The Vestibular Migraine Diet: A Comprehensive Guide

Migraine is often thought of as just a headache problem, but many individuals experience migraine symptoms without severe headaches, such as dizziness, ear pain, or fluctuating hearing loss. Vestibular migraine (VM) is a type of migraine where vertigo and dizziness are prominent symptoms. Diet plays a significant role in managing vestibular migraine. This article explores the vestibular migraine diet, particularly the approach developed by Johns Hopkins, and offers practical steps for implementation.

Understanding Vestibular Migraine

Migraine is a common condition, affecting millions of Americans. It's characterized by episodic attacks of head pain and associated symptoms like nausea and sensitivity to light and sound. Vestibular migraine is a specific type where dizziness and vertigo are dominant.

Individuals with vestibular migraine may experience various vertigo sensations, such as feeling like they are walking on air, light-headedness, spinning, or feeling off-balance. These symptoms may or may not be accompanied by a headache. Other common migraine symptoms reported by those with vestibular migraine include sensitivity to light (photophobia), sensitivity to sound (phonophobia), and nausea. Less common symptoms can include brain fog, fatigue, dry mouth, sweating, diarrhea, excessive yawning, tingling, and visual blurring.

Diagnosing vestibular migraine can be challenging due to the many different types of vertigo. Diagnostic criteria include various types of vertigo (spontaneous, positional, visually induced, and head-motion-induced), as well as head-motion-induced dizziness with nausea. The symptoms must be of moderate or severe intensity, and the duration of acute episodes is limited to a window of between 5 minutes and 72 hours.

The Heal Your Headache (HYH) Diet: A Johns Hopkins Approach

The Heal Your Headache (HYH) diet, developed by Dr. David Buchholz from Johns Hopkins University School of Medicine, is a well-known migraine diet. This diet is a type of low tyramine diet and is often used synonymously with the term "migraine diet." The HYH diet is endorsed by many migraine doctors and is used in the migraine clinic at Johns Hopkins. It's considered a first-line treatment, especially effective for those with vestibular migraine.

Read also: Comprehensive Guide to Migraine Diet

The HYH diet works by minimizing controllable triggers, primarily through avoiding foods that commonly trigger migraine attacks. This approach is based on the "Bucket Theory," which suggests that when you lower your trigger load, you increase your migraine threshold, reducing the severity, frequency, and intensity of attacks.

The diet involves avoiding foods high in tyramine, histamine, glutamate, and certain food additives like sulfites. Alicia Wolf, a cookbook author and vestibular migraine advocate, found the Heal Your Headache book to be extremely helpful, stating it improved her condition from 60% better to 100% symptom-free days when combined with her treatment plan.

Key Components of the HYH Diet

The HYH diet focuses on eliminating specific food components and additives that are common migraine triggers. These include:

• Tyramine and Other Biogenic Amines: Tyramine, histamine, and phenylethylamine are biogenic amines found in many foods. Their concentration increases with ripening and aging.
• Glutamate: Many processed foods contain hidden monosodium glutamate (MSG). Glutamate is a neurotransmitter that can trigger migraine attacks in some individuals.
• Food Additives: Sulfites and other food colorings and preservatives can also trigger migraines in sensitive individuals.

Foods to Avoid on the HYH Diet

The HYH diet requires eliminating several categories of foods, including:

• Caffeine: Any drink or food that contains caffeine, including decaf coffee and tea.
• Chocolate: All forms of milk and dark chocolate. White chocolate may be permissible.
• Monosodium Glutamate (MSG): MSG and foods with high glutamate content, including hydrolyzed vegetable protein, autolyzed yeast, and soy extracts.
• Processed Meats and Fish: Canned, aged, cured, fermented, smoked, tenderized, or marinated meats and fish.
• Aged Cheese and Fermented Dairy Products: Aged cheeses like gouda, parmesan, and brie, as well as yogurt, buttermilk, and sour cream.
• Nuts: All nuts, including walnuts, almonds, pecans, and cashews. Peanuts, which are legumes, should also be avoided.
• Vinegar: All vinegar except clear, distilled white vinegar.
• Alcohol: Especially red wine, champagne, and dark liquors.
• Certain Fruits: Citrus fruits, bananas, pineapple, raspberries, red plums, papaya, passion fruit, figs, dates, and avocados.
• Onions, Pea Pods, and Certain Beans: Broad Italian, lima, fava, navy, and lentils.
• Certain Fermented Products: Sauerkraut and kimchi, as well as kombucha.
• Fresh Baked Yeast Breads (within 24 hours): Baked breads with yeast, bagels, donuts, pizza dough, and pretzels.
• Aspartame (Nutrasweet): Saccharin (Sweet N Low) can sometimes trigger.
• Soy Products: Miso, tempeh, soy protein isolate, and soy sauce.
• Leftovers (past 3 days): Due to the build-up of tyramine.

Foods Allowed on the HYH Diet

While the list of foods to avoid may seem daunting, there are many foods that can be enjoyed on the HYH diet, including:

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• Seeds: Pumpkin, sunflower, and sesame seeds.
• Berries: Dark berries like blueberries and strawberries.
• Fresh Fish and Meat: Fresh salmon, chicken, and beef.
• Naan Bread: Naan bread without yogurt.
• Fresh Cheese: Goat cheese, cream cheese, cottage cheese, American cheese, and fresh mozzarella.
• Vegetables: Leafy greens, corn, potatoes, celery, zucchini, shallots, green onions, squash, and peppers.

Implementing the HYH Diet: A Step-by-Step Guide

Following the HYH diet requires commitment and a structured approach. Here are four steps to success:

1. Commit Fully: Choose a start date and stick to it. It may take several weeks to months to see results, so be patient. Dr. Buchholz recommends giving the diet four months.
2. Gather Resources and Support: Utilize resources like the Johns Hopkins Headache Center handout and online communities. Cookbooks like "The Dizzy Cook" can provide tasty and varied meal options.
3. Focus on What You Can Eat: Create a list of allowed foods and plan meals around them. Remember that the migraine diet is temporary, and favorite foods can be added back later.
4. Understand Common Triggers: Familiarize yourself with the food categories that contain higher amounts of migraine-triggering substances.

The Mediterranean Migraine Diet: A Long-Term Approach

Alicia Wolf, in partnership with neurologist Dr. Shin Beh, created "The Mediterranean Migraine Diet: A Science-Based Roadmap to Control Symptoms and Transform Brain Health." This diet focuses on long-term brain health and is designed to be a sustainable approach for managing migraine.

The Mediterranean Migraine Diet emphasizes:

• Foods high in Omega-3 fatty acids, such as salmon and seeds.
• Fruits and vegetables high in antioxidants, such as green leafy vegetables and dark berries.
• Regular eating and balanced meals to maintain stable blood sugar levels.

Additional Considerations

• Individual Triggers: Migraine food triggers are highly individual. What triggers one person may not trigger another.
• Trigger Stacking: Multiple triggers can accumulate and lead to a migraine attack. Food is just one piece of the puzzle.
• Re-introduction of Foods: The HYH diet is meant to be temporary. Re-introducing foods can help identify individual triggers.
• Lifestyle Changes: Consistent sleep routines, stress management, and regular exercise can reduce the number and intensity of migraine attacks.

Other Potential Treatments for Migraine With Vertigo

Because the diagnostic criteria for vestibular migraine were released fairly recently, there’s a lack of information from placebo-controlled trials on how to best treat it, says Mueller. There is limited evidence to support the use of triptans to treat dizziness in vestibular migraine, based on data from two initial trials, noted one research review. The acute therapies that are typically most effective for vestibular migraine episodes consist of vestibular suppressants (drugs that reduce the intensity of vertigo and related symptoms) and antiemetics (drugs that suppress nausea and vomiting). In some cases, triptans may be effective when used in conjunction with vestibular suppressants or antiemetics if you have used triptans for acute migraine treatment in the past and if your headaches are frequently accompanied by vestibular symptoms.

If a person is experiencing frequent vestibular migraine attacks, the same kinds of preventive medications used for other types of migraine may reduce the number or severity of attacks, says Mueller. The preventive medications that may be prescribed for vestibular migraine include the following:

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• Calcium channel blockers
• Tricyclic antidepressants
• Selective serotonin or serotonin-norepinephrine reuptake inhibitors (SSRIs or SNRIs)
• Antiseizure medications
• Calcitonin gene-related peptide (CGRP) antagonists (also known as gepants)

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