Crunching numbers at the Congressional Budget Office might give most of us a

headache. But for budget analyst Geoff Gerhardt, the problem is
munching, not crunching. According to his calculations, ham plus cheese
equals a classic migraine.

"It's like being hit by a truck," says Gerhardt, who has had migraines for more than 15 years. "Four to five hours after

eating processed meats or certain kinds of cheese, I start having
trouble with my vision. Then I get a strong pain in one temple or the
other, accompanied by nausea and loss of balance."

Seymour Diamond, MD, founder of The Diamond Headache
Clinic in Chicago, says more than a quarter of migraine sufferers have
specific triggers, including food. "One of the most common triggers is
aged cheese," Diamond tells WebMD.

Hold the Cheese, Please

The trouble with aged cheese is that it's high in

tyramine, a substance that forms from the breakdown of protein in
certain foods. The longer a food ages, the greater the tyramine content
is. For people with a sensitivity to tyramine, The Cleveland Clinic
warns against the following types of cheese:

• Blue cheeses
  
• Brie
  
• Cheddar
  
• Stilton
  
• Feta
  
• Gorgonzola
  
• Mozzarella
  
• Muenster
  
• Parmesan
  
• Swiss
  
• Processed cheese

Other foods high in tyramine include processed meats,

pickles, onions, olives, certain types of beans, raisins, nuts,
avocados, canned soups, and red wine.

Doctors concede it can be difficult to avoid all of

these foods. Nestor Galvez-Jimenez, MD, a neurologist with The
Cleveland Clinic Florida, says some of his tyramine-sensitive patients
prefer to take their chances. "They want to drink wine even if they
know it will give them a headache. In that case, I recommend a
preventive dose of medication before dinner." He stresses that patients
should discuss this idea with their doctors before trying it.

Avoid Additives

Certain food additives, including nitrites and some

food colorings, are also common headache triggers. Like tyramine, these
additives may increase blood flow to the brain causing headaches in
some people.

"We don't understand exactly why this happens," Galvez-Jimenez tells WebMD, "but it has to do with changes in blood vessels."

Unlike classic migraines which affects are also
triggered by a substance and are felt on one side of the head,
headaches induced by additives or other substances are usually sensed
on both sides of the head:

• Occur within a specific time after substance intake
  
• Disappears when a substance is eliminated or within a specific time thereafter

Monosodium glutamate-induced headaches, previously

known as Chinese restaurant syndrome, occur within an hour after
ingestion of MSG and can cause at least two of the following:

• Pressure in the chest or face
  
• Burning sensation in the chest, neck, or shoulders
  
• Dizziness
  
• Abdominal discomfort

Experts continue to debate the effects of MSG, an

additive found in soy sauce, Chinese foods and many packaged foods.
"MSG is a big one," says Galvez-Jimenez.

But Diamond, who is currently executive chairman of the

National Headache Foundation, says new research may show MSG is not a
typical trigger after all.

Beware of "Brain Freeze"

Most of us have experienced that brief stab of severe

pain that comes with eating or drinking something too cold. Previously
called ice cream headaches or "brain freeze," this sensation usually
lasts less than five minutes. This type of headache is usually felt in
the middle of the forehead, but for migraine sufferers this pain can be
felt in areas that are affected during a migraine. For people prone to
migraines, it can be the beginning of a full-fledged attack.

"You eat ice cream or another cold food and the next

thing you know, boom, a migraine starts," Galvez-Jimenez says.
According to The Cleveland Clinic, more than 90% of migraine sufferers
say they have to be cautious with cold foods and drinks.

Don't Skip Meals

While many people have sensitivities to particular foods, others develop headaches when they don't eat.

"Anything that disrupts your body's normal stability

can cause a headache," Diamond tells WebMD. That includes oversleeping
and skipping meals.

"It's always important for me to eat the right foods at

the right times," says marketing manager Jeff Patton. "That means
eating lots of protein in the morning and having lunch on time. If I
skip either meal, I get a headache. Then I get crabby and I can't
focus, so it affects my work. It's extremely annoying."

But recognizing the link between headaches and skipped
meals doesn't make it any easier for Patton to eat according to a
regular schedule. "I still get headaches every day," he says, "because
I get distracted at work and I don't eat right."

Patton's headaches usually disappear soon after he
eats, so he rarely turns to aspirin or other medication. "By eating, I
treat the cause rather than the symptom," he says.

Identify Your Triggers

If you get headaches when you skip meals, the
connection may be obvious. But if your headaches start after meals, it
can be difficult to determine exactly which foods are to blame.

Diamond suggests setting aside some time for an experiment. "Isolate a time, eat the food in question, wait for a reaction, repeat and see if it happens on more than one occasion."

That's how beauty consultant Nicole Ehrhart pinpointed
her triggers, including cheese and chocolate. "I've been a headache
sufferer my whole life," she tells WebMD. "Through trial and error, I
figured out which foods to stay away from."

Keeping a headache diary is another way to spot
connections between your headaches and your diet. "One of the first
things I tell my patients is to do a food diary," Galvez-Jimenez says.
"Map out when your headaches start and what you have eaten that day and
the day before."

This more structured approach helped Gerhardt zero-in
on processed meats and cheese. "For six months, I made notes about what
I ate at every meal, particularly on days when I got a headache. It's
not an exact science, but I started to see some patterns. Now that I
know which foods to avoid, I get fewer migraines."

If you decide to try a headache diary, be diligent in

recording what you eat, particularly aged cheese and foods containing
additives, as well as the following possible dietary triggers:

• Aspartame (NutraSweet, Equal) and other artificial sweeteners; foods with meat tenderizers or yeast or yeast extracts
  
• Caffeine in even in small amounts can trigger a migraine in some people
  
• Chocolate, cocoa, and foods containing nuts
  
• Alcoholic beverages especially red wine, beer, and sherry
  
• Aged, canned, cured, or processed meats such as chicken livers
  and other organ meats, and sardines. Also foods prepared with nitrates
  or tyramine can cause problems.
• Cultured dairy products such as sour cream or buttermilk
  
• Dried fruits including figs, raisins, and dates
  
• Breads and crackers containing cheese including pizza
  
• Cheese: Blue, Gouda, Gruyere, provolone, and Stilton
  
• Smoked or dried fish
  
• Canned soups, or soups made from bouillon or based with MSG

While you may be able to identify and avoid triggers on

your own, consider getting help if your headaches don't improve. "If
you find yourself losing time from social activities or work, or if
your headaches persist over several days, see a doctor," Diamond says.
"There are medications to relieve [food-induced] headaches, so no one
should suffer without help."

Published March 15, 2004 on WebMD By Sherry Rauh