability is a trap: it guarantees that you’ll be complaining of headache until you choose to set yourself free.’ SET MYSELF FREE???

“Kerrie, is anyone else insulted by this?? When I walked out of my doctor’s office knowing I had to apply for disability, I was crying, not ‘content’ by any stretch. Having to stop working was horrifying, and produced NO rewards and certainly no improvement in my ‘sense of identity.’ Oh — and how about the big windfall of cash-flow that we pillow-fluffers on disability get to live on?? My-oh-my, sometimes I just don’t know what to do with ALL OF THIS MONEY!!! Guess I’ll just have to go out and buy some more fluffy pillows and bon-bons.

“Sounds like blaming the patient to ME, which is precisely what he chastised the medical establishment for doing at the opening of his book.

“I just don’t get why this book is getting so much acclaim. I don’t care HOW fabulous his dietary and rebound ideas are for some people; this is profoundly insulting, degrading, pompous, disrespectful, and bizarrely ignorant. I fear most for new patients who may read his book and, once again, look poorly on THEMSELVES when the Great Doctor’s big Plan doesn’t cure them.”