Indira P., a thirty-year-old Indian woman, moved to America in 1996 to make an arranged marriage. Shortly after her arrival, Indira developed headaches that occurred almost every day. But she spent the following winter in India and had no headaches while there. When she returned to the United States, her headaches recurred.Indira did not believe that any of her headaches were caused by foods. However, I became suspicious after hearing that she had experienced no headaches while vacationing in India. I asked her what her husband did for a living. As it turns out, he operated a food truck that served sandwiches, and every day he would bring some home. Indira usually ate either a turkey and Swiss cheese or a cheese steak sandwich for lunch. I advised Indira to eliminate cheese from her diet, and when I saw her two months later her headaches were much better.
Sharon M. had daily headaches for about a year. The symptoms were typical of chronic tension-type headaches: a "tight band" around her head that was fairly constant and usually not associated with nausea or vomiting. After ruling out any serious cause of Sharon's headaches, I put her on the headache-prevention diet. Sharon kept a detailed record of everything she ate. (She is a bit compulsive, and in this case, it worked to her advantage.) When I next saw her two months later, she had experienced only a few headaches. Then, after slowly reintroducing the foods known to be common headache triggers, Sharon identified freshly baked bagels, pickles, chocolate, and citrus as some of her headache triggers. As a result, her life was, in her words, "totally changed."
John R. loved diet cola. At his initial evaluation, he said that he drank four glasses a day. Since diet cola contains artificial sweeteners and caffeine both potential headache triggersI recommended that he gradually reduce his intake and switch to something else. But, like many patients, John was reluctant to give up his favorite soft drink. He stopped drinking it for a short period of time, then tried to reintroduce it. Within hours, he suffered a severe migraine headache. John tried on four more occasions to reintroduce diet cola. Each time ended with the same result: a migraine. Finally, he was forced to admit to himself that his favorite soft drink wasn't worth the pain.
Trisha P., age fifty-nine, suffered from headaches since she was eight. When Trisha first came to see me, she complained of frequent headaches and was taking too much pain medicine, which can cause "rebound" headaches. I discontinued her medication, and within a few short weeks, Trisha's headaches became much less frequent. To see if we could eliminate the rest of her headaches, I suggested that she avoid certain foods. After doing so for a few weeks, Trisha gradually began adding them back to her diet, one at a time, to try to identify the offenders. She reintroduced cheeses, artificial sweeteners, and pickles without any problems. One night, Trisha decided to have a piece of ice-cream cake with chocolate sprinkles on it. Seven hours later, she awakened with a migraine. Three days later, she ate a chocolate candy bar and developed a migraine within four hours. Since cutting chocolate out of her diet, Trisha has been doing fine, with only an occasional headache.
When I first saw Nancy R., she drank the equivalent of five cups of coffee a day. On top of that, she was taking a caffeine-containing pain medicine for her headaches on an almost daily basis. I warned her about the problems of "caffeine-rebound" headaches, but she insisted that she couldn't make it through a day without caffeine. After one year, Nancy's headaches became so severe that she began to feel desperate. Again I brought up the issue of her caffeine use, and we developed a plan: Nancy would stop her caffeine-containing pain medicine immediately and would begin tapering off her coffee intake, reducing it by one cup every three days until she had given up coffee completely. During the first couple of weeks off caffeine, Nancy had a number of bad headaches, but when I saw her a month later, her headaches had virtually disappeared.
Chocolate, caffeine, and red wine are common headache triggers, but as the stories of Mary, Indira, and John suggest, there are other, less well known offenders: most cheeses, citrus fruits, beans, freshly baked bread, artificial sweeteners, and preservatives, to name just a few. (A list of foods that frequently trigger headaches can be found on page 27.) Not all these foods cause headaches all the time -- most people are affected by only a small number of them. Some of my patients are unaffected by chocolate but will get a pounding headache from bananas.
Amy C. came to my office complaining of daily headaches that would get so bad that she had to close her office door and turn out the lights for hours at a time. Amy worked as a newswriter and producer, a high-stress position that regularly required twelve- to sixteen-hour workdays. She was not sleeping well, not exercising, and not eating properly. Amy skipped meals frequently, and when she did manage to eat, she ate as quickly as possible. She had gotten into the habit of eating bananas every day because of their convenience. Unfortunately for Amy, bananas are on the headache hit list, at least in large quantities. When Amy cut them out of her diet, her headaches improved.
Rhonda B.'s headaches, which used to trouble her only a few times a month, had become a daily torment. She had lost over forty pounds on a diet that prescribed eating three oranges and one grapefruit each day in addition to other low-fat foods. In Rhonda's case, it was the quantity of the citrus fruits that was the problem. Cutting back on her consumption of oranges and grapefruit helped keep her headaches in check.
Some people are affected by a particular food only at certain times. Eilene M., for example, was troubled by migraines around the time of menstruation. The migraines lasted for up to three days at a time, causing her to miss work. Eventually, Eilene noticed a pattern: Beginning about two days prior to her period and continuing until its end, eating bananas, grapefruit, or yogurt would cause her to develop a severe migraine within ten minutes. During the rest of the month, these foods did not affect her. Fortunately for Eilene, her menstrual cycle is regular, so she can avoid those food triggers during that time of the month.