Vestibular Migraine (VM) is a complex neurological disorder that affects a growing number of people worldwide. It is frequently misdiagnosed due to its varied symptoms, many of which do not include the classic migraine headache. While medications and vestibular rehabilitation remain core treatments, dietary interventions—particularly low histamine diets—are gaining popularity for managing VM symptoms.
In this blog, we explore VM in depth, how it might be associated with histamine intolerance, the role of a low histamine diet, specific foods to include or avoid, and why antihistamines alone are often ineffective. We’ll also highlight resources available and provide references from international and local research.
Understanding Vestibular Migraine
Vestibular Migraine is a type of migraine distinguished by vestibular symptoms such as vertigo, imbalance, and motion sensitivity, due to disruptions in the vestibular system that manages balance and spatial orientation.
Notably, up to 30% of VM sufferers do not experience headaches at all (Lempert et al., 2012). This makes VM a diagnostic challenge and increases the risk of delayed or incorrect treatment.
Common Symptoms of Vestibular Migraine:
- Vertigo or spinning sensations
- Dizziness
- Imbalance or unsteadiness
- Sensitivity to motion
- Nausea and vomiting
- Head pressure/Headache
- Tinnitus or ear fullness
- Visual disturbances (photophobia, visual motion sensitivity)
- Phonophobia (sensitivity to sound)
- Brain fog or cognitive fatigue
Symptoms can last from minutes to days or can be constant, with triggers including hormonal fluctuations, sleep disturbance, emotional stress, or dietary factors.
Histamine Intolerance and Its Link to Vestibular Migraine
Histamine is a biogenic amine involved in the immune system, digestion, and brain function. It’s found in many common foods. The enzyme diamine oxidase (DAO) breaks down excess histamine, but when DAO is deficient or overwhelmed, histamine builds up, resulting in intolerance.
Histamine intolerance has been associated with migraine and vestibular symptoms in sensitive individuals. High histamine levels may cause vasodilation and disrupt neurotransmitter signalling, potentially provoking vestibular migraine.
Histamine and the Vestibular System
Histamine may affect balance through H3 and H4 receptors, which regulate the release of neurotransmitters like dopamine and acetylcholine—critical to inner ear and brain balance centres (Timmerman et al., 2001).
Can a Low Histamine Diet Help?
A low histamine diet involves avoiding foods rich in histamine or that encourage histamine release. This approach has been reported to ease VM symptoms by reducing the histamine burden.
Benefits Reported by Patients:
- Fewer vertigo episodes
- More stable balance
- Reduced brain fog
- Less sound and light sensitivity
- Improved energy levels
Although formal clinical trials are limited, case studies and anecdotal experiences suggest dietary changes can help.
Some VM sufferers also explore DAO enzyme supplementation to help break down histamine from food. However, this should always be done with guidance from a naturopath, food intolerance dietician or integrative practitioner, as quality and dosing of DAO supplements vary widely.
Detailed Low Histamine Food Guide
Freshness is essential. Buy from local farmers’ markets where possible, cook food fresh, and freeze leftovers immediately.
| Category | Low Histamine (Generally safe) | High histamine (To Avoid) |
| Protein | Fresh chicken, turkey, lamb, beef (cooked same day) | Aged meats, deli ham, bacon, sausages, processed meats |
| Fish & Seafood | Fresh-caught or flash-frozen white fish (flathead, snapper, barramundi) | Tuna, salmon, prawns, sardines, mussels |
| Dairy | Ghee, coconut milk, almond milk (unsweetened) | Hard cheeses, yogurt, sour cream, buttermilk |
| Grains | Brown rice, basmati rice, quinoa, oats, millet | White bread, highly processed cereals |
| Fruits | Apples, pears, watermelon, blueberries, lychees | Strawberries, oranges, lemons, avocados, bananas |
| Vegetables | Carrots, zucchini, cucumbers, lettuce, pumpkin | Tomatoes, spinach, eggplant, capsicum, fermented vegetables |
| Legumes | Lentils (fresh-cooked), chickpeas, mung beans | Canned legumes, soybeans, tofu |
| Fats | Olive oil, macadamia oil, flaxseed oil | Canola oil, sunflower oil, margarine |
| Beverages | Still water, rooibos tea, peppermint tea | Alcohol (especially red wine & beer), kombucha, energy drinks |
| Other | Fresh herbs (parsley, basil), homemade broth, gluten-free flours | Vinegar, pickles, soy sauce, chocolate, stock cubes, Vegemite |
Note: Avoid reheated meats and fish. Use Australian-grown produce where possible to ensure freshness.
Why Antihistamines Alone May Not Help
Over-the-counter antihistamines are common first steps in managing allergy-like symptoms. But they may not sufficiently address histamine intolerance or VM.
Limitations:
1. Narrow Mechanism: Most only block H1 receptors. Histamine affects H1, H2, H3, and H4 receptors.
2. No Reduction of Histamine Levels: They block symptoms but don’t reduce histamine build-up.
3. Do Not Improve DAO Function: Histamine intolerance often stems from DAO deficiency or poor gut health.
4. Side Effects: Drowsiness, fatigue, and cognitive slowing—symptoms already challenging for VM sufferers.
Thus, comprehensive management focusing on diet and gut health is more effective in many VM cases.
Resources
- The Dizzy Cook by Alicia Wolf: A cookbook and lifestyle guide for managing VM with diet.
- Heal Your Headache by Dr. David Buchholz: Introduces the headache trigger elimination concept.
Final Thoughts
Vestibular Migraine is life-altering but manageable. For VM sufferers struggling with this condition, a low histamine diet, supported by knowledgeable health professionals, may offer substantial relief—especially if histamine intolerance plays a role.
If you suspect a histamine intolerance, consult your Vestibular Physiotherapist (such as The Vertigo Co), Naturopath, Food Intolerance Dietician or Integrative health care practitioner. Testing DAO levels, assessing gut health, and trying a structured elimination diet could make a difference.
References
- Lempert, T., Neuhauser, H. (2012). Epidemiology of vertigo, migraine and vestibular migraine. Journal of Neurology, 259(1), 10–15. https://doi.org/10.1007/s00415-011-6110-1
- Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American Journal of Clinical Nutrition, 85(5), 1185–1196. https://doi.org/10.1093/ajcn/85.5.1185
- Pinzer, T.C., Tietz, E., Waldmann, E., Schink, M., Neurath, M.F., & Zopf, Y. (2018). Low-histamine diet reduces symptoms of histamine intolerance. Clinical Nutrition, 37(3), 976–983. https://doi.org/10.1016/j.clnu.2017.04.005
- Timmerman, H., & Leurs, R. (2001). Histamine receptors: Molecular mechanisms and therapeutic prospects. Drug Development Research, 52(2), 69–79. https://doi.org/10.1002/ddr.1067https://doi.org/10.3233/VES-130474
Disclaimer: This blog is for general education and awareness. It does not substitute for professional medical advice. Please consult your healthcare provider for personalised treatment.
