Key takeaways

  • Tyramine buildup in the body is linked to migraine headaches and life threatening blood pressure spikes in people who are taking monoamine oxidase inhibitor (MAOI) antidepressants.
  • High-tyramine foods include foods that undergo fermentation, pickling, smoking, and aging. Limiting these foods may be necessary for people taking MAOIs or to limit migraine headaches.
  • It’s important to speak with your doctor before making any dietary changes. They can help ensure you are getting all the necessary nutrients and avoiding all high-tyramine foods.

Tyramine is an amino acid naturally produced by the breakdown of an amino acid called tyrosine. If you enjoy wine or fermented, smoked, or pickled foods, then chances are tyramine shows up in your diet.

Tyramine is generally safe to consume. However, if you take monoamine oxidase inhibitors (MAOIs), it is vital to limit or avoid tyramine in your diet. People with migraine headaches may also benefit from reducing tyramine.

That’s because tyramine can trigger migraine headaches, and it accumulates in your body when you’re taking MAOIs.

This article explains the relationship between tyramine and MAOIs and offers advice for different ways to limit tyramine in your diet, if you need to do so.

A note about personal perspectives

This article includes quotes that describe personal experiences. It is important to note that every person’s experience is unique and influenced by many factors, but these quotes may help add context to what it is like to live with certain conditions or health experiences.

If you’re taking MAOIs or you have migraine headaches, you may benefit from following a tyramine-free diet. It’s a good idea to speak with your doctor first to ensure you’re safe to start this diet and to get adequate nutrition.

Your adrenal glands generally respond to tyramine by releasing catecholamines — fight-or-flight chemicals that act as both hormones and neurotransmitters — into your bloodstream. These messenger chemicals include:

  • dopamine
  • norepinephrine
  • epinephrine

The catecholamines give you a boost of energy and, in turn, can elevate your blood pressure and heart rate.

Most people consume tyramine-containing foods without experiencing any negative side effects. However, the release of this hormone can cause blood pressure spikes, especially if you consume tyramine in excess.

In certain people, including those taking MAOIs, these blood pressure spikes can be harmful or life threatening. However, it’s worth noting that this is rare, as doctors may recommend antidepressants with fewer side effects.

Certain MAOIs, including some antidepressants and medications for Parkinson’s disease, can cause tyramine buildup by blocking the breakdown of tyramine in the body.

Excessive tyramine intake may lead to a hypertensive crisis that can be fatal. A hypertensive crisis can occur when your blood pressure is so high that you have a greater chance of stroke or death.

If your body struggles to break down amines, such as tyramine and histamine, you may experience allergic-type reactions to small amounts of amines. A doctor or other healthcare professional may say that you’re “amine-intolerant.”

MAOIs are a type of medication that blocks the breakdown of certain neurotransmitters in your brain, including serotonin and dopamine.

Doctors may prescribe MAOIs to help treat depression, Parkinson’s disease, and other nervous system disorders.

Although MAOIs have been around since the 1950s, they are no longer a first-line treatment for depression. This is partly due to the risk of side effects.

Instead, doctors may prescribe them for people who do not respond to other treatment options.

Which MAOIs do doctors prescribe for depression?

While MAOIs are not first-line medications for depression, the Food and Drug Administration (FDA) approves the following to treat it:

  • phenelzine (Nardil)
  • isocarboxazid (Marplan)
  • tranylcypromine (Parnate)

They may only prescribe these medications if a person doesn’t respond well to first-line treatments.

Tyramine can trigger migraine headaches in certain people. In these cases, some healthcare professionals may recommend trying a low tyramine or tyramine-free diet as a treatment for migraine.

More research is necessary to prove the effectiveness of a low tyramine diet for migraine headaches. However, if you’d like to try it, the best way to start is to familiarize yourself with tyramine sources, so you know which to consume and which to limit or avoid.

It might also be a good idea to keep a daily migraine symptom and food journal. This can help you discern any connections between certain foods and your migraine symptoms — whether these foods are high in tyramine or not.

Tasmin’s story: A tyramine-free diet for migraine

“I felt like I was at a complete loss with my chronic migraine condition. I’d been suffering with chronic migraine for over 15 years and my neurology team would just give me different medications which all came with their own side effects to manage like poor cognitive functioning, memory loss, vertigo, a speech impediment, and, in one case, suicidal ideation. I’d reached a point where I was struggling to function day-to-day. I was a shell of myself. […]

“From there, I decided to start a low tyramine (and low histamine) diet to see if it had any impact on my migraine attacks.

“Chronic migraine is a complex condition, so while I’d love to say I’m now migraine-free, that’s not the case. I still suffer with migraine attacks and will have periods where my attacks are more severe. But, moving to a low tyramine diet has allowed me to have greater control over the intensity and frequency of attacks. On average, my migraine attacks don’t last as long as they used to.

“If I eat food that releases tyramine, there’s an extremely high chance I’ll have a migraine attack the same or next day. So, by following a low-tyramine diet, I’m able to reduce my attack likelihood just by being mindful of what I’m eating.

“My quality of life is much better day-to-day as I’ve also stopped taking my preventive medications since going low-tyramine and low-histamine, meaning I now only have to navigate my migraine attacks.”

For most people who are amine-intolerant, tyramine’s effects are most obvious when excessive amounts are present. At high enough levels of tyramine, you might experience symptoms like:

  • headaches
  • nausea and vomiting
  • changes in heart rate
  • excessive salivation
  • sweating

If you think you may be sensitive to tyramine, or if you’re taking MAOIs, it’s important to report any symptoms to a healthcare professional.

If you’re taking MAOIs and experience the following symptoms, seek immediate medical care:

  • flushing
  • agitation
  • fast heartbeat
  • heart palpitations
  • muscle twitching
  • high fever
  • seizures

Certain foods have high amounts of tyramine, especially foods that go through fermentation, curing, or aging. Foods high in tyramine include:

  • fermented vegetables, including kimchi and sauerkraut
  • wine and beer
  • grapes
  • overripe fruits
  • avocado
  • pickles
  • cheese, particularly feta and cheddar
  • coffee
  • chocolate
  • cured and salt-dried meats, such as sausage and salami
  • soy sauce
  • picked or salt-dried fish

If you’re planning to try a low tyramine diet, it may be helpful to work with a dietitian to create a meal plan that avoids high tyramine foods.

Fresh, frozen, and canned meats, including poultry and fish, are acceptable for low tyramine diets. You can also include the following:

  • grains, including pasta, bread, cereal, and rice
  • non-fermented or pasteurized dairy, such as milk
  • non-fermented or pasteurized cheeses, such as cream cheese, ricotta cheese, and cottage cheese
  • fresh, canned, and frozen fruits and vegetables
  • eggs
  • raisins
  • cooking fats and oils
  • fresh and canned legumes
  • ketchup and salad dressings that don’t contain fish products or fermented foods
  • tea and soft drinks
  • certain liquors, such as bourbon, rum, vodka, and gin

If you experience side effects from any food or drink — whether it’s high or low in tyramine — it may be a good idea to discontinue eating or drinking that food or drink, and to mention the reaction to a healthcare professional.

A number of factors influence tyramine content, including a food’s production and storage methods, and its age.

Even fresh and cooked foods naturally develop tyramine as they sit in your refrigerator. Heat does not destroy tyramine, so cooking foods will not affect their tyramine content.

The following tips may help you follow a low tyramine diet:

  • Use extra caution when selecting, storing, and preparing your food.
  • Eat fresh produce promptly after purchasing.
  • Read all food and drink labels carefully to avoid trigger ingredients.
  • Avoid spoiled, aged, fermented, or pickled foods, sauces, and condiments.
  • Don’t thaw foods at room temperature. Thaw them in the refrigerator or the microwave.
  • Eat canned or frozen foods, including produce, meats, poultry, and fish, right after opening them.
  • Buy fresh meats, poultry, and fish. Eat them the same day or freeze them immediately.
  • Use caution when you eat out, because you don’t know how restaurants store their food.
  • Label food with the purchase date so you know how old it is.

Tasmin’s story: Tips for following a low tyramine diet

“I’m a foodie, so moving to a low/no tyramine diet has been a huge adjustment for me. I love cooking, eating out, and making flavorsome food. Before going low-tyramine, I’d cook a lot of Asian-inspired dishes, which were unknowingly full of tyramine. I’ve sadly had to wave goodbye to those meals. […]

“Like any diet, I think you need to approach it with a measure of balance. The diet can feel extremely restrictive if you follow it to a tee, which is hard if you’re someone who gets a lot of joy from food. But I also think the exact list of triggers is different for everyone.

“I recommend keeping a diary so you can track everything — what you eat, whether you had an attack, and all the details about how long the attack lasted, how intense it was, and so on. This will help you better understand what foods have the biggest impact, so you can start building a meal plan that works for you. For example, I know bananas, eggs, soy, and leftover food are big triggers for me, so I’ll avoid those entirely. But, things like tomato and cheese are only a trigger if I have them in large quantities, so I’ll just limit how often I eat them.”

If your doctor prescribes MAOIs, it’s important to follow their advice on the right dosage and how to take the drugs safely.

People taking MAOIs may need to avoid certain other medications, including:

  • tramadol
  • meperidine (Demerol)
  • dextromethorphan
  • methadone (Dolophine)
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • tricyclic antidepressants (TCAs)

Certain people, including those with liver problems, pregnant people, or people ages 18 and under, may not be able to take MAOIs.

Research associates tyramine buildup in the body with migraine headaches and life threatening blood pressure spikes in people who are taking MAOI antidepressants.

If you experience migraine headaches, think you may be intolerant to amines, or take MAOIs, you may want to consider a low tyramine or tyramine-free diet.

It’s important to talk with a healthcare professional first and ask them whether this diet would work well for you.