Deedra Mason, ND nutraMetrix® | Director of Clinical Education & Research
Is your diet giving you a headache? You might want to take a second look if you have more than three headaches per month. For decade’s experts in migraines, which is a predominantly a female complaint and experts in a cluster headache, which are more common in men, have noted the link between nitrate food additives and medications for cardiovascular disease, specifically angina pectoralis, and a greater frequency and severity of a headache.(1)
As much as 80% of patients being treated with nitroglycerine complain of headaches with a reported 10% unable to tolerate the head discomfort so much so they choose to forgo treatment of their condition as a result (2). The numbers of individuals troubled with migraines and cluster headaches are staggering at 1 in 4 US households include someone with chronic headaches in need of treatment. Perhaps more disturbing than 38 million sufferers in the US is that 10% or nearly 4 million are children (1). What if there was a common thread between headaches and an individual’s response to nitrates or nitroglycerin. Nitroglycerine is not of concern; no one is suggesting we stop using Nitroglycerine; the interest in the research today is the underlying trigger behind a headache in individuals using nitroglycerine and other headache co-morbidities.
Because we do not fully understand the mechanism and trigger behind a headache, therapy is frequently haphazard or simply reactionary. Meaning more effort is put towards how to remedy a headache vs. preventing one altogether. A classic villain in the headache presentation is nitrite, tyramine, and sulfite rich foods such as aged cheeses, brewer’s yeast and yeast-containing foods such as bread, soups, pickled, aged, smoked and fermented meats, chocolate, citrus fruits, red wine, and beer. Migraines can be triggered by these components and may be relieved by identifying and avoiding the problem foods (4, 5). Lactose-intolerant individuals may benefit from avoiding milk and ice cream. Occasionally those who suffer from migraines also react to salt, and eliminating salt is helpful for some of these people. Various individuals will also respond to a lower protein diet.
Is just food avoidance, or is there a deeper layer of pathology to discover? Some clinicians trained in functional medicine agree there is a food allergy component that must be addressed. Specifically, gut histamine activity from reaction to foods or environment. Histamine is abundant with fermented foods and when mast cells, (a white blood cell that degranulates in an immune response) release their contents in an inflammatory cascade in response to an allergenic trigger. The evidence for the link between gut health and headaches are growing but not well accepted by all practitioners.
What if there is a common link?
New research says there is more than just a dietary link, chronic and frequent headaches may actually occur because of a lack of a particular enzyme or insufficient natural bio-culture in the gut and oral cavity. The body, due to a lack of certain foods, may insufficiently produce an enzyme called Diamine Oxidase (DAO). Some individuals genetically are under producers; this is one reason experts believe headaches and gut disorders are familial. When DAO is low, histamine is often high. Which came first, the chicken or the egg? Is DAO low BECAUSE of histamine, or is histamine high because of a low DAO. Either way, there is new evidence that healthy gut biota is the answer. When there is insufficient bacterial culture or diversity, this balance between DAO and histamine production may be problematic.
Diamine oxidase is linked to the breakdown of histamine and the potential tempering of gastrointestinal hyperpermeability symptoms (6). Considering the crossover of headaches in sufferers of GI complaints, it may be time to explore the common thread and work toward its management.
The brain connects to the gut in an intimate way. The neural and endocrine pathways that affect cardiovascular tissue, cerebral vascular flow, in particular, are just as intimately linked. Studies show oral probiotics, the breakdown of cGMP and nutrients that generate an enzyme called Diamine Oxidase are the links between a healthy gut terrain and a metabolic environment that is proactive in preventing the cluster, migraine and tension headache.
What can you do if you suffer from frequent headaches?
This new look at gut health may offer rescue for many. It turns out the introduction of probiotics; antioxidants, digestive enzymes, and Vitamin C have a benefit on the microbiome, which in turn has the potential to interact with histamine and the link between headaches and gut hyperpermeability.
Since some gut bugs are their own producers of histamine, the counterbalance of other probiotics is necessary to support a healthy gut biome by breaking down histamine. Specifically, Lactobacillus Plantarum and Lactobacillus reuteri (7). If you suffer from headaches, you may consider complimenting your probiotics with inulin, a resistant pre-biotic starch.
Antioxidants like OPC’s and Vitamin C naturally reduce histamine by regulating mast cell activity. In addition, OPC’s may affect the production of Diamine Oxidase especially important in those that may have a genetic pre-disposition to poor production. (8)
It is not a linear line to a migraine-free existence; it is, however, a very good start. It might be YOUR step in the right direction.
2- Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort. Antonio Gonzalez, Embriette Hyde, Naseer Sangwan, Jack A. Gilbert, Erik Viirre, Rob Knight. mSystems Oct 2016, 1 (5) e00105-16
3- National Institute of Neurological Disorders and Stroke. NINDS Headache Information Page Accessed 7/1/2015.
4-American Headache Society Alcohol and Migraine Accessed 7/1/2015.
5-National Headache Foundation. Diet and Headache – Foods Accessed 7/1/2015.
6- Suppression of Histamine Signaling by Probiotic Lac-B: a Possible Mechanism of Its Anti-allergic Effect Shrabanti Dev.; J Pharmacol Sci 107, 159 – 166 (2008)2.
7-Histamine Derived from Probiotic Lactobacillus reuteri Suppresses TNF via Modulation of PKA and ERK Signaling.; Carissa M. Thomas February 22, 2012https://doi.org/10.1371/journal.pone.0031951
8-Vitamins and mast cells. Anogeianaki A.; Int J Immunopathol Pharmacol. 2010 Oct-Dec;23(4):991-6.