This is a draft extract from a book, based on my personal experience of migraine, which I am currently writing and hope to publish next year. I would like to include some short contributions from other people too, so if you have anything you would like to share about this or any other aspect of migraine, please leave a comment below or write to me through the contact page of my website jenniferbarraclough.com.

People who are vulnerable to migraine often report that dietary factors – foods, drinks, and meal patterns – can trigger their attacks, and this is certainly true in my case. Eating cheese is the worst thing for me. It took many years to recognise this, which now seems strange, but because it was something I used to eat almost every day when I was younger I didn’t notice a connection. Also, this was years before it was possible to look up health information on the internet, and we were not taught much in medical school about relationships between diet and disease. Cheese, especially strong aged ones, is implicated for other migraineurs too and this is believed to be because it contains high levels of a biogenic amine called tyramine. This substance gets metabolised in the gut by an enzyme called monoamine oxidase, but people who only have low levels of this enzyme cannot process it fast enough, so that it builds up in the body and can cause not only migraine attacks but also increases in blood pressure and symptoms such as nausea, sweating and anxiety. Other high tyramine foods which are sometimes implicated in migraine include chocolate, processed meats such as bacon and salami, smoked fish, raw onions, fermented or pickled vegetables, broad and fava beans, oranges and other citrus fruits, ripe bananas, pineapples and avocados. None of these disagree with me like cheese does, so I suspect that the combination of chemicals besides tyramine found in different items of food is involved in individual sensitivities. While some migraineurs benefit from a low tyramine diet, others have reported benefit from gluten-free, dairy-free or ketogenic diets, or from giving up all forms of sugar.

While some foods may be best avoided, the good news is that others – those containing high levels of omega-3 fatty acids – have been found to reduce the frequency and severity of attacks. They include oily oily fish, dark leafy greens, chia seeds, flaxseed, tofu, walnuts, and eggs. 

Alcoholic drinks are often blamed for precipitating migraine attacks. This may not be due so much to the alcohol itself, as to the fact that they contain various other chemicals, again including tyramine. I love wine, so am glad to say that white or rose in moderation is not a problem for me, in fact it is probably helpful because of its relaxing effect. Red wine is more risky, and is notorious for provoking headaches even in people without migraine, probably because of its quercetin content. I seldom drink more than one glass of anything nowadays, having found in the past that just a slight excess can be followed by a whole day of feeling very ill with a ghastly mixture of migraine and hangover symptoms. When cheese and wine parties were fashionable they often proved a disaster for me.

Coffee, and other caffeinated drinks, are migraine triggers for some people. I am fine with one double shot flat white or Americano mid-morning, but not more. Sudden withdrawal of caffeine can also lead to an attack, so it is best to keep a fairly constant intake. A few years ago I spent a week at a health resort where coffee was forbidden. I had cut down on it the week before but still had a nasty headache for the first three days, though this did not develop into a full-blown migraine. Paradoxically, caffeine is present in some over-the-counter medicines for migraine, and black coffee has been found helpful during attacks as a treatment for people who do not usually drink coffee at all.

The timing and size of meals is important, as well as the type of food and drink they contain. Going too long without food or water can precipitate a migraine attack, but so can eating too much at one time, so it is important to maintain a reasonably regular meal schedule and to avoid dehydration.

Food triggers may be hard to identify because there can be a delay of hours or even days before their effects develop. If someone gets a migraine soon after eating a certain type of food they may develop a fear of that item and avoid it in future, although the attack may actually have been caused by something else. There may be a psychological element involved – for example if I have given in to the temptation of eating a piece of cheese, I usually worry about it afterwards and my anxiety may increase the likelihood of an attack. 

Avoiding alcohol, caffeine and all suspected food triggers requires a lot of will power, is awkward in social situations, and makes for a somewhat joyless existence for those who enjoy eating and drinking. Some of the “migraine diets” to be found on the internet appear impossibly restrictive and might even cause nutritional deficiencies in the long term. Dietary triggers are not the same as allergies in which eating even a tiny amount of a certain food, peanuts for example, is quickly followed by a severe reaction or even death. Many migraineurs can get away with eating their trigger foods in small amounts now and then provided they are not exposed to other risk factors at the same time.