The Headache Prevention Cookbook
David R. Marks, M.D. and Laura Marks, M.D.
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If you’re one of the 50 million Americans who suffer from headaches, you can eliminate the pain entirely just by changing the way you eat. A headache sufferer himself, Dr. David Marks treats thousands of patients a year at his internationally known headache clinic. The recipes in this book can help you ward off headaches while ensuring that you eat well in the bargain.
The following is an excerpt from the book The Headache Prevention Cookbook: Eating Right to Prevent Migraines and Other Headaches
By David R. Marks, M.D. and Laura Marks, M.D.
Published by Houghton Mifflin; July 2000; $16.00US; 0-395-96716-3
Copyright © 2000 David R. Marks, M.D. and Laura Marks, M.D.
If you’re reading this, chances are that you or someone you know suffers from headaches. Take comfort in knowing that you’re not alone! Headaches affect as many as 50 million Americans a year and account for more than 18 million visits to the doctor. In fact, headaches are the leading cause of absence from work; some researchers have estimated that 30 million workdays are lost each year because of the problem.
But numbers do not even begin to tell the story. The pain of a headache can completely disrupt a person’s life. I have seen patients whose headaches are so severe that they are afraid to plan activities such as vacations, weddings, dinners, or dates. Their lives center on the dread of the next headache attack. Mary P. is a perfect example. When Mary came to my office, she had suffered from two to three headaches a week since her early twenties. Now that she was forty, her headaches were occurring on a daily basis. She complained of a constant throbbing sensation from the back of her head to her forehead. The headaches had become so severe that she was having difficulty taking care of her seven-year-old daughter and four-year-old son. The constant pain was also taking a toll on her marriage. The only way she could get through a day was by taking a lot of pain medicine.
Like Mary, many patients complain that their suffering is worsened by a feeling of helplessness. They have been told by friends and physicians alike that they will have to “learn to live with it.” At one time or another, most headache sufferers have also been told, “It’s all in your head.” Often they blame themselves for their condition. The combination of fear, helplessness, and self-criticism can lead to depression and/or the chronic use of pain medication.
Many doctors now think that heredity may play a major part in the underlying cause of headaches. As I often tell my patients, if you really want to cure your headaches, you need to pick your parents better! I suspect that what a person inherits is the predisposition to getting headaches. I think of it like this: Everyone is born with a certain threshold for getting headaches. Some people have such a high threshold that they never get a headache, no matter how many “headache triggers” they are exposed to. Others have a headache threshold that is high enough so that they suffer from headaches only occasionally, and usually only with extreme triggers, such as severe stress or sleep deprivation. Frequent headache sufferers, on the other hand, are very sensitive to trigger factors and may get headaches in response to a multitude of them.
Stress, lack of sleep, bright lights, weather changes, and strong odors are all potential headache triggers. But what many people, including many doctors, don’t realize is that some of the most common causes of headaches are ordinary foods that most of us eat every day. Avoiding those so-called food triggers can be one of the most effective and least invasive ways to treat headaches, without the risk of side effects and allergies (not to mention the cost) associated with the use of medications. In fact, by just following an appropriate headache-prevention diet, you may be able to get rid of most or all of your headaches!
You may still need to take medication for your pain. But medications have side effects especially when they are taken too frequently. Indeed, one of the most frustrating things about treating headache patients is that they tend to be more sensitive to medications and experience more side effects than people without headaches. Whenever possible, it is ideal to be able to treat headaches without resorting to the use of medication. This is where diet modification is useful.
Diet modification worked for Mary P. After stopping her chronic pain medicines, we were able to identify many food triggers that she had previously been unaware of: Chinese food (even without MSG), cured pork products, aged cheeses, bananas, citrus fruits, and peanut butter cookies. Each of these foods caused a severe headache within hours of consumption. Once Mary identified her headache triggers, she modified her diet to avoid them. Her headaches became less frequent, and her relationships with her husband and children improved dramatically. Mary is just one person who has been helped by eliminating trigger foods from her diet. There are many others:
Indira P., a thirty-year-old Indian woman, moved to America in 1996 to make an arranged marriage. Shortly after her arrival, Indira developed headaches that occurred almost every day. But she spent the following winter in India and had no headaches while there. When she returned to the United States, her headaches recurred.
Indira did not believe that any of her headaches were caused by foods. However, I became suspicious after hearing that she had experienced no headaches while vacationing in India. I asked her what her husband did for a living. As it turns out, he operated a food truck that served sandwiches, and every day he would bring some home. Indira usually ate either a turkey and Swiss cheese or a cheese steak sandwich for lunch. I advised Indira to eliminate cheese from her diet, and when I saw her two months later her headaches were much better.
Sharon M. had daily headaches for about a year. The symptoms were typical of chronic tension-type headaches: a “tight band” around her head that was fairly constant and usually not associated with nausea or vomiting. After ruling out any serious cause of Sharon’s headaches, I put her on the headache-prevention diet. Sharon kept a detailed record of everything she ate. (She is a bit compulsive, and in this case, it worked to her advantage.) When I next saw her two months later, she had experienced only a few headaches. Then, after slowly reintroducing the foods known to be common headache triggers, Sharon identified freshly baked bagels, pickles, chocolate, and citrus as some of her headache triggers. As a result, her life was, in her words, “totally changed.”
John R. loved diet cola. At his initial evaluation, he said that he drank four glasses a day. Since diet cola contains artificial sweeteners and caffeine both potential headache triggersI recommended that he gradually reduce his intake and switch to something else. But, like many patients, John was reluctant to give up his favorite soft drink. He stopped drinking it for a short period of time, then tried to reintroduce it. Within hours, he suffered a severe migraine headache. John tried on four more occasions to reintroduce diet cola. Each time ended with the same result: a migraine. Finally, he was forced to admit to himself that his favorite soft drink wasn’t worth the pain.
Trisha P., age fifty-nine, suffered from headaches since she was eight. When Trisha first came to see me, she complained of frequent headaches and was taking too much pain medicine, which can cause “rebound” headaches. I discontinued her medication, and within a few short weeks, Trisha’s headaches became much less frequent. To see if we could eliminate the rest of her headaches, I suggested that she avoid certain foods. After doing so for a few weeks, Trisha gradually began adding them back to her diet, one at a time, to try to identify the offenders. She reintroduced cheeses, artificial sweeteners, and pickles without any problems. One night, Trisha decided to have a piece of ice-cream cake with chocolate sprinkles on it. Seven hours later, she awakened with a migraine. Three days later, she ate a chocolate candy bar and developed a migraine within four hours. Since cutting chocolate out of her diet, Trisha has been doing fine, with only an occasional headache.
When I first saw Nancy R., she drank the equivalent of five cups of coffee a day. On top of that, she was taking a caffeine-containing pain medicine for her headaches on an almost daily basis. I warned her about the problems of “caffeine-rebound” headaches, but she insisted that she couldn’t make it through a day without caffeine. After one year, Nancy’s headaches became so severe that she began to feel desperate. Again I brought up the issue of her caffeine use, and we developed a plan: Nancy would stop her caffeine-containing pain medicine immediately and would begin tapering off her coffee intake, reducing it by one cup every three days until she had given up coffee completely. During the first couple of weeks off caffeine, Nancy had a number of bad headaches, but when I saw her a month later, her headaches had virtually disappeared.
Chocolate, caffeine, and red wine are common headache triggers, but as the stories of Mary, Indira, and John suggest, there are other, less well known offenders: most cheeses, citrus fruits, beans, freshly baked bread, artificial sweeteners, and preservatives, to name just a few. (A list of foods that frequently trigger headaches can be found on page 27.) Not all these foods cause headaches all the time — most people are affected by only a small number of them. Some of my patients are unaffected by chocolate but will get a pounding headache from bananas.
Amy C. came to my office complaining of daily headaches that would get so bad that she had to close her office door and turn out the lights for hours at a time. Amy worked as a newswriter and producer, a high-stress position that regularly required twelve- to sixteen-hour workdays. She was not sleeping well, not exercising, and not eating properly. Amy skipped meals frequently, and when she did manage to eat, she ate as quickly as possible. She had gotten into the habit of eating bananas every day because of their convenience. Unfortunately for Amy, bananas are on the headache hit list, at least in large quantities. When Amy cut them out of her diet, her headaches improved.
Rhonda B.’s headaches, which used to trouble her only a few times a month, had become a daily torment. She had lost over forty pounds on a diet that prescribed eating three oranges and one grapefruit each day in addition to other low-fat foods. In Rhonda’s case, it was the quantity of the citrus fruits that was the problem. Cutting back on her consumption of oranges and grapefruit helped keep her headaches in check.
Some people are affected by a particular food only at certain times. Eilene M., for example, was troubled by migraines around the time of menstruation. The migraines lasted for up to three days at a time, causing her to miss work. Eventually, Eilene noticed a pattern: Beginning about two days prior to her period and continuing until its end, eating bananas, grapefruit, or yogurt would cause her to develop a severe migraine within ten minutes. During the rest of the month, these foods did not affect her. Fortunately for Eilene, her menstrual cycle is regular, so she can avoid those food triggers during that time of the month.
Identifying Troublesome Foods
Not every headache sufferer is sensitive to food triggers. The first step before undertaking any regimen is to see a doctor and determine if there is any underlying condition that may be causing your headaches.
But a significant percentage of sufferers are affected by food, and I see it every day in my practice. Unfortunately, there is no physical sign or blood test that will tell you if some of your headaches are caused by food. And if you’re not paying very close attention, you may not notice a pattern even if it’s there. For that reason, I recommend that every headache sufferer try diet modification, at least temporarily. To discover if your diet is contributing to your headaches, you’ll need to start with what doctors call an “elimination diet,” in which you will try to eliminate all potentially troublesome foods.
You can follow an elimination diet by using the recipes in this book and by creating your own recipes that avoid foods which can trigger headaches. You should avoid these foods for at least two months and record whether your headaches improve during this time.
After the two-month period, you can begin to reintroduce the potential trigger foods into your diet, one food at a time. Wait for a week or two before adding another. That way you can more accurately determine the effect of a particular food on your headache pattern. If your headaches increase after introducing a food, then you should assume it is a trigger and avoid it permanently. If the food does not result in any change in your headache pattern, you are not sensitive to it.
Paula S., a twenty-eight-year-old Italian woman, came to my office complaining of headaches that occurred three days a week. She was understandably distressed by their frequency but had noticed no particular pattern to them. Three weeks after starting the elimination diet, Paula’s headaches improved dramatically. She was feeling great, but she wanted to go back to her normal diet. As Paula slowly began to reintroduce one food at a time, she remained headache-free, until she came to her favorite cheese-filled Italian foods: ziti with mozzarella, pizza, and lasagna, which she had previously indulged in several times a week — the same frequency with which she used to get headaches!
Another patient, Carla L., had discovered that she was sensitive to aged cheeses like cheddar and Parmesan. But when she ordered a chicken Caesar salad in a restaurant one day, it never occurred to her that the small amount of cheese in the dressing would be a problem. Big mistake! Within an hour, she developed a severe migraine.
Sometimes people have reactions to foods that don’t usually cause headaches. These items are not included on the list of “forbidden” foods because they rarely cause problems. Unfortunately for some people, “rarely” is not the same as “never.”
Gail H. was a teacher who went on the headache-prevention diet. One night she ate a lobster dinner. Within an hour, she developed a severe migraine. After that episode, Gail decided to experiment, and three days later, she had lobster bisque for lunch. Within an hour, she had a migraine. Because lobster is not a common headache trigger, it is not on the list of prohibited foods. But by paying careful attention to her headache pattern, Gail was able to determine that this food had an adverse effect on her.
Michael N.’s food reaction was one of the strangest I have seen in my practice. Michael never had a headache for the first thirty-five years of his life. One day, while driving, he bought a roll of hard butterscotch candies and put one in his mouth. Within fifteen minutes, Michael developed an excruciating cluster headache. He had trouble staying on the road but was able to make it to his destination. When he arrived, he was almost totally incapacitated. Fortunately, this attack lasted for only an hour and a half. However, Michael did not make any association between his headaches and the butterscotch candy. Three days later he ate another butterscotch candy while driving his car. Once again, within fifteen minutes he had a severe clusterheadache.
Why Do Certain Foods Trigger Headaches?
What is it about these foods that trigger headaches? There is certainly no factor common to all of these foods. The truth is that while theories abound, we are a long way from knowing what really causes the pain in your head. It is probably the result of a complex interaction between the nerves, blood vessels, and biochemicals located in the brain. The details of these interactions are unclear at present, but according to one theory, constriction of blood vessels to the brain decreases blood flow to the sensory area of the brain, resulting in the aura that often accompanies migraines. The blood vessels then expand, sending pulsations of blood to the brain, producing throbbing pain. Many headache specialists think that a neurochemical called serotonin plays a crucial role in bringing about these changes in blood vessels and other brain activity, altering blood flow and setting off a complicated cascade of events in the brain that results in a headache.
Food seems to be able to cause headaches regardless of whether you tend to get migraines, cluster headaches, or tension headaches. (For a discussion of the various kinds of headaches, see page 24.)
Although a few health-care practitioners maintain that allergies to certain foods set off headaches, most experts believe that such allergies play virtually no role in causing headaches. It is more likely that substances contained within some foods trigger the headaches either by changing the amount of serotonin in the brain or by affecting the blood vessels in the head. Amines, biochemicals involved in causing blood-vessel constriction and dilation, are found not only in the brain but in many different foods, such as cheese, chocolate, nuts, and certain meats. One common amine, called tyramine, is suspected by many experts to be a major factor in triggering headaches.
Preservatives such as nitrates and sulfites, artificial sweeteners such as aspartame and saccharin, and food additives such as monosodium glutamate (MSG) have all been implicated as headache triggers. They contain amines, which alter the constriction of the blood vessels. But for many of the foods listed below, the reason they trigger headaches remains a mystery. Scientists do know that alcohol can dilate blood vessels, and this may be one reason that alcohol can cause headaches. Many alcohols also contain amines such as tyramine and histamine. Caffeine can be a good treatment for headaches when used in moderation. Paradoxically, however, when it is taken on a daily basis, it can cause more headaches. Caffeine, in fact, is one of the most common food-related causes of headaches that I see in my practice, and it’s the one thing patients often have the most resistance to giving up, until they discover that doing so can help them eliminate disabling pain.
Using This Book
All the recipes in this book have been created without using the major ingredients that are known to be headache triggers. We have noted which foods should be eaten in only small quantities and have tried to suggest the appropriate limits.
We encourage you to add your own headache recipes to ours. We would love to hear about them so we can share them with other patients. By doing so, you will be helping a fellow headache sufferer.
The list of foods that have been reported to trigger headaches is long and varied. The foods included here are the ones most commonly reported to cause headaches; that’s why it’s difficult to avoid them without following the headache-prevention diet. Some of you may be susceptible to many of these foods, others to only a few. If you are lucky, you’ll find you’re not susceptible to any of these foods. The only way to tell is by going on the headache-prevention diet. If you discover an ingredient that triggers your headaches and is not on this list, you should obviously avoid it too.
Prohibited: Beans (lima, Italian, pole, broad, fava, string, navy, pinto, garbanzo, lentils, snow peas), pickles, chili peppers, olives.
Allowed: All other fresh, frozen, dried, and canned vegetables and vegetable juices. Limit tomatoes to 1/2 cup per day; limit onions to 1/2 cup per day.
Prohibited: Dried fruits that contain preservatives (such as raisins, dates, figs, apricots), avocados, papayas, passion fruit, red plums, banana-peel extract.
Allowed: All other fresh, frozen, and canned fruits and juices. Limit citrus fruits (oranges, grapefruits, tangerines, lemons, limes) and pineapple to 1/2 cup per day. Limit bananas to 1/2 banana per day. (Technically, a tomato is a fruit, so remember to limit tomatoes to 1/2 cup per day.) Organic dried fruits without preservatives (particularly sulfites).
Breads and Cereals
Prohibited: Any fresh yeast product straight out of the oven; for example, yeast breads, crackers, pizza dough, doughnuts, soft pretzels.
Allowed: Store-bought and homemade breads (white, whole wheat, French, Italian, bagels, etc.) are fine as long as they are not straight out of the oven and have been allowed to cool (it’s OK to reheat them). Just be careful that they don’t contain other prohibited ingredients, such as raisins, nuts, chocolate, or cheeses. Likewise, you can eat all hot and cold cereals unless they contain specifically prohibited items, such as dried fruit or artificial sweeteners.
Dairy Products and Eggs
Prohibited: Most cheeses. Sour cream, whole milk, chocolate milk, buttermilk, cream.
Allowed: Skim milk or 1% homogenized milk. Cheeses: American, ricotta, cream cheese, Velveeta, pot, farmer, cottage. Skim milkbased yogurt (limit it to 1/2 cup per day). Eggs.
Prohibited: Alcoholic beverages, especially red wine; beverages containing chocolate or cocoa; diet beverages containing artificial sweeteners.
Allowed: Fruit and vegetable juices, noncaffeinated drinks (if they don’t contain artificial sweeteners). Limit caffeinated drinks, such as coffee, tea, or soda, to 2 cups (approximately 16 ounces) per day. For soda, that’s a little more than one can a day.
Prohibited: Most canned soups and bouillon cubes (they usually contain MSG, preservatives, or other prohibited ingredients).
Allowed: Homemade soups and stocks, unless they contain other specifically prohibited foods, such as beans, cheese, or large amounts of onion or tomato.
Prohibited: Chocolate, carob, and licorice; ice cream; desserts containing other prohibited foods, such as nuts or dried fruit, or those made with liqueurs; whipped cream.
Allowed: Cakes, cookies, candies, and pies, unless they contain prohibited ingredients; gelatin, sherbet, and sorbet.
Prohibited: Monosodium glutamate (MSG) and tenderizers containing MSG; soy sauce; vinegar, except for white and cider vinegars; salad dressings containing wine or vinegar, unless it is white or cider vinegar; cooking sherry; olive oil; seeds, nuts, peanuts, and peanut butter; all artificial sweeteners; preservatives, such as nitrates and sulfites; coconuts; capers. Most mustards, ketchups, and mayonnaises.
Allowed: Anything else not specifically prohibited, all herbs and spices, white vinegar, cider vinegar, honey, jams, jellies, dry mustard.
Meat and Seafood
Prohibited: Bacon, hot dogs, pepperoni, sausage, salami, bologna, ham; organs (liver and other organ meats); all aged, canned, cured, or processed meat products; caviar.
Allowed: All fresh beef, poultry, fish, or pork products, unless specifically prohibited; tuna and other canned seafood that is packed in water.
Orange Blossom French Toast
An unexpected burst of orange flavors this morning standard, which is also served with an orange sauce.
Our kids look forward to having this on Sunday mornings.
3 large eggs
Rind of 1 orange, finely grated
1/3 cup orange juice
1/2 teaspoon orange extract
6 slices day-old white bread
2 large navel oranges
2 tablespoons (1/4 stick) unsalted butter
1 tablespoon light brown sugar
2 tablespoons canola oil
Beat together the eggs, orange zest, juice, and orange extract in a baking dish large enough to hold the bread slices in a single layer. Dip both sides of each bread slice into the egg mixture. Arrange the bread slices in a single layer in the dish and let the bread soak up all the egg mixture, about 10 minutes.
Meanwhile, peel the oranges, being careful to remove all the white membrane around the outside. Using a sharp knife, separate the oranges into sections, cutting between the inner membranes. Discard the membranes and any accumulated juice.
Melt 1 tablespoon of the butter and the brown sugar in a small saucepan over low heat. When the mixture foams, add the orange sections and cook, stirring, just until heated through, about 3 minutes. Remove the orange sauce from the heat, cover, and keep warm.
Heat the oil in a large skillet or brush it onto a large griddle over medium heat. Add the remaining 1 tablespoon butter. When the butter foams, add the bread slices and cook until golden brown, turning once, about 5 minutes per side. Serve immediately with the orange sauce.
Veal Chops with Lemon-Basil Butter
This simple dish has a light, lemony flavor that enhances the taste of the veal.
2 tablespoons butter, at room temperature
1 tablespoon finely chopped fresh basil or 1 teaspoon dried, crumbled
1/2 teaspoon finely grated lemon rind
1 tablespoon fresh lemon juice
2 1-inch-thick veal loin chops
Preheat the broiler.
Combine the butter, basil, lemon rind, and lemon juice in a small bowl. Hold each chop on its edge, fat side up. With a small, sharp knife, cut through the fat and halfway through the chop to create a small pocket. Stuff some of the butter mixture into each chop, then spread the remaining butter mixture on both sides of the chops.
Place the chops on a broiler pan and broil about 4 inches from the heat, turning once, for 5 to 6 minutes per side, or until browned and tender. With a fork, pierce the chop, checking often for doneness; overcooking will toughen the veal.
Grape Tarts with Vanilla Pastry Cream
These tarts look like a fancy restaurant dessert.
The tangy grapes contrast well with the smooth pastry cream, creating a unique and satisfying dessert.
12 ounces (about 1 box) vanilla wafers
2 tablespoons unsalted butter, melted
6 large egg yolks
1/2 cup sugar
1/2 cup all-purpose flour
1 3/4 cups skim milk, heated
1 tablespoon vanilla extract
1 cup apricot preserves
3 tablespoons sugar
1 tablespoon fresh lemon juice
1 1/2 cups seedless red grapes, stemmed and halved lengthwise
1 1/2 cups seedless purple grapes, stemmed and halved lengthwise
Crust: Chop the vanilla wafers into fine crumbs in a food processor. Transfer the crumbs to a small bowl and stir in the butter. Line 6 removable-bottom 3-to-4-inch tart pans with the wafer mixture. Chill in the refrigerator.
Pastry cream: Whisk the egg yolks in a medium saucepan, gradually adding the sugar and salt. Whisk until the yolk mixture is thick and lemon colored. Sift the flour over the egg mixture and whisk it in. Gradually whisk in the milk.
Bring to a boil over medium heat, whisking constantly. The custard will start to get lumpy but will become smooth as you whisk. Reduce the heat to low and stir with a wooden spoon. Cook for 2 minutes more, stirring. Press the sauce through a fine strainer into a medium bowl and stir in vanilla. Cover the surface of the pastry cream with plastic wrap and refrigerate.
Glaze: Heat the apricot preserves, sugar, and lemon juice in a small saucepan over medium heat, stirring, until the sugar dissolves. Press the preserves through a fine strainer into a small bowl, then return to the saucepan and keep warm over low heat.
Fill the tart shells with the pastry cream. Cover the top with the grape halves cut side down, alternating red and purple, arranged close together in a circular pattern. Brush the grapes lightly with the glaze. Chill the tarts in the refrigerator. Remove the outer ring from the tart pans and let come to room temperature before serving.
Copyright © 2000 David R. Marks, M.D. and Laura Marks, M.D.