The Vestibular Migraine Diet

There is so much information, and misinformation, about what will and won’t help your migraine, especially Vestibular Migraine. I am by no means a dietician, however I have had many patients be successful with the Heal Your Headache Diet. Heal Your Headache, or HYH, is an elimination diet aimed at reducing your migraine symptoms. It is founded on the theory that you should minimize your most controllable migraine triggers. David Buchholz, author of Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain, lays out the Heal Your Headache diet in three sections. They are the same way that I recommend patients combat their symptoms: avoiding the quick fix, reducing your triggers, and raising your threshold. Buccholz illustrates through the three thoroughly, discussing quick fixes like migraine abortives and pain relievers, then diving into triggers and how to reduce them in your day to day, and then talks about how to raise your threshold.

Heal Your Headache is more relevant in the second two. I find that patients, whether or not they want to get off medications, significantly reduce their symptoms and frequency of the dizzy-attacks of Vestibular Migraine with HYH. Migraine control, remission, and good days, weeks, & months ARE possible. And diet, according to Buccholz, is the most important tool you can utilize – I couldn’t agree more!

So how do you get started?

What Are Triggers?

Triggers are anything that could potentially set off a Vestibular Migraine attack. The most common triggers for Vestibular Migraine are:

  • Weather
  • Allergies
  • Caffeine
  • Alcohol
  • Sulfates
  • Chocolate
  • Monosodium Glutamate (MSG)
  • Aged Cheese
  • Nuts
  • Citrus
  • Processed meats and fish
  • Fresh baked goods (containing yeast)

Heal Your Headache Diet works to avoid all of these, at least at the beginning. That is the intention of an elimination diet – to eliminate everything that could potentially be giving you symptoms. At the beginning this can seem overwhelming. However, rest assured, it is more often than not only for a short time that you need to eliminate all triggers; this is based on the bucket theory.

The Migraine Bucket Theory

The Bucket theory is a theory of migraine symptoms, triggers, and attacks. Think of a bucket. When you’re feeling 100%, at your absolute best, that bucket is empty – you are avoiding all migraine triggers. Alternatively, if the bucket is closer to full, you are likely to have a migraine attack; food, weather, or stress triggers may be at play. There is a threshold of triggers that exist, each person is different and tolerates a different number and type of triggers. Whatever your personal combination of triggers are, regulating the most avoidable, especially when the unavoidable are present, is vital to you feeling your best!

 

Getting Started

The Migraine Brain is triggered by specific chemicals, processes, and pressure fluctuations. Because factors like weather, life stress, and computers are more difficult to avoid, controlling what you put into your body is your best bet.

The first step of the Vestibular Migraine Diet is to educate yourself on all potential triggers, and analyze what may be triggering your migraines, specifically your diet. Don’t drink alcohol or coffee? Then you have nothing to worry about there, however it is more than likely you fall into the category of eating or drinking from quite a few groups on the list.

  • Caffeine (including in decaf coffee/tea or chocolate)
    • Swiss Water Process Coffee & naturally decaffeinated tea, are typically safe
  • Alcohol (vodka and dry biodynamic white wines are best tolerated)
  • Chocolate (carob is even a trigger for some people, usually white chocolate is safe)
  • Monosodium Glutamate (MSG) goes by many names, and is a trigger for many
    • See below for a list of other names for MSG
  • Processed meat
  • Aged cheese and other aged dairy
  • Vinegar (except clear distilled vinegar)
  • All nuts, including nut butter and flower
  • Onions
    • Garlic, green onions, and leeks are great substitutes
  • Legumes (peanuts, pea pods, lima beans, fava beans etc.)
  • Soy (beans, sauce isolate, etc.)
  • Yeast risen baked goods
  • Aspartame (Nutrasweet)
  • Tyramine – in leftovers more than a few days old (2 days maximum)

The above list is a great place to start when it comes to avoiding foods. There are other foods not on this list that may be causing your migraine, like gluten, dairy, or sugar – I would only avoid these if you aren’t getting any results in the first 3-4 months of avoiding the above.

Click here for a print out you can keep in your kitchen or take with you to the store from The Dizzy Cook!

What to do About Caffeine

Caffeine can be a difficult one, especially because many people with migraine actually use caffeine as a migraine relief treatment. However, I have found anecdotally and from other Vestibular Migraine specialists that caffeine is actually a trigger for dizziness. Caffeine can also be difficult to cut out as it will give you a different kind of headache if you quit ‘cold-turkey’. As you start with the Vestibular Migraine diet, it’s important that you try to cut out all triggers at once, including the caffeine. BUT I do recommend that if you are a regular coffee drinker, you do the coffee more slowly. Start with half-caf, then real decaf (Non-Swiss Water Processed), and then lastly switch to Swiss Water Processed Coffee, or naturally decaffeinated tea, in order to avoid a caffeine headache. Do this slowly, not all at once like the rest of the Vestibular Migraine diet, if you need to.

Why is Tyramine Important?

Tyramine is an amino acid that is found in aged foods (like cheeses and meats) and foods that have been stored for an extended period (more than 2 days). Tyramine is well known as a substance that can easily trigger a migraine, especially when there is a build up in your system. Tyramine builds up in food when it is stored in the fridge or pantry, especially in high protein foods – like the leftovers you stored from dinner last night.

It is important to avoid Tyramine as those who experience migraine have a difficult time breaking the chemical down. This will cause your brain to release norepinephrine, and the imbalance between the chemical itself, and norepinephrine will cause neurons to incorrectly fire, causing a headache.  (1)

Avoiding Tyramine:

Tyramine is found in leftovers and some other foods and beverages as well. Here are some products to avoid if you’d like to lower Tyramine in your Vestibular Migraine diet: (2, 3, 4)

  • Leftovers stored for more than 2 days
  • Citrus fruits
  • Beans (fava, lima, broad beans)
  • Kimchi
  • Miso
  • Raw Onions
  • Tofu
  • Sauerkraut
  • Alcohol: beer, red wine, vermouth
  • Soy sauce & teriyaki sauce
  • Dried meat and fish
  • Aged cheeses

Here are some foods that are usually safe for those avoiding Tyramine that are good replacements:

  • Fresh cooked foods (or homemade and immediately frozen foods)
  • Apples,
  • Peppers, leeks, garlic
  • Green beans
  • Chickpeas, kidney beans, black beans
  • Ricotta
  • Cream cheese
  • Organic, fresh meat without additives
  • Eggs
  • Berries (blackberries, boysenberries, etc)
  • Seeds

Why is Histamine Important?

Histamine is the hormone/chemical produced when you’re having an allergic reaction to something – think hives from bee stings. Histamine is present in many foods, and a buildup of histamine can cause blood vessel swelling and the migraine that follows. Some research has found that those who have migraines are deficient in enzyme diamine oxidase (DAO) which should break down histamine, but the lack of DAO will result in a histamine buildup, causing your headache. Because of this reaction, it’s important to avoid histamine whenever possible – and because food is the option you can best control, be sure to familiarize yourself with the list and avoid the foods accordingly.

Along with histamine containing foods are histamine releasing foods. These are foods that themselves do not contain high levels of histamine, but do produce histamine in your body when you digest the food. It is good to avoid these as much as you can as well so you body both doesn’t ingest histamine or produce histamine.

Avoiding Histamine:

Histamine is hidden in many things we don’t think about, but is found in many of the same categories as Tyramine.

  • Citrus fruits (lemons, limes, oranges, etc)
  • Cured foods (cured or processed meat)
  • Aged foods (aged meats and cheeses)
  • Fermented foods (kimchi, wine, kefir, kombucha)
  • Nuts (including flours, milks, and butters)

Histamine releasing foods are often the same as those containing histamine:

  • Avocado
  • Tomato
  • Vinegars
  • Legumes
  • Papaya, pineapples, plums
  • Chocolate
  • Milk
  • Nuts
  • Bananas
  • Shellfish

Here are some low histamine replacements:

  • Seeds (sunflower seeds/butter)
  • Goat and sheep milk & cheese
  • Fresh cream cheese, mozzarella, butter
  • Apples, pears, and berries
  • Fresh meat (that has not been stored or “left over”)

Why is Monosodium Glutamate Important?

Monosodium Glutamate (MSG) is a hidden trigger for almost all migraineurs. The reason that it causes headache is not fully understood, but we do know it is a trigger for almost all migraine brains.

MSG is a flavor enhancer, it brings out umami and salty flavors better than most other chemicals. It occurs both naturally in foods, and some food producers intentionally add it to foods to make them taste better. It is hidden in the back of many packages, it can be hard to recognize because it has so many names.

Here are a few to get you started:

  • Hydrolyzed
  • Autolyzed
  • Anything -glutamate
  • Gelatin
  • Fermented items
  • Anything enzyme modified

Avoiding MSG can be difficult because it comes in so many forms, but in this article you can find the secret names MSG hides behind to help you get started!

Once you’ve started

Always remember that you are completely capable of controlling the foods that you put in your body, however it is also easier for me to tell you how to eat, than it is for you to overhaul your diet. This process can take a few months to begin to feel a difference, so if you don’t start feeling better immediately know that this is normal. The most important part is consistency – keep a food diary to try and figure out your food triggers.

Remember that it is okay to mess up. In the first few weeks, you may not notice you’ve unintentionally eaten MSG, or tyramine. Although it may feel frustrating, don’t forget that you will already have decreased your overall triggers and you may not get as severe of a reaction as you once may have.

I also find it helpful to focus on what you can eat, instead of what you cannot. There are still so many foods you can have, and experimenting with new flavors that you may not have tried in the past can be fun!

Click here for a PDF list of what you should avoid, and what’s safe to eat from The Dizzy Cook! 

Will This Alone Heal my Migraine?

Think back to the migraine threshold, food is just one of the many triggers responsible for your migraine. Uncontrollable triggers, like weather, stress, and routine change, will always be hanging in the background. Controllable triggers are the one you can hold yourself accountable for. Always stay hydrated, don’t skip meals, and avoid coffee & alcohol. The first 3-4 months are the clearance portion of the Vestibular Migraine Diet. Try to avoid every possible trigger to the best of your ability.

Keep a headache log during this time. Sometimes it can feel as though you don’t have any symptom relief, but then you try and eat a trigger food, like aged cheese, and you’ll feel so much worse. For most people, the Vestibular Migraine Diet along with other treatments, is the most successful approach to feeling your best!

Sources:

(1) Robinson, J. (2020, June 21). Tyramine-Rich foods as a MIGRAINE Trigger & Low Tyramine Diet. Retrieved March 29, 2021, from https://www.webmd.com/migraines-headaches/tyramine-and-migraines

(2) Histamine Intolerance Awareness. (n.d.). The food List. Retrieved March 29, 2021, from https://www.histamineintolerance.org.uk/about/the-food-diary/the-food-list/

(3) Paleoleap. (2019, April 01). Visual guide to histamine intolerance: Paleo leap. Retrieved March 29, 2021, from https://paleoleap.com/visual-guide-histamine-intolerance/

(4) Weeks, G. (2018, August 14). Links between histamine intolerance and migraines. Retrieved March 29, 2021, from https://patient.info/news-and-features/is-a-histamine-intolerance-to-blame-for-your-migraines’

(5) Wolf, A. (2020, March 31). What is the Heal Your Headache Migraine Diet. The Dizzy Cook. https://thedizzycook.com/whatishyh/

 

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