Headaches and the Food Connection -- with Elaine Magee, MPH, RD

By Elaine Magee, MPH, RD
WebMD Weight Loss Clinic - Live Events Transcript
Event Date: Tuesday, March 29, 2005

Tension headaches and migraines account for 90% of all headaches. Now, instead of running for the aspirin bottle, WebMD nutrition expert Elaine Magee, MPH, RD, offers advice about what foods you can eat to help prevent and reduce headache symptoms. Elaine joined us on March 29, 2005 to talk about the relationship between headaches and food.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome back to WebMD Live, Elaine. Thank you for joining us today.

It's always my pleasure to chat on WebMD Live.

How did you come across the connection between food and headaches?

The publisher asked me to write a book for the Tell Me What to Eat series on this topic and I couldn't really say yes until I looked into the research and what was out there on it. To my surprise, there was a lot of great information and progress on this subject.

Through writing this book, I met up with a wonderful headache expert from the Diamond Headache Clinic, Frederick Freitag, DO, who helped me fill in the blanks that I found in the literature and reviewed my work on the book and was so excited, offered to write the forward.

How many people suffer from headaches and migraines?

We are talking about more than 45 million Americans seeking medical attention for severe or chronic headaches. Within this group is a subgroup of people who specifically suffer from migraine headaches. This is around 18 million people, some say 23 million. And it's a primarily female condition, migraines. Mostly women suffer from them.

What foods are linked to migraines? Is it an allergy?

We really don't know exactly how these different foods are triggering migraines. Some researchers suggest an allergic type of reaction; others suggest a relationship to the change in blood flow to the brain. So given all that, these are the types of possible food migraine triggers:

  • fasting or skipping meals
  • excessive caffeine consumption or caffeine withdrawal
  • alcohol, such as red wine and port
  • aspartame (NutraSweet) found in some sugar free products
  • MSG, found in all sorts of packaged pre-made food products, snack foods and Chinese food
  • nitrates/nitrites
  • tyramine, an amino acid
  • certain foods like chocolate, citrus foods and others
  • a high-fat diet has actually been connected to migraines

What about sulfites in wines? They are really a pain.

The research didn't differentiate between the sulfites and the effect of alcohol as the trigger. Some people name all types of alcohol. Some list reactions to specific types of alcohol: red wine, whiskey, and some say beer. Some newer research is now suggesting the phytochemicals called phenols found in red wine may be the real headache triggers.

You mention aspartame; were any other artificial sweeteners implicated as headache triggers?

Not that I saw in the research. And only some people mention NutraSweet as a trigger, not a large amount. Keep in mind that stress is the number one migraine trigger. So one of the best things you can do is to work on the stress in your life and how you manage that stress. And eating a healthy diet and not skipping meals helps a lot of people sort of de-stress their diet. Our tendency when we're stressed is to eat junk food, and that's exactly the wrong thing to do, in terms of migraines.

In what foods is tyramine present?

Food sources are all over the map. There isn't a lot of concrete data on tyramine content in foods. Basically researchers have found larger amounts in aged cheeses, red wine, alcoholic beverages, such as beer, some processed meats, avocados, overripe bananas (some experts say it's the peel that causes the problem and as long as you shave the outside of the banana to make sure no inside peel is being eaten, you won't have a problem), chocolate, nuts, seeds, pork, venison, and soy-based foods.

How much do wheat and gluten, as well as dairy products, play a part in contributing to migraines?

Not the wheat gluten, to my knowledge, unless it happens to be one of the symptoms of the wheat allergy. But it did not come up in the common types of headaches that I researched for the book.

In terms of dairy, there is a connection between the fat, and I'm listing a specific fat, trans oleic acid. This type of fat is found mainly in meat, butter, milk and cheese. Some new research has shown that people who take in higher amounts of this type of fat were almost three times more likely to have hay fever, compared to people who ate the least. The cheese could be linked to the hay fever type of headaches.

Also, cheese comes up as one of our major tyramine sources. So if someone is sensitive to tyramine-containing foods, they may have problems with certain types of cheeses. There are so many cheeses listed in the "avoid" column that it's easier to list the cheeses that may not cause you problems, and they are:

  • cottage cheese
  • cream cheese
  • Monterey jack (thought to be OK for many)
  • mozzarella (also thought to be OK for many)
  • ricotta

Many of the recipes in this book use the Monterey jack or mozzarella cheese for this reason.

Assuming a migraine is triggered by food or drink, what is the typical or average time span between consumption and onset of headache?

The headache may come about several hours to several days after eating a trigger food. A reaction to MSG can happen within an hour, but some of these other things can take longer to trigger a headache. That's one of the reasons this can get tricky. Food Step to Freedom No. 1 in the book is to keep a headache and diet diary. In this diary you're going to keep track of your stress, what you ate, how much you ate, when you ate it, and when the headache came on, so you can see patterns for yourself.

Keep in mind that a food or beverage may not be a trigger 100% of the time. Often foods are triggers only when they are combined with other triggers. I call this "one plus one equals two." Or one trigger plus one trigger equals headache.

Also, it can depend on how much of the food or beverage was consumed. A little bit of chocolate may not cause a problem, but the whole Easter bunny may. Or a small glass of champagne versus half a bottle of champagne.

Any quick remedies besides avoiding these foods?

There are the Ten Food Steps to Freedom. Some are going to tell you what to avoid and others are going to tell you what may help, so let me get through those ten food steps for you:

  • Keep a headache and diet diary.
  • Avoid skipping meals. Eat when you're hungry, stop when you're comfortable.
  • Limit caffeine to a moderate and consistent amount daily or eliminate it completely, if you can or want to.
  • Avoid eating a high-fat diet.
  • Switch to plant and fish sources of omega-3s when possible.
  • Find out if NutraSweet is not so sweet for your headaches.
  • Limit tyramine-containing foods if you appear to be sensitive to it. Switch to the cheeses you can use (see above).
  • Avoid certain additives if sensitive (MSG, nitrate/nitrite).
  • Beware of certain dehydrating beverages -- those containing alcohol and caffeine. Stay hydrated as much as possible.
  • Work a couple of magnesium-rich foods into your day if you have hormonal headaches.

What foods are sources of nitrates and nitrites?

Start with the Easter ham and we'll work our way down to sausage. There are brands that contain nitrates and nitrites. For soups, it's basically most soups that contain bacon, ham or sausage. And it's frozen food that contains bacon, ham, pepperoni or sausage. Look for them in canned foods like Spaghetti-Os, sliced franks, canned hams, canned beef, Spam, canned deviled ham, and jerky. Every single brand of jerky that I saw contained nitrates and nitrites. And lastly, it's in luncheon products like pastrami, bologna, ham, hot dogs, salami, pepperoni (even turkey pepperoni), and certain brands of prepackaged sausages.

There are a couple of brands of luncheon meats that did not appear to contain nitrates at this time, and they were Healthy Choice and Hillshire Farms oven-roasted turkey.

"Sugar doesn't really specifically come into play with headaches and migraines."

You also mentioned magnesium-rich food as something we should eat if we get hormonal headaches. What are good food sources for magnesium?

Increasing the amount of magnesium in your diet has been demonstrated to prevent menstrual migraine in controlled trials. So let me give you the top 12 from the long list in the book:

  • almonds
  • whole-grain bagel
  • barley
  • black beans
  • black-eyed peas
  • bran cereal with raisins
  • Brazil nuts
  • 100% whole-grain bread
  • brown rice
  • bulgur
  • cashews
  • Wheat Chex

What do I do when I'm at a restaurant and the waitress says she doesn't know whether there's something in the food that contains a pain trigger?

The more you know the better. I do have some restaurant "do's" from the book that I could share. There are some restaurant "don'ts," also. Let's talk about the "do's":

  • Plan ahead and do your homework on restaurants.
  • Select fresh fruits or vegetables when you are given the option with your meal.
  • Ask that fat not be added to the vegetables.
  • Enjoy broth-based soups rather then creamy soups.
  • Order salad dressings on the side so you know exactly what amount you're eating. You can always go for the olive oil and vinegar with nothing added to it.
  • Go for the grilled foods, particularly roasted turkey sandwiches because the turkey tends to have less tyramine than chicken.
  • Look for menu items that are described as broiled, barbecued, grilled, poached, steamed or roasted. These tend to be the lower-fat options.
  • Opt for petite portions of meat or other dishes, when given the choice.

There's much more information in the book but this gives you an idea of some positive things to do in a restaurant.

You say there are foods you can eat to prevent and reduce headaches. Or is it simply foods to avoid that you have already covered?

Since stress is the number one trigger of migraines, let's talk about how to de-stress your diet. Basically you want to eat healthy, balanced, nutrient-rich meals. That's your best nutritional defense against stress. When we are most stressed we do two things: we skip meals and we eat junk, and we drink alcohol or coffee. None of these things are going to help you with your headaches. Let's look at de-stressing your diet six ways:

  • Keep carbs handy and healthy. Stress hormones behoove us to eat a higher carbohydrate diet, so we want to choose our carbs wisely by choosing foods that give us carbs, plus fiber plus nutrients, like fruits, vegetables, beans, and whole grains.
  • Omega 3s to the rescue again. Although the uplifting effect of Omega 3s on mood hasn't been proven quite yet, plenty of studies suggest a strong connection, particularly for one of the Omega 3s in fish.
  • Cut the caffeine. One researcher found that when people sensitive to caffeine eliminate it from their diet their mood and energy levels significantly improved.
  • Eat smaller more frequent meals through the day to provide your body with a consistent supply of energy and help you avoid feeling tired or overly hungry.
  • Eat breakfast. People who eat breakfast tend to have more consistent moods and are less likely to suffer food cravings later in the day.
  • Alcohol is actually a depressant and overdrinking only adds to the stress in your life.

I have a 15-year-old daughter who has been suffering with migraines for two years now. They put her down for a week at a time. None of the medications seem to help as she wakes up with many of the headaches. Can blood tests detect if there is any allergy to food and if so, how accurate are they?

Not to my knowledge is there a test you can take to understand if your migraines are being triggered by your diet. That's why the migraine diet diary becomes so helpful. We have one in the book you can use, just make copies for each day. There is a high degree of genetic influence, too, on migraine sufferers, so note that her children will also have a higher tendency toward it. My best advice is to get as much information as possible for her and work closely with a headache clinic or headache expert in your area, someone who can help her find the right medication and dose as she finishes growing.

Why, when I eat some sugar -- like candy, jam etc. -- does it give me a headache?

I vaguely remember seeing jam on one of the food lists, but sugar doesn't really specifically come into play with headaches and migraines, only in that you don't want to cause spikes in blood sugar and then quick drops, which is why you want to avoid the caffeine and junk- food quick fixes. Your body may crave sugar when you're stressed because it wants the quick calming effect of carbohydrates, but try to give it carbohydrates that will be long lasting, like whole grains, al dente pasta, beans, rather than the sugar fix.

I often find that with Chinese food as well as other foods containing soy sauce or other "natural flavors," that I'm fine when I first eat the food, but if I put it in the refrigerator overnight, the next day, it will cause a migraine? Is it fermentation?

It's possible that you're reacting to the chicken having higher levels of tyramine. The soy sauce itself and the MSG itself does not increase over time, to my knowledge, but it's also possible you have a one-day reaction time to the MSG that you consumed the day before. Generally people react within one to two hours to MSG, but it's possible you have a reaction time that's longer. It's also possible you're reacting to higher levels of the tyramine in the meat in the Chinese food or you're reacting to the soy sauce in the Chinese food and that's giving you a 24-hour reaction time.

We are almost out of time. Before we wrap things up for today, do you have any final words for us?

Thanks for spending some time learning more about eating and headaches and migraines. It's become one of my favorite books that I've done. This book follows the same popular format of the other Tell Me What to Eat books, including a chapter with recipes. Check the book out from my web site, recipedoctor.com, or amazon.com. And it is available in Chinese and Spanish.

Just one more side note: If it looks like eating less fat is helpful to your headaches, check out my recent cookbook Fry Light, Fry Right! which is all about making over our favorite foods.

We are out of time. Our thanks to Elaine Magee for joining us today. For more information, please read Tell Me What to Eat If I Have Headaches and Migraines.

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