The Ultimate Elimination Diet
How I tamed my chronic, untreatable migraines and you can, too
Sr. Theresa sat at her desk wearing her usual black and white attire. Her desk, positioned at the front of the class allowed her the best view of us. We worked in silence. Once in a while, her eyes scanned the room searching for mischief. Finding none, she’d return to grading homework.
Something about this day was different.
The pain started at the base of my skull. Not so much a throbbing, but more like lightning bolts striking a tree. I stood and approached Sr. Theresa.
“I have a really bad headache.”
The anguish on my face told her everything she needed to know.
“I’m not supposed to give you this,” she reached into her desk and pulled out a small container of pills. Handing one to me, she said, “Get a drink of water and let’s see if this helps.”
A short time later while sitting at my desk attempting to begin my assignment, terror filled me. I could see the pencil in my right hand, but I couldn’t feel it. Placing it onto my desk, I massaged my hand, and then my arm. They were numb.
Panicked, but not wanting to cause a scene — this was 8th grade after all — I returned to Sr. Theresa’s desk. Tears streamed down my face.
“I can’t feel anything in my right arm!”
I don’t recall ever seeing Sr. Theresa move so fast. She wasn’t overweight or anything. It was that she, for the most part, was a calm person.
She rushed me to the office.
I lay on a couch in what might have been the teachers’ lounge. The door remained open.
When the school reached my mother, she drove me to a hospital. This is where things get fuzzy. My memories of this get jumbled with memories of other hospital visits. What I do know is that there wasn’t anything they could do to help me.
This was the beginning of going into a hospital with a migraine and leaving with one. It didn’t end until about 15 years later. But, it did end. That’s what’s important to know.
Controlling migraines without medication is possible.
My first elimination diet didn’t work
The first neurologist I agreed to see ran a bunch of tests with machines that I don’t remember the names of. He tested my balance which was only affected if I was having a migraine attack. At the end of the first appointment, he put me on an elimination diet.
He handed me a few sheets of paper with a list of what I could eat, and what I couldn’t. It seemed ridiculous to me. What college students do you know who will read every label and not eat fast food? It was the early 90s and Burger King’s Bacon-Double-Cheeseburger Deluxe was a food staple.
But, I tried.
I don’t recall everything that I couldn’t eat, but MSG and peas were on the list, as were processed meats, aged cheeses, alcohol, and citrus fruits. It was like he was telling me to become a vegetarian without outright saying it.
I’m from, “meat & potatoes” land. There were probably more cattle in Nebraska than people back then.
What I was supposed to do was remove all of the offending foods. After a month, I could choose one item from the “don’t eat” group, try it, and then wait to see if I had a migraine attack. I also had to keep a food diary.
For example, I might eat provolone cheese which used to give me a headache 30 minutes after eating it. If that happened after I’d been headache-free, then no more provolone cheese for me.
I gave up on this elimination diet a few months into it if I recall correctly.
My Ultimate Elimination Diet
I’m not a fan of diets or dieting. My preference is to make lifestyle changes. More than 20 years ago, I decided to become a vegetarian. This decision was incredibly easy. After having taken three Zomig for migraine over the course of a day, I was taken to an emergency room. The doctors gave me more drugs and kept me overnight. I left the next morning with a migraine.
That was my line in the sand. I never wanted to experience that again.
Within a few days after leaving that hospital, I read everything I could get my hands on about vegetarianism. Becoming a vegan was a lot like the elimination diet. The difference was that I was motivated to make the change.
Veganism is like a cleanse.
- Step 1: Remove all sources of dairy, eggs, and meat (including fish) from your diet forever. Not really. I was a vegan for several years, but I could have done it for one-three months like an elimination diet. The effect would have been similar.
- Step 2: Remove all sources of caffeine, including chocolate.
- Step 3: Track your migraines. This helps you identify if sleep, stress level, or weather could be a trigger for you. Migraine Buddy helps you record your migraine attack fast. The interface is simple. You record your attack and complete a few questions about what preceded it. You also can add specific notes.
- Step 4: Determine if some form vegetarianism other than veganism will work for you by reintroducing a food group. Again, wait to do this for about three months (like the elimination diet below.)
I didn’t eliminate citrus fruits. In fact, I ate almost all kinds of fruits and nuts. That’s never been a trigger for me. But, in step 1 of veganism, you could take them out, and reintroduce them in step 4.
- Laco-only: You eat dairy, but no meat, fish, or eggs.
- Lacto-Ovo: You eat dairy and eggs, but not meat, or fish.
- Ovo-only: You eat eggs, but not dairy, meat, or fish.
- Pescatarian: You eat fish, dairy, and eggs, but not meat. *Some pescatarians don’t eat eggs and/or dairy. I did this for a while, too.
Why not just do the elimination diet, again?
The difference between the Ultimate Elimination Diet and a Medical Elimination diet for me is in how I handled it psychologically.
For example, when I was trying to do the elimination diet it was all about what I couldn’t have. Every doctor appointment focused on this. In my mind, it wasn’t about getting healthy. I felt like things were being taken away from me.
Because my migraines weren’t medically treatable, I felt like they were in control. I also knew my doctors didn’t know how to help me but were forcing a diet on me that they didn’t know would work.
From a motivation perspective, I felt like I’d lost some autonomy in the decision process.
Becoming a vegan, and then following a vegetarian path, was completely my choice. When someone tried tempting me with chocolate, I didn’t feel like I was missing out anymore. I knew I was getting stronger, and having chocolate would make me sick.
But, doctors know a lot more about how to treat migraines now, and there are better medications available.
Modern-day elimination diets
Now doctors know more about how to use an elimination diet to assess triggers. They also know that while some foods might be triggers, most migraine suffers have a threshold of tolerance.
For example, I knew about how many cans of Coke I could consume in a day before I would get a migraine. I also knew not to eat aged cheeses, peanuts, or peanut butter, especially if I’d been drinking Cokes for breakfast. If I had the inklings of a migraine, I knew how much Coke to drink to stop it.
It’s all about balance.
The new elimination diets work like this:
- Step 1: Eliminate all offending foods for three months.
- Step 2: Introduce one offending food at a time.
- Step 3: After you introduce a new food, keep a diary. Note the date you had the food and your reactions if any.
- Step 4: Wait a few days before introducing another food from your avoid list.
- Step 5: When assessing reactions, review what you ate before the new food that week.
If you don’t have a reaction to a new food, it could be because you’ve built up a tolerance from your 3-month cleanse. It doesn’t automatically mean you’ll never have a reaction to it.
For example, I can eat peanuts as long as I don’t eat chocolate, drink tea, or red wine for a week or so.
Sometimes cravings for certain foods give you clues about potential triggers. I had an intense craving for Thai curry the same day I was having a series of attacks. Chances are, had I given in to that craving, the migraines would have worsened. This would have been true because what I wanted was Panang Curry which has peanuts in it.
Here are some examples of what to avoid:
- Caffeine: Coffee, tea (hot or iced), cola; even decaf coffee and tea may be a problem; try caffeine-free herbal tea
- Cheese: Avoid all cheeses except American, cream, and cottage cheese. Avoid cheese-containing foods such as pizza and macaroni-and-cheese.
- Monosodium glutamate (MSG): Chinese restaurant food, many snack foods and prepared foods, Accent and other seasoning products; MSG may be labeled as hydrolyzed vegetable/soy/plant protein, natural flavorings, yeast extract, Kombu, “broth,” “stock,” and others; read labels — note: “hydrogenated” is OK)
- Nuts: All, including nut butters (e.g., peanut butter)
- Processed meats: Those that are aged, canned, cured, marinated, tenderized, or contain nitrates or nitrites; includes hot dogs, sausage, bacon, salami, bologna, and smoked salmon
- Alcohol and vinegar: Especially red wine, champagne, and dark/heavy drinks; vodka is best tolerated; white vinegar is OK
- Citrus fruits and juices: No oranges, grapefruits, lemons, limes, pineapples, or juices from these fruits. Vitamin C and citric acid are OK
- Certain vegetables: Avoid lima, fava, and navy beans, and pea pods, sauerkraut, and onions.
- Aspartame (Nutrasweet)
Over-the-counter Medications to Avoid
- Caffeine-containing medications: Excedrin, Anacin, etc.
- “Sinus”/decongestant medications: Actifed, Sudafed, Dimetapp, Sine-Aid, Dristan, and all other “sinus” and cold products that contain decongestants; plain antihistamines without decongestants are OK
A complete list can be found from the University of Wisconsin School of Medicine and Public Health.
Migraines don’t have to ruin your day or your life. Managing them is about drawing a line in the sand and making the decision to tame them.
If you’ve struggled with implementing an elimination diet that your doc recommends, find your motivation for following through. That’s the key. Oh, and changing the language you use to describe what’s happening.
The event is the same. For example, “I have medically untreatable migraines.”
The language is where your power is.
For me, I never knew that migraines are a neurological disease. I’m glad I didn’t! That would have made them seem so much worse. That language would have made me believe there was nothing I could have done to help myself. And, if that was true, then my motivation to become a vegetarian probably wouldn’t have happened.
My language became more positive as I benefited from my new lifestyle. When people asked about my migraines, I said, “I’ve got them under control.” The fewer attacks I had reinforced my new lifestyle choice.
My migraines still weren’t medically treatable. There wasn’t a migraine-specific medication that ever worked. What worked was my decision to follow an elimination diet. Positive results led to greater confidence in my approach.
We’ve come full circle: Migraines are treatable without medication.
Will it be easy? Probably not. But, it will be worth it. You’ll have fewer times in a dark, quiet room and more time with your family and friends. And, let’s not forget the cost savings. Migraine medications are expensive, especially the new ones. What if an elimination diet reduces or eliminates your need for the medication? That would be awesome.
Elimination diets are lifestyle changes that help migraine sufferers get healthy, gain more control, and live a happier, less painful, day-to-day life.
Who doesn’t want that?
If you’d like to know more about the latest migraine treatments, feel free to shoot me a message in the comments. Thanks for reading!
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