Monday, July 11, 2016

Could It Be Tyramine?

On a cold morning in early February 2015, I woke up with what turned out to be the worst migraine of my entire life. At the time, I was used to having migraines that lasted three, five, sometimes even seven days. But this one was different. Pain meds didn’t touch it and no matter what I did, it wouldn’t go away. For five weeks it stayed there. During those weeks, I paid a visit to both Urgent Care and the ER, but could not get relief. I prayed every single night for it to go away, but it didn’t. Sometime during week three, I desperately made an appointment at a reputable Headache Clinic in Chicago.

It snowed the entire drive to Chicago and by the time we got there, it was late and we were so hungry we chose the quickest option: Taco Bell.  I woke up in the early hours of the next morning with what I knew to be food poisoning. That, coupled with this daily migraine---death felt like a more viable option.   I was so sick and dehydrated by the time I got to my appointment, I laid on the floor in the waiting room curled up in the fetal position, my head throbbing. The doctor took one look at me and admitted me to the hospital.

It was during this hospital stay, I was first introduced to Tyramine and the idea it could be a problem. I was one of those Migrainers who did not believe my diet contributed that much to my migraines.  The literature I was handed insinuated I would have to cut certain foods out of my diet, you know, to see if Tyramine was a trigger for me.  Too many of those foods were my favorites. There was no way I was giving up my red wine.  Feeling better from the pain meds and all the IV fluids, I tossed the literature aside and ordered myself a Lou Malnalti’s deep dish cheese pizza.

I was released from the hospital a few days later, and I was only a half hour down I-65 when the same migraine returned. In the days following, I got desperate and began giving this idea of eliminating trigger foods another consideration. I started doing my research and decided it was worth a try. I wish someone had told me about tyramine 14 years ago.


Tyramine is a chemical compound produced by the breakdown of an amino acid called tyrosine.(3)  Tyramine naturally occurs in many foods, particularly aged or fermented foods and is often found in cheese, cured meats, beer and even ripe bananas.  It also occurs in food when it has been prepared and stored for a long time. Due to its chemical structure, tyramine is also called a monoamine. There is an enzyme in the human body called monoamine oxidase (MAO). This enzyme breaks down monoamine and processes tyramine. (2) Some people like me, have a problem breaking down tyramine when they consume high levels of it. This is often presented in physiological symptoms such as: high or low blood pressure, nausea, vomiting, heart palpitations, and of course, migraine and headaches.

Experts have known since the 1950s that tyramine is a problem for some people and in the 1960’s they began suspecting it could be a trigger for migraine headaches.  Researchers are still trying to figure out why tyramine might trigger headaches and migraines in some individuals and not in others. It was observed that certain people with migraines, are also deficient in the MAO enzyme, and would get a headache after they consumed food high in tyramine.  Another explanation is that tyramine causes the brain to release Norepinephrine rapidly, leading to an imbalance of brain chemicals, and producing bad side effects like migraine. (2)

I now know, I carry 2 SNP’s for the MAOA gene, which is linked to tyramine and affects the way the body processes it. For me it causes migraines. For someone else, it might cause high blood pressure or a host of other symptoms.

I cut tyramine out last year, or at least I thought I had. I wasn’t entirely convinced tyramine was a problem for me, and frankly, getting rid of tyramine is hard, really hard. It is hidden in so many things, and requires strictness with food preparation and storage. Tyramine grows in leftovers in the refrigerator if they sit past 24-48 hours, in meat if it is not prepared immediately or frozen, and fruits and vegetables if they are not fresh.  High levels of it are found in bananas and avocados as they ripen. And then there is the cheese. Who doesn’t love cheese? I cheated often on this diet because I found it REALLY difficult to give up pizza.

I am a carrier of the MAOA gene, indicating tyramine is a BIG problem for me.  I have not consumed high levels of tyramine since.


If you struggle with migraines or headaches, and are serious about improving your quality of life, then an elimination diet is absolutely necessary. Tyramine is a great place to start because we know there is a link between tyramine and headaches.

If you search the web, you will find hundreds of opinions on what has tyramine and what should be avoided. The National Headache Foundation gives a recommendation here. The chart on this link divides food into columns and I would argue the “Use With Caution” column should also be entirely avoided in the beginning.  

High amounts of tyramine are found in aged cheeses:  blue, cheddar, Swiss, Gorgonzola, Gouda, Parmesan, Romano, feta and Brie. Aged, dried, fermented and pickled meats should be avoided such as: bacon, sausage, liverwurst, pepperoni, salami, ham, hot dogs and corned beef. Meat should either be consumed the same day it was bought or frozen immediately. You will find high levels of tyramine in breads and baked goods that contain yeast--homemade yeast breads, sourdough bread and yeast extracts. (Always read labels. Lots of seemingly healthy snacks such as pretzels contain yeast extract.) Very ripe or dried fruits can also be a problem.  Bananas and avocados are high in tyramine, but other fruits and vegetables will also have tyramine as they lose their freshness.  Avoid fermented vegetables like sauerkraut, kimchee, pickles, certain olives, and other fermented foods like tofu and bean curd.  You can forget soy sauce, beer, and white and red wine. Nuts, specifically peanuts and peanut butter are also culprits. Don’t ever thaw food at room temperature. Instead, use the microwave and be aware that simply cooking food will not lower the tyramine content.

An elimination diet requires time and patience, so it is unlikely headaches and migraines will disappear overnight. I am a firm believer in giving an elimination diet AT LEAST 3 months. Some nutritionists will say 6-8 weeks, but I know my body is a slow responder. So, I think 3 months is a fair amount of time to try this tyramine free diet. After eliminating, you can reintroduce foods with tyramine and see if it causes a problem. Just remember, a food induced headache or migraine may not show up for 24 hours, so keeping a food diary is also a really good idea.

For me, tyramine is a problem. I know it contributes to my migraines and headaches if I consume it. BUT, it is only one piece to an extremely complicated puzzle that is my body. There were so many other diet and lifestyle changes I had to make to get on the right path of improving my quality of life. Given that experts know tyramine is definitely a problem for some people, it is a good place to start.

1.       “Low Tyramine Diet For Headaches,” The National Headache Foundation Online. October 25, 2007. n.p. July 9, 2016.
2.       “Tyramine and Migraines, “ WebMD. WebMD Medical Reference. January 24, 2015. Referenced July 9, 2016
3.       Van Eaton, Jamie. “Tyramine- Free Diets,” Healthline. December 2, 2014. Referenced July 7, 2016

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