Here are some common triggers of food-related headaches. Of course, foods are not the only way to develop headaches.
Extreme Cold: a physical reaction to cold fluids or foods may trigger a migraine.
Nitrate/Nitrites: in individuals unusually sensitive to nitrates (1 mg of sodium nitrate); found in spinach, beets, radishes, lettuce, packaged or processed meats.
MSG: in susceptible individuals causes the Chinese restaurant syndrome. MSG is also found in hydrolyzed vegetable protein.
Alcohol: provokes headaches within 30-45 minutes, the time it takes to dilate arterioles; Alcohol causes histamine release.
Vasoactive amines: foods containing serotonin, tryptamine, dopamine, and norepinephrine include avocado, banana, plum, orange, pineapple, wine, pickled herring, fermented cheese, and salt dried fish. Patients with diet-related migraines have lower levels of a platelet enzyme (phenolsulphotransferase) that breaks down these products. Red wines contain inhibitors of phenolsulphotransferase.
Histamine: causes increased heart rate, and at higher doses, flushing and a vascular headache. Beer, wine, fermented foods (sauerkraut), and chocolate contain enough histamine to induce headaches. Foods that release histamine include egg whites, strawberries, shellfish, tomatoes, citrus fruits, and alcohol.
Tyramine: foods rich in tyramine (mature cheeses, pickled herring, and meat or yeast extracts) may produce migraines. Other foods that 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.
Phenylethylamine: a vasoactive amine in chocolate, cheese, and red wines that often precipitates migraines.
Aspartame: one study showed regular use of aspartame (Equal, Nutrasweet) was linked to headaches.
Caffeine: regular use and withdrawal from caffeine is associated with headaches
Nicotine: headaches are a withdrawal symptom.
Chronic Vitamin A: chronic high dosages can cause intracranial pressure to become elevated.
At the present time, food skin tests or RASTs are not sufficient predictors of which foods will cause headaches and are not indicated for screening patients with headaches. Skin and blood tests for allergies can be misleading since the headache is often not due to allergies but is a metabolic reaction. A food-headache diary is the most valuable way to determine which foods, if any relate to your headaches. At least two weeks of complete avoidance is necessary before the relationship is clear. Remember that many substances or combinations of foods can trigger headaches. If you have headaches frequently, it is helpful to avoid all of the above foods. If the headaches improve by avoiding these foods, then consider challenging yourself with an individual food. For those with infrequent headaches, the diet dairy is often enough to identify the triggering factor(s).
The features of a headaches that require immediate medical attention include: severe, sudden headaches that seem to come on like a “bolt of lightening;” headaches accompanied by loss of consciousness, alertness, or sensation, confusion, visual blurring, or other neurological changes; recurring headaches affecting one particular area such as an eye, temple, etc.; headaches that are increasing in severity; headaches accompanied by neck stiffness or fever; or any unexplained change in the nature or frequency of the headaches.
Evidence for allergic headaches:
1) histamine infusion produces headaches
2) Anti-allergy medications of relieve headaches associated with upper respiratory tract symptoms
3) In double blind food challenge studies for allergic conditions, patients occasionally complain of headaches
4) Individual cases have been documented