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By Maria Masters / Health.com
September 2, 2015
TIME Health
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As if migraines weren’t awful enough, it can be downright overwhelming to sidestep all the things that could set off an attack. Problem is, food triggers not only vary from person to person, but much of our knowledge about them comes less from carefully controlled studies and more from observing patients, explains Lee Peterlin, DO, the director of headache research at Johns Hopkins University.

Before you cut out every one of these items from your diet, here’s something to keep in mind: Fasting or skipping meals can be an even bigger migraine trigger for women, says Dr. Peterlin. Remember that as you go through this list, then turn to your fridge. (Though you might want to reconsider that charcuterie…)

Alcohol

Wine, especially red, is believed to be one migraine trigger. According to a review by researchers in Brazil, migraine sufferers say that alcohol may play a role in their attacks about 30% of the time or more. The reason is still up for debate, but some experts believe that certain compounds in wine, like tannins and flavonoids, are the culprits. One 2014 study suggested that red wines that contains higher amounts of tannins—think big, bold wines like cabernet sauvignon—might be even more likely to trigger a migraine. Plus, drinking alcohol may lead to dehydration, which can also contribute to a headache, says Dr. Peterkin.

Caffeine

If you’re prone to migraines, you might want to reconsider your coffee or soda intake: Too much of it can cause an attack, possibly because caffeine acts on certain receptors in the brain that are linked with migraines, according to one 2009 review. Limit caffeinated beverages to 8 to 12 ounces a day, says Dr. Peterlin.

But there’s a twist: Since caffeine has a pain relieving effect, consuming a small amount of it during an attack may actually help that “just-kill-me-now feeling” to subside faster—as long as you’re not overusing it in the first place, she says.

Aged cheeses

Gorgonzola. Camembert. Cheddar. Aged cheeses (i.e., all the good ones) are beloved for their rich flavors and textures—and because life isn’t fair, they’re also commonly cited migraine triggers. Experts aren’t sure what, specifically, is to blame, but research suggests that aged cheeses can contain compounds called tyramines, which may interact with the neurotransmitters in the body and lead to a migraines.

Cured or processed meats

Hot dogs, sausages, even that turkey sandwich you had for lunch—all of those foods might set off a migraine too, says Rebecca Traub, MD, a neurologist with ColumbiaDoctors. These meats can contain a preservative called sodium nitrate, and researchers speculate that this additive may also cause changes in brain chemistry that contribute to the headache.

MSG

You might be familiar with monosodium glutamate (MSG)—it’s gotten a bad rap over the years, mainly for its possible link to obesity. Lesser known is the suspicion that it may also contribute to migraines. Although the evidence isn’t conclusive, one 2008 study suggested that 2.5% of these headaches may be triggered by the ingredient. If you’re trying to avoid the stuff, just remember that, yes, MSG can be found in Chinese foods and packaged products, but it’s also found naturally in foods like tomatoes and cheeses and in ingredients like hydrolyzed vegetable protein, according to the Food and Drug Administration.

Citrus fruits

This food group is still up for debate—some studies have found a link between migraines and citruses, while others haven’t. Still, it’s possible that citrus fruits might trigger migraines in some sufferers, and they’re certainly on experts’ radars as being a possible—though much rarer—culprit, says Traub. To help pinpoint what’s causing your migraines, Traub recommends keeping a headache diary, either on a calendar or in a journal. Log your migraines, the severity of the attack, the foods you’ve been consuming, and any medications that you’re taking, she says.

Aspartame

No stranger to controversy, this artificial sweetener is also suspected of triggering migraines in some people. “It’s one of the first items I ask my patients to cut out of their diets,” says Louise Klebanoff, MD, a neurologist with the Headache Center at Weill Cornell Medical College. That recommendation is based more on observation that carefully-controlled studies, but if you want to avoid the low-cal sweetener, it can be found in in packaged foods and beverages, including diet sodas, breakfast cereals, puddings, gelatins, and more.

Legumes

Beans, peas, and lentils are also suspected migraine triggers, says Dr. Traub, though they’re also less common offenders than, say, alcohol and caffeine. Experts haven’t quite pinned down why legumes seem to bother some migraine sufferers, but other research points to the importance of plant foods in warding off these headaches: One 2014 study in The Journal of Headache and Pain found that people who went on a vegan diet experienced less pain during their headaches than they had on their normal diet. Sure, plant foods contain anti-inflammatory compounds, but the researchers also note that their subjects lost weight during the study—and obesity in particular has been linked with migraines, according to some research.

Nuts

This food also falls into the “not well studied, but observed by doctors” category, says Dr. Klebanoff. “I tell people to watch their diets, but don’t be obsessive,” she says. “If every time you eat a handful of nuts and you get a headache in the next four to 12 hours, then it’s probably a trigger.”

Chocolate

This one’s tricky. “Chocolate hasn’t been substantiated as a true migraine trigger,” says Dr. Peterlin. While people may believe that chocolate is the culprit behind their headaches”, some experts think that the reverse is actually true—that the craving for sweets is a symptom of an oncoming migraine, not the cause of it. According to the 2012 review by researchers in Brazil, people in the earliest stages of a migraine attack can experience chocolate cravings, but that the food itself isn’t responsible for the headache. But because it can be hard to tell which is which, Dr. Klebanoff says that it’s still on her list of potential migraine triggers—and something that people should be aware of.

This article originally appeared on Health.com

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