WSJournal. Why That Banana or Onion Might Feel Like Three Martinis

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Woke up with a hangover? It isn't just heavy alcohol consumption that can bring on a massive headache the next day; some researchers say a range of unexpected foods, from cheese to pickles to citrus fruit, can do the same.

Some people suffer from severe headaches the day after eating certain trigger foods according to neurologists. Many such foods contain tyramine, a natural food chemical that transmits signals along pain nerve endings. Sumathi Reddy has details on Lunch Break. Photo: Getty Images.

The idea that eating, say, a banana or onion can trigger a headache is controversial. What little scientific research has been done on the subject has often been inconclusive. And most studies depend on patients reporting what they ate before headaches set in, data that aren't always reliable.

What's more, the possible biological links between food and headache aren't clearly understood. Some experts believe there may be a chemical reaction that leads to some headaches, while others think foods could trigger a vascular response involving nerves and blood vessels around the head. A newer theory suggests that certain foods may prompt an immune-system response that triggers headache. A possible culprit is tyramine, a naturally occurring chemical in food.

Despite a lack of evidence, there is widespread belief that certain foods are associated with both migraine and tension-type headaches, the most common type. More than 50% of migraine sufferers change their diet or avoid specific foods, according to an analysis of studies on headache triggers published last year in the Handbook of Clinical Neurology. As many as one-third of people who regularly get common headaches have reported a link between eating and drinking and headache, the analysis said. Although heavy alcohol consumption is generally associated with hangovers, that biological mechanism isn't clearly understood, either.

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A substance in fermented soy products like miso soup might trigger headaches.

An estimated 10% to 15% of the population suffers from repeated migraines, mostly women, while as many as 40% of people regularly get common headaches. Headaches can be triggered by a range of things, from stress to lack of sleep to a change in the weather, and every person is susceptible to different triggers, or combination of triggers. Experts say food can be another factor that sets off a headache. But a big difference is that people might be able to avoid the foods that prompt the ailment, says David Buchholz, an associate professor of neurology at Johns Hopkins University and author of the book "Heal Your Headache."

Dr. Buchholz says he suggests to patients with severe headaches that they temporarily stop eating certain foods that appear to be linked to the condition. The tricky thing is that headache triggers vary widely between people. A food that prompts a headache on a day when a person has had little sleep, for instance, might have no effect on another day.

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Salami

Ellen Loughrin, 51, went to see Dr. Buchholz a few years ago after suffering from fatigue, vertigo and other symptoms as a result of migraines. "I really resisted the idea that foods could be the source of this, especially a whole bunch of foods that are promoted as essential for your health and an optimal way of living" like avocados, legumes and bananas, says the Rochester, N.Y., resident, who works as a project manager for a software implementation company.

Ms. Loughrin says her symptoms a year later were much reduced. She avoids pizza, oranges and peanut butter, one of her favorite foods. Yogurt, also, is off the table. And she reads labels carefully to make sure there are no onions in packaged foods. "In a few years I may start experimenting and adding some of the trigger foods," she says. "Right now quality of life is worth more than the foods."

"There's a fairly long list" of foods that can potentially trigger headaches, says Linda Porter, a pain-policy adviser at the National Institutes of Health. "I think the difficulty is that the triggers may be more a combined effect from different things. They can sometimes be a little bit hard to identify." Still, she says, if it isn't an essential food, it's worth eliminating it from one's diet.

The National Headache Foundation suggests patients might want to limit their intake of tyramine to help control headaches. Tyramine's connection to headaches came to light with the advent of a class of antidepressants, known by the acronym MAOIs. The drugs block an enzyme that breaks down excess tyramine, which can boost blood pressure and cause headaches and nausea when it accumulates in the body.

Certain foods, including some aged cheeses, pickled products and nuts, have relatively high levels of tyramine, which is formed from the normal breakdown of an amino acid. Tyramine can accumulate in foods that are aged, fermented or stored for long periods, experts say. Other potential headache triggers include some foods with nitrites, such as processed meats; citrus foods and juices; freshly baked goods with yeast; soy products; and caffeine and alcohol, even in very small amounts. The most commonly reported dietary headache trigger is monosodium glutamate, or MSG, a flavor enhancer that may be added to canned vegetables and soups and processed meats. The time interval between consuming a trigger food and contracting a headache can be a few hours to 48 hours.

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Blue cheese

"If I have MSG, the next day I'll have such a terrible headache I feel like I've had about 1,000 drinks even though I haven't had any," says Amy Worcester Lanzi, of New York City. "You get to the point where you just avoid it." Other trigger foods for the 39-year-old include hot dogs and other processed meats, flavored chips and sugary treats, she says.

A small group of studies has looked at the possibility that certain foods set off an immune-system response that triggers headaches, although results have been mixed.

David Dodick, a neurology professor at the Mayo Clinic and chairman of the American Migraine Foundation, cited a randomized, controlled study published in 2010 that tested 30 migraine patients on diets that either included or excluded foods associated with high levels of antibodies for each person. After six weeks, the diets were reversed. The study, published in Cephalalgia, the journal of the International Headache Society which Dr. Dodick edits, found that participants had significantly fewer migraines when they avoided certain foods. Food isn't the primary cause of migraines, but it can induce or aggravate attacks, the study said.

A similar study, involving 167 migraine patients in the U.K., found that participants on diets eliminating trigger foods had fewer headaches, but the difference wasn't statistically significant. The study was published in 2011 in Nutrition Journal.

But another study, published in December's edition of Headache, the journal of the American Headache Society, looked at migraine sufferers who also have irritable bowel syndrome. The randomized, controlled study, which involved 21 participants, found that eliminating certain foods associated with an immune-system response could effectively reduce symptoms from both disorders.

Write to Sumathi Reddy at sumathi.reddy@wsj.com