Thursday, January 28, 2010

Tyramine, Migraines, and Hypertension

Two common complaints in the ER are headache and elevated blood pressure. After dealing with the symptoms only to see the same patients return again and again with the same problems, I did some reading into some of the causes for these issues.

For migraine, it turns out that certain foods are significant triggers. Foods that contain high levels of a mono-amino acid called tyramine can cause migraines. This is the same substance that patients on the anti-depressants MAOIs are told to avoid so as to not develop seretonin syndrome. Well it turns out that many aged and processed products contain high amounts of tyramine. Here is a list:

Wine, Hard Cheese (Sharp Chedder, Swiss), Pickles, Sauerkraut, and nearly all processed meats like bologna, hot dog, sausage, bacon, corned beef, pastrami, SPAM, vienna sausages, pepperoni, soy sauce, teriaki sauce, tofu, and chocolate, etc). Pretty much all the good stuff. Cured ham is okay.

But it turns out that tyramine releases large amounts of seretonin, norepinephrine, and dopamine. That may be why these foods are so addicting because they make us feel good. But for people who suffer from migraines they can trigger one. knowing that tyramine releases seretonin and dopamine, it makes sense that the treatment for migraine is to block both seretonin and dopamine. Triptan medicines like Imitrex and Relpax are seretonin blockers, while Compazine and Reglan used in the Emergency Department limit Dopamine.

So, what about elevated blood pressure. Well, in addition to all these foods being very salty, the release of norepinephrine will cause increased blood pressure. A routine treatment for HTN is what we call a "water pill" or diuretic. Medicines like HCTZ and Lasix lower blood pressure by dehydrating the patient and stimulating the kidneys to get rid of excess water. But just so you realize how these medicines work. They really are not water pills but anti-sodium pills. The medicines really stimulate the kidneys to get rid of sodium and the water follows the sodium by osmosis. So, realize and remember, if you are eating more sodium then your kidneys and the medicines are able to get rid of, you will retain water, gain weight, have increased blood pressure, bloat, have worse circulation, swell, and slowly damage your kidneys, heart, brain, and eyes. You could even develop a fatal bleeding-type stoke if your blood pressure gets high enough. And the tryamine-norepi BP effects just go on top of the salt effects of eating these foods.

So, the message of the day kids is eat fresh.

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