Aged cheese, tyramine and migraine

Where the idea came from

The tyramine theory dates from work by Hanington in the 1960s (described in MacGregor 2016). In a capsule study of diet-sensitive patients, headache followed tyramine on 78% of occasions and lactose on 6% (Hanington, reported in Peatfield 2003). Cheese is still widely named. In a clinic study of 126 patients, milk and cheese were linked to migraine in 10.3% (reported in Hindiyeh 2020). The Migraine Trust says dairy, especially cheese, is commonly reported, but study results are inconclusive.

What controlled studies show

Study	Design	People	Result
Moffett 1972	Double-blind, placebo-controlled, capsules	25 with migraine, including a group with diet-related attacks	No significant relationship between tyramine and headache
Ziegler 1977	Double-blind controlled trial, 200 mg tyramine	80 with migraine	Tyramine provoked headache in 8. In 7 of them retested, this did not repeat. Placebo provoked as-severe headaches in more patients
Jansen 2003	Review of oral challenge studies	13 studies of biogenic amines	2 conclusive studies on tyramine and migraine, both negative
Sudharta 2023	Systematic review	7 non-randomised studies, 322 people	Headache in 17.2% to 50% after tyramine, 0% to 42.1% after placebo. Link unclear

Ziegler concluded that dietary tyramine alone is rarely, if ever, the main trigger of an attack, though it might play a part under certain conditions. Jansen concluded that there is no scientific basis for dietary advice on biogenic amines in these patients.

Limits of this evidence

• The studies are old, and the 2023 review rated risk of bias as moderate in six studies and serious in one.
• Several tested tyramine itself, not cheese. A negative tyramine result does not rule out another component of cheese.
• The 2023 review’s abstract reports headache and does not say that attacks met migraine criteria.

If you take an MAOI

This is a separate safety issue. Monoamine oxidase inhibitors block the breakdown of tyramine. Mayo Clinic warns that with an MAOI, high-tyramine foods can cause a serious spike in blood pressure that may need emergency treatment. The evidence on this page concerns migraine only and does not change your prescriber’s food instructions.

How to check it in your diary

1. Log the type of cheese, amount and time. Mayo Clinic lists aged cheddar, Swiss and Parmesan as generally high in tyramine, and fresh cheeses as less likely to be.
2. Log the rest of the meal. Wine, cured meat or a late dinner can come with the cheese and need their own entries.
3. Use one time window. The American Migraine Foundation’s rule is a headache within 24 hours of the food.
4. Count cheese days with no attack.

The Migraine Trust does not recommend cutting out foods unless you are sure one affects you. The American Migraine Foundation warns against removing all suspect foods at once. Discuss restrictive diets with a clinician. For the general method, see how to test a suspected trigger.