On April 21, I had the worst headache of my life. It felt like bad sinusitis. However, there was visual aura in the upper and bottom part of my field of vision. I felt that I was looking thru a glass prism. It lasted the whole night and was relieved the next day after taking a sinus medication.
An aura can present as a visual distortion. (see image below). I had occasional migraines with aura without any headache before, especially after intense exercises such as heavy weightlifting. That day when I had a severe migraine, I did 25 minutes of high-intensity interval training. So I thought it was from that.
In the next few days, I had episodes of spinning sensations called vertigo. They were so bad that I almost fell. A visit to a neurologist and some tests confirmed the diagnosis of migraine with aura.
Since then, I searched the internet for available literature on the internet on how to prevent hypertension and migraines with aura. The result is this present series. This article is part 2 of the introduction. You can find Part 1 here.
How can some Foods cause Hypertension and Migraines?
Migraine affects 12% of the population. It is probably more than that because some are undiagnosed, some headaches may be infrequent, or the problem may not be severe enough to warrant a visit to a doctor. If patients do, the headache may be labeled as something else like a tension headache.
Common foods, cheese, preserved meats, and fermented vegetables like sauerkraut and kimchi can cause migraines. These foods can have biogenic amines like tyramine that can release the hormones noradrenaline and adrenaline.
The released hormones constrict the blood vessels all over the body, including the brain. This vasoconstriction can cause hypertension and limit blood supply to essential organs like the heart and the brain.
In some cases, depending on the amines ingested, the rise in blood pressure can cause a hypertensive crisis. Hypertensive crises can cause strokes and heart attacks.
After the blood vessels constrict, they dilate, and blood flow increases. The increase in the blood flow may sound good, but it causes more problems. The dilatation in the blood vessels of the brain is the current explanation for the headache part of the migraine.
As the blood flow resumes, parts of the brain get hyperstimulated. The hyperstimulation can make the migraineur feel, see, hear things that are not there. It depends on what part of the brain is affected. That explains the various manifestations of migraine with aura without headache. Those symptoms are listed in this article.
Other foods with nitrates like hotdogs and bacon and monosodium glutamates (MSG) from home-cooked and restaurant foods can also cause migraines by dilating the blood vessels.
Migraines with Aura without Headaches
Migraines with aura without headaches can be misdiagnosed. In part because the physician may not be able to “localize” what part of the brain is involved.
Usually, to make a neurological diagnosis, a physician figures out whether a patient’s complaint makes neuroanatomical sense. For example, if someone has a weakness on the left side of their body, most likely, the problem is on the right side of the brain.
In migraine with auras, the presentations may be unusual. If someone with migraine aura without a headache complains to their doctor that they have a “funny feeling” going up from their right fingers to their chest and then go down their left fingers, they may leave their doctors scratching their heads. Some doctors may even think that that patient is crazy.
That’s because the parts of the brain that gets hyperstimulated during migraines may be random and can involve different parts of the brain.
Anyone Can Have Food Related Hypertension and Migraine
Tyramine
Hypertension and migraines with aura can happen to anyone, not just to migraineurs. Migraineurs are people diagnosed with chronic migraines. Anyone exposed to the high levels of biogenic amines like tyramine from their food can get transient hypertension and migraines.
High tyramine levels are present in foods that are “aged,” fermented, or have been in the refrigerator for many days. Think of hard cheeses, cooked ham, and draft beer.
Some fresh fruits can also have high levels of tyramine like grapes, watermelon, cauliflower, and cabbage.
On that day and the days before I had a severe migraine, I was eating an aged Edam cheese and lots of peanut butter.
The Monoamine Oxidase (MAO) Enzyme
Usually, monoamines like tyramine, present in foods get broken down or metabolized to harmless substances by the MAO produced by the intestines. Some people with mutations in their genes may have low MAO production.
Some antidepressant drugs can bind MAO and increase tyramine. Those drugs are called monoamine oxidase inhibitors or MAOI. MAOI has been around since the 1950s.
The interaction between tyramine and MAOI drugs was discovered by a British biochemist. He noticed that his wife, who is on an MAOI, gets a severe headache after she eats cheese.
Since then, other foods and seasonings like soy sauce and tabasco, and beverages like coffee have been found to and contain MAOIs. MAOI in foods and drinks can interact with tyramine from other foods and increase the tyramine levels and blood pressure.
Cigarette smoking does the same. A future article will list MAOI containing foods.
Knowing this is useful for blood pressure control
There is abundant literature about the effects of MAOI drugs and tyramine containing food. However, I did not encounter any scientific research that describes the interaction between foodstuffs and beverages with tyramine and MAOI that result in hypertension. What I am proposing here is still theoretical and not yet supported by studies.
Hopefully, this article will spur someone to do controlled studies.
Fortunately, hypertension resulting from foods with tyramine and foods with MAOI are of short duration. It becomes a problem if the intake is habitual or if overeating happens. Hypertension that results can become chronically high. That is another reason why chronic smoking can lead to hypertension.
Another reason why food interactions are a problem is that someone may be diagnosed with hypertension. They then try to diligently make a lifestyle change with exercise and eat a healthy diet that is low in salt, sugar, and fats.
However, hypertension can still be uncontrolled because of tyramine-MAOI food interactions, and thus the risk for strokes and heart attacks from hypertension are not reduced.
On the next physician visit, if hypertension persists, that leads to an increase in the dose or addition of blood pressure medications without addressing the root cause of the problem. Higher doses and more drugs have more side effects.
Future articles, I will list the food sources of tyramine and MAOI and how to deal with the problem.
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References:
Souci SW, Fachmann W, Kraut H. Food Composition and Nutrition Tables. 8th ed.
Stuttgart, Germany: MedPharm Scientific Publishers; 2016
Herraiz T. Relative exposure to beta-carbolines norharman and harman from foods and tobacco smoke. Food Addit Contam. 2004;21(11):1041‐1050. doi:10.1080/02652030400019844
Image credits:
Visual aura By Tehom – Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=5343938
Edam cheese By Yvwv – Original photo by Yvwv., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1438438
Coffee by Photo by Mike Kenneally on Unsplash
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