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The Claim

Tyramine in meat, cheese, red wine and beer, can increase blood pressure and trigger migraines.

The Overview

Tyramine is a plant-based amino acid that is present in foods such as processed meat, cheese, red wine and beer. It has a mild stimulatory effect in the body, and can increase blood pressure, which may make it a trigger for migraines.

The Evidence

SIGN guidance did not find sufficient good quality evidence to support changes in diet to avoid migraines, except that migraine sufferers should not skip meals.1BASH guidance does not recommend the blanket avoidance of cheese or other foods by migraine sufferers.2

There is a long list of common foods that potentially contain vasoactive amines (eg serotonin, tryptamine, dopamine, histamine or tyramine). These include; avocado, banana, plum, orange, pineapple, wine, pickled herring, fermented cheese, and salt dried fish. Patient information suggests that beer, wine, fermented foods (sauerkraut), and chocolate contain histamine. Strawberries, shellfish, tomatoes, citrus fruits, and alcohol are said to release histamine. Tyramine is mainly found in mature cheeses, pickled herring, and meat or yeast extracts. Other foods that may contain tyramine include chocolate, eggs, wheat, fava beans, peanuts, citrus fruits, tomatoes, potato, pork, cabbage sauerkraut, vanilla, soy sauce, beer, ale, wines, sherry, port, and salted dried fish. Tyramine is formed during the aging of protein-rich foods.

A narrative review found insufficient reliable evidence to suggest that vasoactive amines (such as tyramine) triggered migraines.3 The theory is that these nitrogen-based chemicals can open up blood vessels in laboratory settings and may also do so when eaten in foods. A more recent narrative review suggested there was some good quality evidence showing that vasoactive amine-containing foods triggered headache, however, these foods were considered in conjunction with others, so it is not possible to isolate vasoactive amine-containing foods as the sole cause of the headache.9 Two other narrative review suggested that some patients may be more sensitive to beer or wine and could benefit from identification of individual food triggers, but did not make any recommendations about general avoidance of foods by migraine sufferers.[4,10]

One study found that beer consumption lowered the risk of a migraine.11

The Conclusion

Tyramine (and other vasoactive chemicals) have been shown to make blood vessels open up in a laboratory setting, but no review has yet proved that it has the effect on the human body consistently. The studies that have taken place have contained other variables, and as such Tyramine cannot be considered to be the sole cause. Although the body of evidence suggests that avoiding these potential triggers might be useful for some sufferers, one other study has suggested that beer (which contains Tyramine) can lower migraine risk, but this has not been independently verified.

Research evidence sources

1SIGN. Diagnosis and management of headache in adults : A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network; 2008. Available here

2BASH. Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type headache, cluster headache, medication-overuse headache. Hull: British Association for the Study of Headache; 2010. Available here

3 Crawford P, Simmons M. What dietary modifications are indicated for migraines? J Fam Pract. 2006;55(1):62-6.

4 Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009;25(5):446-52.

5 Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology. 2004;63(11):2022-7.

6 Boardman HF, Thomas E, Millson DS, Croft PR. The natural history of headache: predictors of onset and recovery. Cephalalgia. 2006;26(9):1080-8.

7 Wober C, Holzhammer J, Zeitlhofer J, Wessley P, Wober-Bingol C. Trigger factors of migraine and tension-type headache: experience and knowledge of the patients. J Headache Pain. 2006;7(4):188-95.

8 Freeman M. Reconsidering the effects of monosodium glutamate: a literature review. J Am Acad Nurse Pract. 2006;18(10):482-6.

9 Damen L, Bruijn J, Koes BW, Berger MY, Passchier J, Verhagen AP. Prophylactic treatment of migraine in children. Part 1: A systematic review of non-pharmacological trials. Cephalalgia. 2011;26(4):373-83.

10 Panconesi A. Alcohol and migraine: trigger factor, consumption, mechanisms. A review. J Headache Pain. 2008;9(1):19-27.

11 Wober C, Brannath W, Schmidt K, Kaptian M, Rudel E, Wessley P, et al. Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia. 2007;27(4):304-14.

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