We’ve all heard that red wine and aged cheese can trigger migraines. Here’s the theory behind this.

Biochemistry 101

Red wine and aged cheese have two possible things in common, as far as I can tell: one is that they both are high in histamines, and the other is that they are high in tyramines.

Tyramine is a derivative of tyrosine, one of the 20 amino acid building blocks in protein. The body produces tyramine from tyrosine if the food is old (not fresh), or fermented. The same is true of histamine: the body produces histamine from histidine (its parent amino acid) in old or fermented foods.

Histamine and Tyramine are both amines, or compounds that contain a nitrogen atom with a pair of hydrogens. Tyramine is derived from Tyrosine, and it can also turn into the catecholamine neurotransmitters (norepinephrine, epinephrine, and dopamine).

Here’s where I think this matters: the catecholamines get broken down by (among other enzymes) the enzyme MAO, Monoamine Oxidase. Histamine, as mentioned here, gets broken down primarily by the enzymes DAO in the gut, and HMT in the rest of the body. But right after the HMT step in the breakdown of histamine, it too requires MAO for full elimination.

In other words, the buck stops with MAO for both tyramine (catecholamines) and histamine elimination. This means you can end up with a “bottleneck”: consume too many histamines that you can’t break down (via histamine-containing foods, allergies, etc), OR consume too many tyramine-containing foods, and your MAO gets backlogged. That means these amines—all of them—continue to circulate in the bloodstream and cause problems. My guess is, the symptoms you experience depend on which amines are highest.

  • High tyramine means you’ll end up with too-high catecholamine side effects (think too much adrenaline, since adrenaline is the same as epinephrine—one of the catecholamines): high blood pressure and racing heart. Epinephrine causes vasoconstriction of some blood vessels (those with an alpha receptor) and vasodilation of others (those with a beta receptor). This vasodilation is also what sets off the process of a migraine—and this is the reason why sometimes beta blocker medications are prescribed to prevent migraines (such as propranolol).
  • High histamine means insomnia (histamine in the brain keeps you awake), arrhythmia or unusual heartbeats, rashes and hives, headaches and migraines (this can be the direct cause, because of the connection to serotonin, discussed here), vertigo, flushing, nasal congestion, swelling, and abdominal cramping.

Foods High in Amines

The list of foods high in histamines is quite similar to the list high in tyramines, though not exactly the same—this is because both are produced by similar processes, but the foods have to have contained histidine and tyrosine originally in order to produce their byproducts. Here’s the high tyramine list, with a little asterisk for those that are also contraindicated for histamine intolerance:

  • Strong, aged cheeses (sharp cheddar, blue cheese, etc)*
  • Cured or smoked meats or fish*
  • Soy products (tofu, miso*, soy sauce*)
  • Alcohol (beer and wine)*
  • Fava beans
  • Any fermented or pickled foods (including sauerkraut, sourdough breads, kimchi, etc)*
  • Aged or overripe fruits*
  • Raspberries*
  • Avocados*

Testing for Tyramine Sensitivity

There is no direct test for this to my knowledge—this is one reason why doctors encourage migraine sufferers to keep a headache diary, to identify your specific triggers. However, genetic tests (such as 23 & Me and LiveWello) will test for MAO enzyme mutations. If you have a homozygous mutation in one of more of these enzymes, you’re likely predisposed for amine sensitivity, including both tyramine and histamine.

Treatment for Tyramine Sensitivity

The safest route, once you determine that these foods are triggers for your migraines, is of course to avoid them. If you are tyramine-sensitive, it’s also not a great idea to take the amino acid L-Tyrosine as a supplement.

It is possible to experiment with optimizing MAO function even with genetic mutations, by supporting the enzyme with its vitamin and mineral cofactors (which include magnesium, Vitamin B6, and Vitamin C. This is probably at least part of the reason why magnesium and Vitamin B6 are so often recommended for migraine sufferers). If you choose to go this route and attempt to continue eating some of the foods on this list, I recommend seeing a functional medicine doctor or a naturopath who can help you find the right doses for you, and perhaps look at your full genetic profile, since many of these enzymes work together.