Additional Info on Migraine

General migraine info:

Book: Heal Your Headache, David Buchholz, M.D.

Migraines can alter brain structure permanently

 

Migraine as food allergy:

People with migraines had reactions to food allergens, the most common reaction was to wheat (78%), orange, eggs, tea, coffee, chocolate, milk, beef, corn, cane sugar, and yeast. When 10 foods causing the most reactions were removed migraines fell precipitously, hypertension declined. (Grant EC (1979). “Food allergies and migraine”. Lancet. 1 (8123): 966–9.)

A specific instance attributed to wheat. (Pascual J, Leno C (2005). “A woman with daily headaches”. The Journal of Headache and Pain. 6 (2): 91–2.)

Could a hidden allergy be causing your migraines?

In accordance with my own experience, researchers could not trigger migraine with bright light by itself. I also observed that bright sun light is not itself a trigger but would make throbbing pain worse once the migraine already started.

 

And a random case I read. Christine H. Lee’s tiny hole in her heart caused her migraine, which was discovered when it caused her stroke.

I Had a Stroke at 33

The hole, or more accurately a flap, is called a patent foramen ovale, or PFO. All fetuses have a hole in their heart between the left and right chambers, to bypass the lungs as they take oxygen from their mother’s blood. Once born, that flap fuses. And once born, nearly a quarter of humans have holes in their hearts that don’t completely close. For some, the hole is severe and needs to be closed immediately. For many others, the hole is undetected. Maybe like I used to, you get migraine headaches, or have altitude sickness at 5,000 feet instead of 10,000 feet, or find yourself panting while doing a slow jog, no matter how often you train.

Migraine Mysteries

Many years ago, I once went to the doctor with complaints about my headaches. He prescribed pain killers and gave a lack luster talk about perhaps keeping a diary to try to find my triggers. It might have been an off day but he just seemed exasperated.

Unfortunately this is a pretty common experience for migraine sufferers. It doesn’t seem that our pain is taken seriously. Well, we now know that migraines are not harmless and can cause long term brain damage. More reason why we shouldn’t just stop at symptom control. There is an underlying cause, though it may be different from person to person, therefore requiring quite a bit of detective work.

Available trigger lists are a starting point but the answer is highly individual.

From casual observance I knew I was likely to get migraine after moderately intense exercise, watching a movie at the theater, and a few random cases after eating out. Generally symptoms were somewhat worse around my period and once migraine starts pain intensified under sun light. I usually had to lie down in a dark quiet room until the next day.

Mate’s cases usually happened after eating out.

In my case, migraine after exercise reduced by nearly 90% when I went gluten free. The other 10% or so disappeared when I eliminated tree nuts, soy, some seeds, and some beans (all seeds of plants, is there something to this??).

 

In summary our migraine triggers:

Me: food allergies (wheat, tree nuts, soy), combined with exercise/ free glutamate/ other highly stimulating environments (movies at the theater)/ hormones and/or NSAIDs.

Mate: amines? (tyramine, histamine?) mold? (Suspects are fermented soy, fish sauce…)

Both: fresh baked yeast bread

Exercise Induced Allergies

Exercise induced allergies are an example of symptoms being provoked only when two (or more) factors are present at the same time. This makes it much harder to tease out the cause(s).

Food dependent exercise induced anaphylaxis (FDEIA) was first described in a case study in 1979, which seems fairly recent by medical standards. In comparison, Aspergers (now high functioning Autism) was first described in 1944.

Wheat allergy and delayed migraine connection was first confirmed through DBPCFC (double blind placebo controlled food challenge: the “gold standard”) in 2006.

Other possibilities such as free glutamates (MSG), NSAIDs amplifying allergic reaction have been described.

A study of WDEIA (wheat dependent exercise induced anaphylaxis)* shows that both aspirin and exercise increase the presence of gliadin in the blood stream** and the chronic induced behavior may extend to NSAIDs, MSG, Benzoate and other synthetic chemical food additives.

*Or GDEIA (gluten dependent exercise induced anaphylaxis)

**Morita E, Kunie K, Matsuo H (2007). “Food-dependent exercise-induced anaphylaxis”. J. Dermatol. Sci. 47 (2): 109–17. doi:10.1016/j.jdermsci.2007.03.004. PMID 17507204.

Exercise Woes in the Past

All throughout my teens and twenties jogging caused abdominal pain. I could feel my intestines painfully juggling inside me quite frequently leading to diarrhea. If I jogged everyday, it seemed my body adapted the best it could so this problem would reduce. But, if I even skipped a couple of days the pain would come right back.

Occasionally this led to nearly passing out and vomiting. Understandably some companions were spooked and never asked me to work out together again.

Any exercise with enough intensity to cause me to sweat would make me itch all over.

Uphill hiking, moderate to intense, more than an hour long, would cause additional problems. I would become swollen, pale, and nauseated. At first I thought I was weak and didn’t have endurance, but the odd thing was that I wasn’t out of breath and I was entirely fine the next day when others who seemed fine on the mountain might be suffering from muscle aches and fatigue.

In the recent past, 1/4 of the time I did not feel well enough to exercise, either due to hormones and/or use of NSAIDs*. Out of the 3/4 of the time I could exercise, 1/3 of the time I suffered severe migraine immediately after and 3/3 itchiness.

All these symptoms became a thing of the past once I became aware of my allergies, which truly brought back the joy in moving my body.

* NSAIDs: NonSteroidal Anti-Inflammatory Drugs such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve).

Fresh Yeast Attack

This was funny because five people ate the same thing. I made a sweet flatbread, gluten free, leavened with yeast.

After just a couple of bites to taste while frying them up a horrible crushing headache hit so I had to retreat to bed in a dark room even before the others had really started eating. Another person had the worst gas for two days along with headache, blowing our minds about how much gas production is possible from a human being. The other three people had no problem whatsoever. We all have no noticeable problem eating commercial gluten free yeast bread, which most likely were baked more than a few days ago and sometimes even frozen.

I wonder what the mechanism is and haven’t been able to find one yet. If anyone has an explanation for this please share. Some migraine trigger lists have fresh baked yeast bread on it, less than a day old. There must have been enough people with anecdotal evidence for this to be on these lists, to which we are adding our little episode as well.

Fresh Cut Grass

At least two possibilities if you react to fresh cut grass.

Grass allergy (late spring, kicks up the pollen)

Or

Mold allergy (year around)

I clearly have a problem with fresh cut grass. I suspect mainly the mold being kicked up when the lawn is mowed.

Unfortunately, I may also have grass allergy. Haven’t got tested for it yet but I get sneezing fits in May out on the grass even when it’s not freshly cut. And possibly related to my grain food allergies. After all cereal grains are the seeds of grass.

https://www.allergicliving.com/2010/07/02/outdoor-allergy-grass-allergy-attack/

In the central and northern United States and Canada, grass generally pollinates in May, June and July. Farther south, the pollen starts filling the air a couple of months earlier. 

• Avoid being the person who cuts the grass in the pollinating months of May through July. The lawn mower kicks up the pollen and sends it into your eyes and nose. If it’s only grass allergy you’re contending with, you may be fine to mow the lawn in other months.

Kim notes however, that “often patients will have allergy symptoms with fresh cut grass in August or September. That’s not grass pollen allergy, that may be mold allergy from the molds being stirred up.” As well, Stark cautions that the dust the lawn mower creates while it’s trimming can get into your nasal passages like pollen, and also cause symptoms.

Gochujang Incident

Gochujang is a Korean condiment. A mixture of hot pepper, sweetener, and fermented soy paste (doenjang). I had been avoiding these for some time after going gluten-free as most commercial versions contain wheat and/ or barley. I finally found some products made the traditional way that were gluten-free. I made a bowl of bibimbap (rice, egg, and sauteed veggies) and added a dollop of the gochujang. But a short while later I ended up vomiting and sweating profusely. I had been episode free for over a year. I am pretty sure this gochujang was the culprit because I ate everything at home that day, made myself, and everything else were items I knew to be safe. When a reaction is this painful and I’m pretty sure about the culprit, I don’t want to test it again for the sake of knowing with absolute certainty. This incident finally got me thinking about that allergy I had to mold and especially to aspergillus mix. Traditionally fermented soy paste can include many varieties of molds but the main one is aspergillus oryzae. Unlike most commercial versions, the product was also unpasteurized, which meant the cultures were alive, and may have been the critical reason why this was the first clear acute reaction I had to a fermented soy product.

Mold as Food Allergy

Mold was not something we were looking out for but incidents made it increasingly clear that I was reacting to it. The presence of moldy fruit or freshly cut grass would cause sneezing, runny nose, and headaches. When ingested (accidentally, from a mold contaminated smoothie maker) it also caused sharp abdominal pain in addition to the aforementioned symptoms. Later in the day it would lead to dizziness, food cravings, and napping.

Mold allergy is mostly thought of as an environmental, inhalant allergy, but does it have any implications for food choices? Despite the smoothie maker incident and later a positive skin prick test result for aspergillus mix I did not think much of it. It wasn’t until my incident with gochujang that I realized this had relevance with what I put in my mouth as well.

There was not much information online about mold allergies and food. The more formal sites seemed to suggest the relationship is not clear. A few other sites had an extensive list of foods mold allergic people should avoid. Unlike most food allergies, mold is not something you can avoid 100%. There is always some mold in the environment, and mold is always starting to grow on food. This is why things get very murky when you realize you react to mold in food. It becomes a function of your individual tolerance level and the amount of mold in the food.

Now, I am but one person. Well, perhaps two, when I count my spouse, who tested positive to pretty much every type of mold out there.

For what it’s worth, in our experience,

fine: commercial vinegar, pickles, ketchup, soy sauce (small amount)

fine only when sufficiently fresh: raw sprouts, grapes, berries, kimchi

clear problem: raw (unpasteurized) fermented soy products, old fermented or pickled vegetables, sauerkraut, chocolate (might be by different mechanism), any leftovers stored more than a few days

gray area: cooked fermented soy

In short, cooked or pasteurized items did not cause any acute reactions. For example, mushrooms seems to be fine as they are always eaten cooked. Food prepared with a reasonable level of hygiene, and eaten within two to three days with refrigeration, are also likely to be fine. Items likely to have significant live cultures are obvious no no’s.

Cooked fermented soy is the main gray area. We are highly suspicious of it causing at least some mild gastrointestinal symptoms and headache. Though in my partner’s case the main mechanism of this might be high amines. We also noticed that chocolate and cooked fermented soy seems to cause a low mood.

Sneaky Soy

(Phase 6)

It was frustrating at times to constantly suspect yet another ingredient, sometimes even obscure additives in processed foods. Many things were eliminated at one point or another, usually something newly added or relatively infrequently eaten. But symptoms still continued. In hindsight, in such a case it is more likely due to something you eat fairly frequently yet never suspected for one reason or another. 

The main one was soy. The reason it was not suspected was that a larger amount was needed to cause reactions and the immediate reaction, headache, was relatively subtle (although it sometimes got worse over the next day or so) and tended only to happen with less processed forms of soy such as edamame and soy milk. Other more processed forms of soy like tofu caused headache the next day. Diarrhea was more severe and problematic but it also was usually delayed by a day causing us to suspect many other foods eaten right before the incidents.

Later I learned that soy generally tends to have a much higher sensitivity threshold than other allergens, like 100 times higher. So even if you have soy allergy you are unlikely to react to soybean oil, soy lecithin, even soy sauce.

Perhaps my reaction to soy is not an allergy in itself but rather some kind of cross reactivity to my other allergies. My symptoms are a less severe hybrid of that from nuts/ grains (headache) and milk (diarrhea), and the latter is much delayed.

Tree Nut Allergies

I only became aware of my issue with tree nuts after eliminating wheat and milk from my diet. So I do not know when I started to have these allergies. They are considered a more common adult allergy but for what it’s worth I did find chestnut to be addictive since childhood. And based on symptoms, chestnut and possibly pecan were the only ones I thought might actually be a true IgE allergy. I tested positive to pecan but chestnut was not available for testing.

Reaction patterns and sensitivity and severity are all over the map depending on which nut and in what form it is consumed.

Compared to whole nuts, nut milks have much less solids. Most commercial almond milk contains very little protein. It seems my sensitivity level is such that for some nuts I tolerate a small amount of nut milk. Also in my case raw nuts cause a more instant reaction than the same nut roasted.

With roasted chestnut there was no immediate reaction but migraine after exercise, all over itchiness, and later acne. But a small bite of raw chestnut caused immediate abdominal pain and itchiness all over.

With pecan, I only had a small taste of pecan milk, which was enough to cause an instant headache. The swiftness of this was alarming. So I’ve never tried more than this amount. And this was repeated a few days later with just a lick of pecan milk.

Hazelnut milk caused a pretty immediate sore bloated pressure feeling in the stomach but no other obvious symptom. But when I ate the solids left over from making the nut milk (one bite of a cookie made with the remaining hazelnut meal) I had another shock, vomiting, and diarrhea episode.

After severe reaction to hazelnut, milder suspicious issues with almond, macadamia nut and pistachio, I decided perhaps it was not worth the risk to test every tree nut out there. So for the time being I am avoiding all tree nuts except coconut (but is this technically a tree nut? Some classify it as a fruit).

In general tree nut cross reactivity patterns tend to cluster into two related groups: (pecan, walnut) and (almond, cashew, pistachio) with hazelnut potentially appearing in either group.

My tree nut symptoms also cluster into two groups.

Wheat-like reactions (headache, itchiness): pecan, chestnut, macadamia nut?, (walnut? haven’t tried due to its close relation to pecan)

Milk-like reactions (FPIES/ diarrhea): hazelnut, almond, cashew

Highly suspicious of juniper berries (unlike the name, this is similar to pine nut found sometimes in carnitas, other foods?) also causing gastrointestinal trouble (mild milk-like reaction).