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Can I be Migraine-Free and still eat Cheese?

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Cheese seems to be pretty high up on the list of foods to avoid when you’re a migraine patient.  But as with anything related to migraine, it ain’t so simple.

First of all, my list isn’t your list.  Just because cheese triggers and attack in Josh, there’s no proof that it may trigger an attack in Ashley.

The common theory when it comes to cheese is that it contains tyramine, an organic compound in a lot of foods that may trigger migraine attacks.  Many migraine patients have tried a low-tyramine diet, and many have been helped by it.

Is there cheese that's safe for a migraine patient?

But here’s the catch – some cheeses are super-high in tyramine, others are not.  Don’t just "avoid cheese" – there are many cheeses that may not bother you at all.  (Of course, if you’re avoiding dairy altogether, skip the rest of this article and read this.)

Worst Offenders

The cheeses that are aged tend to be the worst offenders.  From What Your Doctor May NOT Tell You About Migraines, here is a list of the common cheeses that are high tyramine, the worst first:

  • English Stilton
  • Blue cheese
  • Sharp (old) Cheddar
  • Danish blue
  • Mozzarella
  • Swiss Gruyère
  • Feta
  • Parmesan
  • Gorgonzola

Others that are often listed are Boursault, Boursin, Brie, Colby, Emmenthaler, Camembert, Gouda, Muenster, Provolone, Romano, Roquefort, and Swiss.

Now, there’s a bit of a fight over whether or not mozzarella should be on the list – particularly because people love their pizza.  So we’ll talk more about mozza in a moment.

Safer Cheeses

So, did the list above seem kind of long?  In the book Heal Your Headache, Dr. Buchholz offers this list of cheeses that are fairly low in tyramine.

  • Cottage cheese
  • Ricotta
  • Cream Cheese
  • (good quality) American cheese

The key here is fresh – young cheeses tend to have less tyramine.  Go to your local cheese shop and see what fresh cheeses they offer – you might find a new love.  You also might get away with some processed cheeses, such as Cheese Wiz, but I’m not into recommending a lot of processed food when it comes to migraine.  And frankly, some processed cheeses are real serious migraine triggers.

And back to mozzarella.  Different tests of mozza have led to different results, which is why you sometimes see it as a cheese to avoid, and sometimes as a safe cheese.  For most, if you think cheese with tyramine may be a problem, it’s probably wise to err on the side of caution, and then carefully add it back into your diet later.  Fresh goat cheese may be another one to try after a while

So, yes, you may be able to eat cheese.  Maybe for you, cheese isn’t a problem at all.  But if you’ve found a connection between cheese and your migraine attacks, try avoiding the worst offenders for a while and keep track in your migraine diary.

Exhausted after Ocular Migraine?

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Many patients report feeling exhausted after ocular migraine – but first we need to discuss what ocular migraine actually is, since it’s an outdated term.

Recently I wrote in particular about ocular migraine without headache, a term which may refer to retinal migraine, but perhaps more likely migraine aura without headache.

In other words, ocular migraine is a term that could be used to describe any kind of migraine with includes a visual aura.

These types of migraine are very common.  Most often they’re accompanied by the migraine headache we all love to hate, but sometimes there’s no headache at all – simply the visual aura.

If you’re feeling exhausted after a migraine attack, it might help to know that you’re not alone!  "Migraine hangover" (that is, the way you feel after migraine, even when no alcohol is involved) is a very common symptom.  Sometimes this is called a postdrome symptom – something that comes after the peak of the attack (the part that usually includes the headache).  This phase could last many hours, or even more than a day.

There are two key things you need to think about when it comes to the migraine hangover:

  1. Don’t do anything crazy  It’s easy for people to try to suddenly get back into life, or take too much medication, or eat something they shouldn’t, during this phase of the migraine attack.  Be careful, and go slow – you don’t want the attack to come back.
  2. Treat the whole disease.  The best way to deal with this feeling of exhaustion is to treat migraine disease as a whole, not just the way you feel at the moment.  Find a good doctor or specialist who knows your medical history, and discuss your options.  Be sure to talk about as many symptoms as you can – not just headache (if you have one).

Feeling exhausted after a migraine is only one of many symptoms.  Read more about migraine symptoms here.

Exhausted hippos

10 Critical Mistakes First Time Migraine Patients Make

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You’ve just been diagnosed with MIGRAINE.  It’s natural to be confused, maybe even nervous or scared.

I’ve spent many years listening to and helping migraineurs.  I’ve found that there are some common mistakes that people make when they’re first diagnosed with migraine.  Here are my top 10 – maybe one of them will help you to avoid the same mistake!

Quick Fix Please! (not always possible)
  1. Expect fast results.  No, actually, don’t expect fast results!  It’s true that some migraine patients find a solution right away.  But a decent trial period for a new treatment is often 3 months – and that’s just trying one treatment.  It’s not just migraine – many neurological diseases require this kind of patience (for example epilepsy or muscular distrophy).
  2. Don’t see the doctor again.  After all, it’s "just" migraine.  I just need some "painkillers" and a rest and I’ll be fine.  No – you should go back to the doctor for follow-up.  This especially applies when your symptoms change.  But really, because migraine takes time to treat and because it’s a disease with complex symptoms and causes, you should be going back for more help.
  3. Be satisfied with a diagnosis of "Migraine".  In 1988, the Headache Classification Committee from the International Headache Society came out with a document intended to classify headache disorders, including many different types of migraine.  The latest edition is from 2004.  Knowing what type of migraine you have means you can find better treatment faster.  When you get a diagnosis, check to see if it’s in the document and if your symptoms match.  If not, find another doctor and get a second opinion.  (A simplified version of the International Classification of Headache Disorders (migraine section) here)
  4. Rely on popular news reports and commercials for information on migraine treatment.  News reports and commercials are important ways to get information out to the public.  However, they will almost never give you a balanced view of migraine treatment.  That’s why crowds of people go after a "miracle" treatment before trying things that are much more likely to actually work for them.  Please take news bites with a grain of salt.
  5. Blame it on "stress".  "Oh, it’s just stress – I just need to wait until life calms down a bit."  Using stress as a scapegoat has kept many, many migraine patients from proper treatment.  Stress does not cause migraine, and there’s some debate about whether it even triggers migraine attacks.  It’s a factor in the overall picture, but there are likely other issues that you need to deal with in order to properly treat migraine.  It’s not "just stress".
  6. Rely on over-the-counter "painkillers".  Instead of making use of medications and treatments that can specifically help migraine, patients often take the "shotgun" approach, and take a general purpose painkiller.  This often leads to more symptoms and more pain in the long run.
  7. Think you’ve tried "everything" after three different treatments.  No one has tried "everything", because in this day and age there are so many treatments (yes, valid ones) for migraine that it could take a lifetime to give them all a try.  Sure, it’s discouraging when you’ve tried 5, 10, 15 treatments over many years.  Take a break – but don’t give up.
  8. Rely one one kind of treatment.  Only try yoga, or just drugs.  Only try vitamins, and ignore the rest.  Guess what?  Many migraineurs have had great success with a variety of treatments.  Medications and a change of diet, or the chiropractor and exercise, or magnesium and biofeedback… Don’t be quick to rule out other types of treatment.
  9. Ignore other symptoms.  What other symptoms?  Well, a very common symptom of migraine is headache.  It’s easy to focus on head pain, and ignore other symptoms.  But your doctor can treat you better if she knows about other symptoms you’re having, even if they’re not migraine related.  Dizziness?  Nausea?  Sensitive to light?  Neck pain?  Depression?  And guess what?  Many migraine symptoms are experienced between actual migraine attacks.  The more you can describe your symptoms, the better treatment you’ll get.
  10. What would you add?  Oops – I don’t have a #10 mistake!  You have some experience – what would you add as a mistake that people make when they’re first diagnosed with migraine?  Leave a comment!

Migraine after Sun Exposure?

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No, you’re not the only one who gets a migraine attack after being out in the sun.  It’s actually pretty common.  But why?

There could be a number of reasons.  Here are common migraine after sun explanations:

Migraine after sun?
  • Migraineurs are simply more sensitive to light.  I don’t mean during an attack, although that may be true as well.  Migraineurs are often simply more sensitive all the time.  A study in the far north, for example, found that migraineurs were more likely to have attacks during the times of the year when there was more sunshine.
  • Change.  Migraineurs tend to be more sensitive to change.  If you’re suddenly going from dark to light, or if you’re spending time out in the heat, sudden changes in your body could trigger an attack.
  • Hydration!  Being out in the sun could mean you just need to drink more liquids.
  • Flickering.  Yes, the high contrast flicker between sunlight and shadows, such as flickering light through the trees as you drive by, could trigger an attack.
  • Weather patterns.  Some researchers believe that weather systems that are warm and humid (the passage of a warm front with low pressure) may trigger migraine attacks.  Often these weather systems have overcast skies, but not always.

What can I do about it?

Here are some tips to avoid the sun migraine trigger:

  • Stay hydrated – carry a bottle of water.
  • Slow down – warm up, cool off, especially if you’re exercising.  Avoid going from a dark room into bright sunlight.
  • Check with your optometrist – make sure it’s not an eye problem that’s making things worse.
  • Try a quality pair of sunglasses – suggestions here:  How Sunglasses are helping fight Migraine and Precision Tinted – Especially to Fight Migraine.
  • Avoid flickering – if you can, look away or close your eyes to avoid flickering light.

Also, consider the tips in the article and tips from our visitors (comments below) for headache after working out.

Sinus Headache: Say NO to Antibiotics!

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There is increasing evidence that those who a diagnosis of sinus headache, or a self-diagnosis of sinus headache, should NOT be taking antibiotics.  Why?

First of all, a number of studies have suggested that many – perhaps most – perhaps even 80%-90% – of these patients actually have migraine.

So chances are you should be taking migraine meds instead of sinus meds.

A study published in Neurology in 2002 (Lipton et al) looked at patients with migraine who also supposedly had sinus headaches.  Patients were given analgesics, antihistamines, and/or decongestants for their headaches.  About half were dissatisfied with these treatments.

These patients then took migraine medication for two of their "sinus headaches" – in this case, sumatriptan.  Surprise surprise, 73% had pain relief within 2 hours.  45% were pain free within two hours!

Antihistamines, decongestants, antibiotics – all big business.  But what if most were being given to the wrong people?

The misdiagnosis likely has to do with the high prevalence of congestion and other sinus headache symptoms in migraine.  Many people don’t realize that congestion is common in a migraine attack, or even nasal discharge.  And many doctors are confused as well.

But what if you’ve had a proper work-up, and you believe you do have a sinus infection?  (More on how to differentiate between a migraine attack and sinus headache here)  Chances are you should still say NO to antibiotics.

Most often, sinus headaches from an infection are due to a virus infection – and a virus infection will not be helped by antibiotics.

A recent study in the Journal of the American Medical Association confirms this in real life.  85 adults with uncomplicated acute sinusitis were given an antibiotic, and 81 were given a placebo.  (see Author Insights: Treatment of Acute Sinusitis With Antibiotics Often Futile)

At 3 days, there was no difference between the groups in quality of life or symptom relief.  At 10 days, there was no difference between the groups in quality of life or symptom relief.  No difference!

In the USA, 1 in 5 antibiotic treatments is given to someone with sinusitis.  That’s a HUGE number of people in one country alone getting a medication they don’t need, that won’t help them!

And those were patients who most likely really had sinusitis.


So let’s take the millions who are diagnosed with, or believe they have, sinus headache.  Subtract most of them – they actually are having a migraine attack.

Now take the few that remain – should we give them antibiotics?  Most likely not.

That’s millions of people with so-called sinus headache – almost all of whom should should NOT be taking antibiotics (or antihistamines, or decongestants…).  And that probably means you, sinus headache sufferer.

In a world where we’re more and more concerned about the personal and worldwide impact of overuse of antibiotics, it’s time we cut those millions of prescriptions.  If you’re not sure, do some research and be sure that you not only have a sinus infection, but an actual bacterial infection (not viral), AND that it’s worth it to take the antibiotics.

Unless you’re in that tiny minority, do yourself and us a favour – get a proper diagnosis, and if you need to take something that will actually help you.

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Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.