Tyramine Intolerance – underlying cause of migraine headaches?

A migraine is more than just a really bad headache. While migraine is characterized by intense, debilitating headache, it also may include nausea, vomiting, difficulty speaking, sensitivity to light and sound, and may- or may not be preceded by an aura (sensory, motor, visual or speech symptoms that act like a warning signal that a migraine is about to begin). People with a reduced ability to clear the amino acid tyramine (which is called tyramine intolerance) often experience migraine, along with other symptoms including heart palpitations and GI issues, including nausea and vomiting.

In those who have insufficient amounts of an enzyme called monoamine oxidase (MAO), levels of tyramine can build up, and this is called tyramine intolerance.  A tyramine intolerance diet can be helpful in helping reduce people’s symptoms.

Tyrosine combines with other amino acids to form proteins, and just like the amino acid histadine breaks down to histamine (see this previous article on histamine intolerance), tyrosine breaks down to form tyramine. Normally, the excess tyramine is broken down by the enzyme monoamine oxidases (MAO) — in the same way that excess histamine is broken down by the enzyme diamine oxidase (DAO).  In individuals that take certain types of medications such as MAO inhibitors (used in treating some types of depression) and certain medications used for treating Parkinson’s disease, levels of tyramine will build up in the body because the enzyme that breaks it down is inhibited.

In those who have insufficient amounts of the enzyme monoamine oxidase, levels of tyramine can also build up and this is called tyramine intolerance [1].

Symptoms of Tyramine Intolerance

The body naturally responds to the presence of tyramine by making catecholamines such as epinephrine and norepinephrine which are neurotransmitters involved in the “fight or flight” response. If tyramine accumulates, too much of these chemicals are released, which leads to an increase in blood pressure and heart rate [2]. If these chemicals go high enough (such as is the case with those taking certain medications) this can lead to a very rapid and dangerous increase in blood pressure called a ‘hypertensive emergency’ which can result in bleeding in the brain (hemorrhagic stroke)[3] and rarely, even death.  At very least, the very high blood pressure can cause damage the body’s tissues and organs.

Those with a reduced ability to clear tyramine due to tyramine intolerance may experience migraine, heart palpitations or GI issues, including nausea and vomiting [2].

Tyramine Intolerance Diet

In those taking MAO Inhibitor medication or specific medications for treating Parkinson’s disease,  a tyramine-free diet is prescribed. Since the adverse effects of eating tyramine-containing foods can be so serious, strict adherence is needed.

For those with diagnosed tyramine intolerance, a low tyramine diet will be recommended, and for those with suspected tyramine intolerance a low tyramine diet may be trialed to see if symptoms improve. This is especially the case in people who experience migraine— as it has long been thought that tyramine may underlie the constriction of blood vessels that increases blood pressure associated with migraine[4].

Low Tyramine Diet — not as easy as following a ‘list’

Tyramine naturally occurs in small amounts in protein-containing foods, but as foods age, mature or ripen, tyramine levels increase.

Avoiding strong or aged cheeses, cured, smoked or processed meats, pickled, cultured or fermented foods (including many Asian condiments), nuts and nut butters and some seeds and seed butters, aged spreads such as Marmite and Vegemite, and alcoholic beverages [3,5] is a good place to ‘start’, however reducing tyramine in the diet isn’t as straight forward as simply following a “list’.

Knowing which cheeses, for instance have high levels of tyramine and which have moderate levels can be looked up, but some tyramine-containing foods may act as a trigger to migraine in one person, but not in another — so it is often unnecessary to restrict all tyramine-containing foods. Sometimes by me helping people systematically eliminate the most common tyramine triggers is sufficient to provide them significant relief — without them having to eliminate all tyramine-containing foods.  That’s where experience helps!

More Info?

If you have been diagnosed with tyramine intolerance or suspect you may be sensitive to tyramine, I can help.

You can learn more about the Histamine / Tyramine Intolerance Specialty Hourly Service here  and I also offer a migraine add-on option to the Complete Assessment Package which you can learn about here. If you would like information as to which is a better fit for your needs, please send me a note using the Contact Me form above.

To your good health!

Joy

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References

  1. Joneja, J. Histamine and tyramine sensitivity – how closely are they linked? Food Matters, October 2017, https://www.histamine-sensitivity.com/histamine-tyramine-similaraties-10-12.html
  2. Van Eaton J. Tyramine-Free Diets. Healthline, Feb 1, 2019, https://www.healthline.com/health/tyramine-free-diets
  3. Hall-Flavin D. Mayo Clinic, MAOIs and diet: Is it necessary to restrict tyramine? https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/maois/faq-20058035
  4. Costa MR, Glória MBA. Migraine and Diet, Encyclopedia of Food Sciences and Nutrition (Second Edition), 2003, https://www.sciencedirect.com/science/article/pii/B012227055X007835
  5. Skypala IJ, Williams M, Reeves L, Meyer R, Venter C. Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence. Clin Transl Allergy. 2015;5:34. Published 2015 Oct 13. doi:10.1186/s13601-015-0078-3

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