When you first get diagnosed with migraine it can be disappointing to learn that there is no cure, and there is no clear cause. If you are lucky then your Doctor might suggest you keep a diary to track the main triggers for your attacks, and they might even recommend avoiding certain classic triggers to see if that helps. Often though we are left to figure out daily migraine management on our own.
I have had migraine since I was a little girl. I remember when I was just seven I asked my Mum to please put her perfume on after she said goodbye to me in the morning as it gave me a bad headache. Trigger spotting from an early age! As I got older my triggers increased.
My first elimination diet was in 2010, following a program run by one of the major hospitals here in Sydney, the RPA Elimination Diet. At the end of the diet & double blind testing, salycilates weren’t great for my stomach, gluten was terrible, artificial colours were off the menu but worst of all were the biogenic amines. These set off migraines and hives and a host of stomach troubles.
So what are biogenic amines? They are basic chemical compounds found naturally in many of the foods and drinks we consume regularly. They come from protein breakdown or fermentation. The RPA didn’t break these down into specific amines, but classed them together. Foods high in amines include:
Aged & smoked meats
Fermented dairy products (such as yogurt)
Wine & beer
Nuts & peanuts (actually a legume)
This isn’t an exhaustive list, but it contains some of the main offenders!
The Hypersensitive Brain
Nine years after I completed that protocol, amines had well and truly worked their way back into my diet. I knew the main things that set me off (bacon, canned tuna, aged cheese) but let the rest slide.
With the shift into chronic migraine it started to feel like simply being alive was a trigger. Every day little things seemed to set me off! A bad smell, bright light, delicious meal - any of these could send my head reeling and I’d see the little blue warning dots that told me what was around the corner. I became confused about what my triggers might be. Red wine didn’t always do it and chocolate seemed OK? From the things I had read online these were supposed to be big NOs! Why couldn’t I handle sleeping in? Was it all stress, all in my head? What was going on?!
A chronic migraineur’s brain is hypersensitive and wired to migraine. I find it easiest to think about it like this - the brain has been through so many migraine attacks that it is frazzled, and having a migraine attack becomes one of the easiest things it can do, it almost requires less effort than not having an attack. Changing our lifestyle to avoid known triggers could help us rest our brains, and starting preventative medication can also help raise the attack trigger threshold too.
Heal Your Headache
At the end of 2018 I bought and read Heal Your Headache by Dr David Buchholz, after seeing how much it helped many members of the Migraine Strong Facebook community that I had just joined. Quick side note, if you’re looking for a positive and supportive group of migraineurs the ladies that run this group are amazing. I didn’t feel silly asking any of the questions I had, and always enjoyed reading their thoughtful and sensible replies. They had all been helped by this book, so I gave it a go. It was an excellent read.
The Heal Your Headache (HYH) plan isn’t just an elimination diet, although that is a large part of the approach. Dr Buchholz also suggests reducing the medication you are taking and considering the other factors that add to your migraine buckets. The first chapters talk you through migraine, rebound headache, possible preventatives you could try and other non-food considerations. The bucket theory basically suggests that an attack will be triggered when your own personal trigger bucket is full. Some triggers such as monthly hormonal shifts are bigger than others such as bacon or sunshine. Chronic migraineurs have less room in the bucket before it fills up and triggers an attack, so it can be helpful to understand your smaller triggers as well as the bigger more obvious ones.
In January 2019 I decided to give it a try, and now in September I am still following a loose and relaxed version (more on this next week!). So far I have dropped caffeine from my life forever, and won’t be having much aged cheese in the future either. Chocolate seems to be OK (there is hope fellow chocoholics!) and I can handle white wine but not red. Overall though the plan has given me back something far more important than recognising that soy sauce doesn’t agree with me. It has empowered me to remember that the choices that I make, and the way I live my life, can absolutely impact how I’m feeling. I have started exercising again more regularly this year, started trying to regulate my sleep times (as much as you can with a toddler!) and saying no to things that I know won’t suit me. I can’t control my migraine much of the time, but I absolutely can influence how I feel generally by taking care of myself.
Diet and Mindset
Diet is just one component of a migraine management lifestyle, but it becomes a big one in people’s minds. There are so many factors to consider when deciding if trying an elimination diet is right for you. One topic touched upon sometimes in the Facebook group is food anxiety. I want to be completely honest here, I struggled with disordered eating as a teenager and young adult. I consider myself well and truly in recovery (for over a decade now) but knew that this would make trying a diet like this harder. To support myself I started seeing a psychologist before embarking on both diets. This time around I am also planning to see a dietitian to help me make sure I’m still eating a healthy balanced menu each day. My approach to the HYH diet is more relaxed than it ideally should be, and could mean that I am missing smaller triggers. However for me it has to be a balance of trying to improve my migraine while also maintaining the healthy approach to food I have cultivated as an adult. Cutting food groups and avoiding long lists of ingredients can be triggering for me, so I don’t stick to it the way someone with no history might.
If you start to find yourself nervous about eating certain things, or restricting more and more food groups to try to find an answer I would really encourage you to chat to someone about it so they can support you. Life with migraine can be tough, and elimination diets can be tough, so it makes perfect sense that you might need a boost if you decide to tackle both at once. This diet isn’t about weight either, and it’s also important to keep in mind that both being overweight and being underweight are both tied to an increased likelihood of developing chronic migraine. With everything we do to manage migraine, staying as healthy as possible for us has to come first.
Pros and Cons
This post has become a lengthy essay! There are many pros and cons to consider before embarking on an elimination diet. I have decided to split this post about diet in two,and will be back next week with the pros and cons as I see them, and suggested resources for anyone who wants to give it a try.