In the world of migraines, the questions outnumber the answers — especially when it comes to food.

For most people, red wine, chocolate and assorted cheeses mean a good time.

But a small portion of the 28 million Americans who suffer from migraines would tell you about the throbbing pain, the nausea, and the light and noise sensitivity that follow such indulgences.

Researchers have been examining the connections between food and migraines, trying to identify the trigger that can cause so much distress.

One challenge in finding clear links is that the triggers are not always consistent, with the exception of alcohol and caffeine.

Early research focused on migraines as a vascular disease. A chemical called tyramine, found particularly in aged cheeses and fermented meats, emerged as the likely culprit in the debilitating headaches, because it has an effect on blood vessels.

Tyramine is produced naturally from the breakdown of an amino acid. The levels of tyramine in food increase when the products are aged, fermented or stored, or in foods that are not fresh, such as aged cheeses, dried fruit and ripe avocados.

Doctors know now that migraines start in the brain. Researchers say it’s possible that tyramine can set a migraine in motion.

“Chemicals (such as tyramine) may act on the brain and produce downstream changes in the blood vessels that give rise to migraines,” said Dr. Richard Lipton, director of the Montefiore Headache Center at the Albert Einstein College of Medicine in New York.

In other words, after the migraine gets started in the brain, the blood vessels become dilated and inflamed, producing the throbbing pain many patients describe.

Tyramine could be triggering the release of chemicals that get the migraine started and then produce the changes in the blood vessels.

Some doctors believe that it’s not just food that causes migraines but a combination of factors, which would help explain why triggers are not always consistent.

In some cases food is a trigger only when a patient is stressed, is having trouble sleeping or skipped the gym.

Dr. Merle Diamond, co-director of the Diamond Headache Clinic, said the brain of a migraine patient doesn’t like change.

Migraine sufferers “have a more sensitive nervous system, so migraine patients tend to have more difficulty falling asleep at night. Migraine patients tend to be light sleepers overall; their brains are just a little more sensitive to overstimulation,” Diamond said.

Diamond, who said she sees about 1,000 patients a month, said about 30 percent of her patients have food sensitivities.

Research still has a long way to go. Dr. Michael Marmura, assistant professor of neurology at Thomas Jefferson University, which is affiliated with the Jefferson Headache Center in Philadelphia, said it is possible that some people simply get a craving before a migraine.

They satisfy their craving and still get a migraine, so they blame it on the food.

“It’s not clear if the food that they ate caused all of their headaches,” Marmura said. “It’s probably true for many of those patients but probably not true for all of them.”

This is why doctors recommend tracking what you eat.

“Keep a diary to look for connections to get to know yourself and to avoid those factors that matter in you and not in other people, because there is so much variation from person to person and the triggers matter,” Lipton said.

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By Alejandra Cancino, Tribune Newspapers