Migraine Attacks Triggered by the Food You Eat: A Conversation With Alicia Wolf

Nora McInerny:

Life sometimes has a way of blindsiding you with a feeling of being overwhelmed at the worst possible time. It could come while you're out with friends, running an important meeting, or just with your family at home, a spiraling thought that leaves you feeling helpless. That's why you have your self-care, your coping strategies. That's why you have us. I'm Nora McInerny, and this is The Head Start: Embracing the Journey, a podcast where we'll be taking all those things you usually save for your friend group out into the open so we can all find a bit of optimism.

I'll definitely be sharing my experiences and vulnerabilities, and trying to pick up some things along the way to work into my own routine, but this show isn't about me, it's about life. And wow, that just made it sound very deep, and I guess it will be deep, but it won't be heavy. For those battling Chronic Migraine, these conversations are going to be even more helpful and relatable, so definitely stick around.

This show is brought to you in partnership with AbbVie. So first, let's hear some important safety information and stay tuned to the end of the podcast for more.

Speaker 1:

Indication: BOTOX^® (onabotulinumtoxinA) is a prescription medicine that is injected into muscles and used to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years and older.

It is not known whether BOTOX is safe and effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).

Important Safety Information: BOTOX may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX:

• Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are preexisting before injection. Swallowing problems may last for several months.
  
• Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms, including loss of strength and all-over muscle weakness; double vision; blurred vision; drooping eyelids; hoarseness or change or loss of voice; trouble saying words clearly; loss of bladder control; trouble breathing; and trouble swallowing.

Please see Important Safety Information, including Boxed Warning, within this podcast or on the website below.

Nora McInerny:

Hi, everyone. Welcome back. I am so excited about this show. I'm excited about spending time with all of you over the coming weeks, and I'm excited about today's episode. We're going to talk about nutrition, but not in some all-consuming, throw out all the food in your pantry diet plan type of way.

We all know those types of plans don't work. They are unreasonable. They're unrealistic, and they just make us feel bad about ourselves. I don't need that, and you don't either. Instead, we're going to chat about how even a little bit of change in what you eat can help you have more energy.

Small things and small changes do make a big difference for me. I am a person who needs to be reminded to drink water. I am a person who will eat the same thing every day for three to six weeks, and then never look at it again. I know that when I eat better, I feel better, but do I eat better? No, I don't, because at the end of a long work day, I just want whatever, whatever is easiest, whatever is there, which means whatever my kids will eat without pitching a fit.

I have children who eat about 11 things, if I'm being generous, and several of those are just the same thing, assembled in slightly different ways, like a quesadilla or a cheesy roll-up, which is cheese, rolled up in a tortilla instead of flattened between tortillas. Very, very different. I also have a husband who does the vast majority of the cooking, so messing with his process and his domain is a touchy subject. It's like when your boss comes in 90% of the way through a project and is over your shoulder like, "Hey, have you ever thought of ..." So if you can't tell, I am a mess in this area.

I'm not a cook, I'm not someone you would follow on Instagram to get any kind of recipe from. The last time I made dinner, the garlic turned blue. Blue. I had to Google it, and it's apparently safe to eat, but it is also very unsettling, and I just tried to eat without looking at my food at all. So I feel like I might be overthinking this a bit, which is why I am looking forward to today's conversation with our guest, Alicia Wolf.

Alicia is also known as The Dizzy Cook. She has two kids, she runs her own business, and though she is not diagnosed with Chronic Migraine, she's a cookbook author and a recipe developer with a focus on people living with migraine attacks. We'll be talking to Alicia in just a bit, but first, it's time for a chat with my buddy and our resident headache specialist, Dr. Rhyne. Dr. Rhyne, welcome back.

Dr. Rhyne:

Hi, hi, hi.

Nora McInerny:

Always good to see your face. Always good to hear your voice.

Dr. Rhyne:

Same. It's cool to connect with you again to talk about my favorite subject.

Nora McInerny:

So I have talked a little bit about my relationship with cooking, nutrition. What I cannot speak to is how, for people who are living with Chronic Migraine, food is so critical. This can be a friend, this can be a foe. So I have a few questions around this.

Dr. Rhyne:

Sure.

Nora McInerny:

So you're a headache doctor, but like any good doctor, it's not like you're just looking at someone's head and being like, "Well, that's the only part of you I can see." You're also looking at their whole human experience, and a huge part of that is obviously, or maybe not obviously, is nutrition.

Dr. Rhyne:

Yeah, it's critical. I think we take it for granted because we all eat every day, drink every day, and it's just kind of a thing that we do, and that's probably where the difficulty and the stress when it comes to managing Chronic Migraine, and how nutrition fits into that becomes really hard because we don't pay a ton of attention to it, most of us, and so when all of a sudden you have to, because you see the impact that it has in terms of your headaches, it becomes a big deal. And so yeah, it's massive. We need to avoid foods that can trigger migraine attacks, and that's different for different people, and we need to focus on foods that can nourish our bodies more effectively. And so the fact that it's not a one-size-fits-all component makes this even more complicated, and so it's sort of out of sight, out of mind until it isn't.

And I can't tell you how many times patients come in and they just say, "What am I doing wrong? What am I supposed to eat? What am I not supposed to eat?" And I tell them, "I don't know, you tell me." That's how we start the conversation and talking about how this really does have to be a time where we start employing a level of mindfulness to the way that we eat, to the way that we cook, and these are huge changes for people to make in their life sometimes. And so finding somebody out there, communities out there, tools and resources out there to make that process at all easier is going to be way more valuable.

Nora McInerny:

So there's two sort of aspects to food that can become a trigger for a migraine attack. And first is just the smell, right?

Dr. Rhyne:

Yes.

Nora McInerny:

And then the second is actually eating the food. What are some of those really common smells and foods that trigger a migraine attack. And how do patients shift their diets to accommodate or account for those triggers?

Dr. Rhyne:

So the first thing that we generally will talk to patients about is just simply being honest with themselves. If this is something that's culturally part of what you do, if this is the way that you do your thing from a family standpoint, or if this is how you celebrate, be honest with yourself. If you love that glass of red wine and you're going to go celebrate somebody's graduation or a marriage, you know this is your trigger, and so sometimes if you start that way, people will just be more honest. And then, looking at really basic things like the nitrogen rich foods, the processed foods, tyramine rich foods, aged foods, artisanal foods, sometimes they'll put that down there, and then alcohol would be the first big three that we would look at, and have them better explain what's going on there.

Nora McInerny:

And there's one thing to know what your triggers are. It's another to live your life because food is not, of course, just food. Food is a way that we commune with each other. Food is a way that we show our love for one another. Food is a huge part of our social interpersonal lives.

Dr. Rhyne:

Absolutely. And so having an honest discussion with yourself, understanding where that's going to be, and looking to strategies to still be able to appreciate. I use this as an example. If you can't do pasta because you have a gluten sensitivity, and that's the thing that's going to set you off, then we start talking about doing zucchini noodles instead, for example.

Nora McInerny:

I am a celiac, not to brag. I can't have the best breads. And I think also, when you explain it to people, they are happy to accommodate. My brother-in-law famously bought gluten-free pasta sauce for $14. It's all gluten-free mostly. I'm like, "Ah, it's just tomatoes, buddy." Like it's a wheat thing." But he was like-

Dr. Rhyne:

Yeah, he wanted to make sure, man. He was going to make sure.

Nora McInerny:

He wanted to make sure.

Dr. Rhyne:

Yeah,

Nora McInerny:

He wanted to make sure. It was the cutest thing in the world. He's like, "Yes, I got this." I was like, "Thank you. Thank you so much."

I'll be right back after this break with Alicia Wolf. Stick around. Welcome back to The Head Start: Embracing the Journey. Today, we're joined by Alicia Wolf, the creator of The Dizzy Cook. That is a diet and lifestyle website for anyone living with migraine and Chronic Migraine. Alicia, welcome to the show.

Alicia Wolf:

Thank you so much for having me. I'm excited to be here.

Nora McInerny:

Well, good. Alicia, I'm going to start off with the oldest question in podcasting/radio, a question that I have asked people four years. What did you eat for breakfast today?

Alicia Wolf:

I actually had what I could whip up as fast as I could before my baby woke up, and that was scrambled eggs with a little bit of parsley and ground beef, and some strawberries and a toaster flaxseed waffle. Is that a lot?

Nora McInerny:

I don't know what I was expecting. My jaw dropped. That was beautiful. That was beautiful. That is exactly the response I should have expected from a person who can cook, and yet. And yet.

Alicia Wolf:

I mean, to be fair, the waffle was frozen, so that was easy.

Nora McInerny:

Dr. Rhyne, I don't mean to make assumptions, but I'm willing to bet that Alicia is the person on this call who had the most balanced breakfast. Can you prove me wrong?

Dr. Rhyne:

If I can get a full cup of coffee down and a little bit of toast and butter, I'm killing it, I'm doing great. But I love how you tried to make us feel better by saying, "But the waffle was frozen."

Nora McInerny:

Oh my goodness. So, Alicia, would you mind telling us a little bit about yourself? So how about where you're from, a little bit about your family. You mentioned a baby.

Alicia Wolf:

Yeah. I am from Dallas, Texas, and I have a new baby. I have a two-year-old who is very rambunctious, and I have an amazing husband, who we are about to celebrate our anniversary. We'll be married for eight years, and he has been just so amazing on this journey.

Nora McInerny:

So, Alicia, you are our food person. You proved it with your breakfast today. When it comes to your experience with migraine attacks and being mindful of nutrition at home, what does a typical day look like for you?

Alicia Wolf:

Yeah. So not every day is the same. I mean, some days, I'm dealing with really high nausea, especially if I'm having a bad attack, you don't feel like cooking, so it can look different all the time. I mean, today's breakfast was a really good one. Sometimes it looks like a smoothie, where I just try to balance everything.

So try to get at least some greens in, and then some protein with every meal. Cottage cheese is a great way to do that. A lunch for me would look like ... So I have this thing that I tell people, it's called Get a Naked Chicken for the Week, and whether that's either a chicken you roast by yourself. It's not a scandalous chicken, but it's just a chicken without a ton of seasoning on it.

And if you roast that, you can have it for almost the whole week and make soups out of it, sandwiches, chicken salad. I hate leftovers. I hate eating leftovers. I like something new every day, but you don't want to spend that effort cooking sometimes. And then for dinner, I love spicy salmon bowls, marinated in coconut aminos, which is a great sub for soy sauce, if people are sensitive to soy sauce and you have a really flavorful meal.

One thing I always like to do is the sauce. So it's really easy to make your own sauce, and that can kind of elevate any meal you have. So whether that's a homemade ranch dressing or a simple spicy mayo that you've made yourself, that can kind of elevate your meals and make them extra delicious.

Nora McInerny:

I love a sauce.

Alicia Wolf:

Yes.

Nora McInerny:

I love a sauce, and this is something that ... I don't know if we can keep this in the podcast because it is disparaging. I think my husband's great. He has one weakness, Alicia, no sauces.

Alicia Wolf:

Oh. That's not fun. To be fair, my husband's not a big sauce guy either, but I'm working on it with my toddler. He gets a sauce with everything.

Nora McInerny:

Right? Also, thank you for encouraging people to try cottage cheese.

Alicia Wolf:

Honestly, food now, there's a substitute for everything out there, so it's really easy to find if you do have sensitivities, and cottage cheese is kind of having a moment. It's very trendy right now. So I used to hate the texture, but I found that blending it really made it better, so it's a good sub that I use a lot for yogurt, and it has even more protein.

Nora McInerny:

Dr. Rhyne, you see so many Chronic Migraine patients. When you're talking to them about triggers, what are the common smells, foods, et cetera that most commonly trigger a migraine attack?

Dr. Rhyne:

So the textbook answer, which again is maybe not complete enough to really walk people through what their experiences are, when it comes to food, there are three in particular that we sort of think about, alcohol being one of them, tyramine being one of them, or nitrogen is the other, nitrates and nitrites. And the way that I try to walk my patients through understanding ... Because they come and they go, "What am I doing wrong?" It's the most heartbreaking question, right? The first answer is when it comes to food, that we want to think like a caveman.

And I'm not an anthropologist, so I say caveman like human out in the woods, that human being living in that environment, didn't have processed foods. If they cooked things, which they were, they were using fire to cook food, it was a very primitive approach to doing that. We pay a ton for it now, farm-to-table. The human body is built to consume food that way, and so trying to eat as close to that caveman diet as we can, as clean, as fresh, as unprocessed. I know this is all kitschy stuff that we hear out in the food ether, but it's true, particularly for those folks who are dealing with Chronic Migraine.

Alicia Wolf:

I love the reframing everything because there's a lot that we have to reframe as people living with migraine attacks because if you get in your head too much about it, it can be a very sad place, and to kind of look at it from a new perspective is really nice.

Nora McInerny:

Right. Alicia, I'm wondering, what are the foods that might trigger your migraine attacks that you avoid in your cooking, and how did you discover them?

Alicia Wolf:

Yeah. So there are so many different diets out there. If you look up, "What is the best diet for migraine?," I mean, you're going to get so many different opinions, and sometimes that's a paleo/keto way of eating, sometimes it's through these elimination diets. And so I thought what would be easiest for me to follow and what I kind of decided would work best in my life was to do an elimination diet. I had looked at this diet.

It was from the Johns Hopkins Migraine Center, and they had put together a list of things that could potentially be triggering. So not everyone with migraine has food triggers, but I think a lot more people do than they realize, because without fully doing an elimination and doing it correctly, it can be really, really difficult to accurately pinpoint what those food triggers might be. So how I did this was I eliminated all these things from my diet at first. The first month is just kind of adjusting and learning to clean out your pantry because I started reading labels for the first time, and that's when I started realizing, "Oh my gosh, they are putting nitrates in everything. And I am seeing all these additives and even MSG in a lot of packaged foods that I was eating that looked healthy on the outside, but when you start reading it, you realize they're even putting flavorings into raw chicken, which is crazy to me that you even have to check your raw chicken when you go to the grocery store.

Nora McInerny:

How hard is it to get a naked chicken these days?

Alicia Wolf:

Apparently very hard to get a naked chicken.

Nora McInerny:

And this episode title is called Alicia and the Naked Chicken.

Alicia Wolf:

So all of this to say, it takes about a month to kind of figure out what you're doing in this whole thing before you even really get the hang of it. And once you do, it gets a lot easier. You start finding products that you enjoy eating, and that it makes your grocery shopping experience a lot easier. I realized this diet has had a major impact on my life, not just from a standpoint of decreasing migraine attacks from me, but also providing a lot of joy and reframing my mindset when it came to cooking.

Nora McInerny:

So when in that sort of journey of discovery did you decide to create The Dizzy Cook?

Alicia Wolf:

Yeah. So I have always loved to cook in the past and it's something that's always been a part of my life, but when I started this diet, I was in a really dark place. So I had just lost my job in watch design. I was newly married, and it really felt like a part of me had died because I didn't know who I was anymore without my career. I mean, I was trying to get a promotion at work, and I was working really hard at that.

My husband and I had just came back from a trip around Asia, and we were kind of at the top of the world. We were going to try to have a family soon, and this hit me like a ton of bricks. And so I was seeing a therapist at the time, and she recommended to write down a list of all the things I love to do, and, "Where would my next career come from? How would I make any money?" And so I just wrote down all the things I loved, taking care of animals, dogs, that sort of thing, and cooking was one of them.

And that's kind of where I realized like, "Okay, I'm cooking a lot for this diet, and it's the one part of my day where my husband and I sit down together." It makes me feel like I contributed to our family, even if it's not financially, it gives me a sense of purpose, and I then just got really excited about planning out our meals. And so while I had all this cooking experience, I had never really applied it to put online for other people, so I was just kind of giving people random recipes that I had put together without amounts.

Nora McInerny:

Regular people do need the amounts, I'll say that much.

Alicia Wolf:

Yeah.

Nora McInerny:

Regular people are like, "You want me to scramble it? How many? How many eggs are we talking? Am I scrambling the whole dozen?"

Alicia Wolf:

Exactly. Yeah. No, they do need amounts, even for salt and pepper and everything. So I started putting everything online. I started measuring things, and it just really started to grow, and people started sharing the recipes and reporting back that I loved them, so became not just my mom, like, "Hey, Alicia."

"Does anyone read that? This was really good the other night."

Nora McInerny:

Shout out to moms, though. You know who I can always count on. I can always count on my mother-in-law to be the first like and the first comment for everything. And the first comment is always like, "I love it, and I love you."

Alicia Wolf:

That's so sweet. My mother-in-law is one of my best recipe testers. So I know if things are good if she's making it consistently for her family, because she's an Ina follower to the end, and so I know if I can replace Ina for at least two nights a week, that's good recipe.

Nora McInerny:

That's big. I don't know if there's a better compliment than that. I've not cooked a meal in ... I mean, I did one last week, and it was not good. The whole family sat through it.

Alicia Wolf:

But hey, it was a time with your family.

Nora McInerny:

Yeah. It was definitely something we got through together, and they were like, "Is mom going to keep cooking?"

Alicia Wolf:

Bonding.

Nora McInerny:

I was like, "Absolutely not." Okay? And just the feedback I'm getting here is enough to keep me humble. Okay. So you make The Dizzy Cook, and it really is more than just sharing recipes, Alicia. You really have built like a true community.

Alicia Wolf:

Yeah. I mean, that was really the amazing part of it, is from what I had hoped for when I just started sharing were some friends with us, and I wanted to know that I wasn't the only person out there who was struggling, and it really did bring me some of my best friends. I mean, some of which I've never met in person, which sounds so crazy to say, but your migraine friends are the ones who just really, really get you. And I feel like I can share so much with them because sometimes they understand more than some of my family or friends who don't struggle with migraine attacks. So even just to get up in the day or how difficult it is to cook some days, I mean, they will understand that versus people who don't live with this.

Nora McInerny:

The writer, Laura McKowen, she wrote that one stranger who understands what you're going through can do what all the friends and family in the world cannot. Now, I'm paraphrasing her, I'm not quoting her. But it's the power of that shared experience. Whether or not you've ever met in real life is incredibly powerful and very important.

Alicia Wolf:

Yeah. I mean, one of my favorite parts of this community I have, it's called Dizzy Cook Recipe Chat, and people just share what they made for dinner. And sometimes it's beautifully plated, and you can tell they worked really, really hard on it to share, and that just makes me feel so good. I'm so proud of them. It's amazing that something as simple as just cooking dinner can fill people with such a sense of purpose, and pride, and excitement, and just make you feel like a different person.

Nora McInerny:

I love that. Dr. Rhyne, do you see that sort of importance of community, of finding at least a person who gets it in your practice with your Chronic Migraine patients?

Dr. Rhyne:

Alicia had talked a lot about the other pieces that trigger migraine attacks, the stress hormones, the weather, the totality of triggers, and that while she's chosen food to sort of be the path that she's leading the fight in that place. I think it's really smart that she talks about the fact that it's more than just what you're putting in your mouth, it's the way that you feel too. And so, Alicia, you talked a lot about the isolation that comes with what you feel when you're sick, and there's only one way to not be isolated, and it's to be surrounded in some way, whether that's virtually or in real life, to be surrounded by people who understand.

Nora McInerny:

Okay. So, Alicia, we do like to end this show by asking our guests to share a message for people living with Chronic Migraine who might be listening to this. We don't call it advice, but do you have a message that you would like to leave our listeners with?

Alicia Wolf:

Yes. This is something that I wish someone would've been around to tell me in the beginning, but it was actually something my neurologist told me, and I was trying so hard. I was doing the diet, and the massage therapy, and the physical therapy, and all the things. I just wish someone would've told me living with migraine attacks is possible.

Nora McInerny:

Alicia, thank you so much for everything you do, for everything you shared with us today. It's just been a delight to get to know you, and thank you for doing this with me.

Alicia Wolf:

Thank you.

Nora McInerny:

Thanks for listening to The Head Start: Embracing the Journey. We hope you found something worthwhile here with us today, a new coping strategy, a relatable story, the comfort of knowing you're not alone. I am so happy to be a part of creating this community for all of us, and especially for people living with Chronic Migraine. If you haven't found a treatment plan that is working for you, please do reach out to your headache specialist to explore your options. I truly hope this has helped you find a bit of comfort and maybe a smile, maybe.

See you next episode, and stay tuned for more important safety information. The Head Start: Embracing the Journey is hosted by myself, Nora McInerny, executive produced by Yvonne Sheehan, our head of post-production is James Foster, our researcher is Ciara Kaiser, and our writer is John Irwin. Original music by Soundcat Productions and Artlist.

Please see additional Important Safety Information, including Boxed Warning, within this podcast or on the website below.