Between 20-30% of migraine sufferers identify specific foods as attack triggers. The relationship between food and headaches is complex: the same substance can trigger a headache in some people and not in others, and the same food may be tolerated one day but not another depending on other concurrent factors (stress, sleep, hormonal cycle). There's no universal list of foods to avoid—there's your personal list, identifiable through systematic food tracking.

Alcohol: the most documented trigger

Alcohol is the most frequently reported food trigger for migraines, especially red wine. The mechanism isn't fully understood yet: dehydration from the diuretic effect of ethanol, acetaldehyde (a toxic metabolite), biogenic amines (tyramine, histamine in red wine), sulfites as preservatives, and the direct vasodilatory effect. Red wine is more often implicated than white: it contains more histamine, more tyramine, and more sulfites. Beer is the second most common alcohol trigger. The main mechanism may be the release of platelet serotonin through acetaldehyde.

Tyramine: the biogenic amine in fermented and aged foods

Tyramine is a biogenic amine produced by the decarboxylation of tyrosine during food fermentation and aging. In people with reduced MAO enzyme activity (monoamine oxidase, the enzyme that breaks down tyramine), tyramine accumulation causes noradrenaline release with vascular effects that can trigger migraines. High-tyramine foods include: aged cheeses (most associated with "cheese migraines"), red wine, beer, aged cured meats and processed meats, marinated and canned fish, fava beans, fermented foods (soy, miso, tempeh, sauerkraut in large quantities). Tyramine is dose-dependent: small amounts of aged cheese are tolerated by most migraine sufferers, large amounts are not.

Caffeine: both trigger and remedy

Caffeine has an ambivalent relationship with headaches. As a remedy: it constricts the dilated cerebral blood vessels in migraines (the mechanism behind pain relievers with caffeine like Moment or Saridon). As a trigger: caffeine withdrawal in those who are dependent causes classic withdrawal headaches. As a trigger: excessive caffeine (over 4-5 coffees daily) can cause rebound vasodilatory headaches. The strategy: for chronic migraine sufferers, gradually reducing caffeine intake to 1-2 coffees daily and avoiding sudden changes (same time every day) reduces withdrawal headaches.

Sulfites: the preservative in wine and processed meats

Sulfites (E220-E228) are preservatives used in wine, dried fruit, some processed meats, and pre-treated potatoes. In sensitive people (some asthmatics, rarely migraine sufferers) they cause an allergic response or intolerance that can manifest as headaches or bronchospasm. The "wine headache" from sulfites is probably overestimated as a cause: studies show that sulfites in white wine (often higher than red) rarely cause headaches as much as red wine does. The histamine in red wine is probably more relevant.

Monosodium glutamate (MSG): the debated trigger

"Chinese Restaurant Syndrome" (headache, flushing, sweating after Chinese meals) was historically attributed to monosodium glutamate (MSG, E621). Modern research has downplayed this: controlled double-blind studies haven't confirmed MSG causality in most subjects reporting sensitivity. However, MSG in high doses on an empty stomach could have effects in specific individuals. MSG is found in: Asian cuisine dishes, bouillon cubes, salty snacks, potato chips, fast food in large quantities. For those suspecting this sensitivity: a blinded elimination and reintroduction period is the only way to verify it.

Skipping meals: hypoglycemia as a trigger

The blood sugar drop that occurs when skipping meals (especially breakfast or lunch) is one of the most underestimated headache triggers. The brain is the first organ to feel glucose decline: it activates the sympathetic nervous system causing vasoconstriction followed by vasodilation (the vascular alternation typical of migraines). Eating regularly, not skipping meals, and always having a snack on hand: simple habits that reduce this trigger immediately and predictably.

How to keep an effective headache-food diary

For each headache: note the start time, intensity (1-10), duration. Then reconstruct: what did you eat in the last 24 hours (not just the last few hours: some triggers have a 12-24 hour delay), did you skip a meal? Did you sleep less than usual? Are you perimenstrual? Did you drink alcohol? How much time passed between two consecutive headaches (pattern)? After 8-12 episodes in this diary, patterns almost always emerge. The diary is the most useful diagnostic tool that exists for food-related headaches, infinitely superior to generic lists of foods to avoid.

The elimination protocol for food triggers

If the diary suggests a specific trigger: eliminate that food for 4-8 weeks (the time needed for the vascular system to stabilize). Record headache frequency. If it improves: reintroduce in small quantities (low dose). If the headache returns: you've confirmed the trigger. If it doesn't improve: that food wasn't the problem; look for other triggers. Don't eliminate 10 foods at once: impossible to identify the culprit. One food at a time.

Magnesium therapy: the most documented supplement for migraines

Magnesium has the strongest evidence among supplements for migraine prevention. The Italian Society for the Study of Headaches includes magnesium in its guidelines for migraine prophylaxis. The mechanism: magnesium reduces the sensitivity of NMDA receptors (involved in migraine pain propagation) and stabilizes neuronal excitability. Recommended doses: 400-600 mg of magnesium (oxide, citrate, bisglycinate) daily for 3-6 months. A 30-40% reduction in migraine frequency compared to placebo in meta-analyses. Safe, economical, and with minimal side effects (only high doses cause diarrhea).