Intended for healthcare professionals

Rapid response to:


Chocolate, heart disease, and stroke. . . and other stories

BMJ 2018; 362 doi: (Published 30 August 2018) Cite this as: BMJ 2018;362:k3620

Rapid Response:

Migraine, chocolate and a phenylethylamine-oxidizing defect Re: Chocolate, heart disease, and stroke. . . and other stories

Experience at migraine clinics found that chocolate could be a cause of migraine. Those who "never touch the stuff" are likely to have discovered this for themselves which is why they avoid eating chocolate.

Edda Hannington reported a tyramine headache due to chocolate, cheese and red wine.1 Chocolate contains phenylethylamine. Patients with a phenylethylamine-oxidizing defect have learnt to avoid eating any type of chocolate.2

Migraine can be prevented by avoiding other main precipitants including contraceptive or menopausal progestogens and oestrogens, smoking and ergot medications.3,4 It is also important to replete common nutrient deficiencies - usually of zinc and magnesium. 5

1 Hannington E. Preliminary report on tyramine headache. Br Med J. 1967 May 27;2(5551):550-1.

2 Sandler M, Youdim MB, Hannington E, Corne SJ, Stephens RJ. Phenylethylamine-oxidizing defect in migraine: circulatory implications. Clin Exp Pharmacol Physiol. 1975;Suppl 2:79-81.

3 Grant ECG. Oral contraceptives, smoking, migraine and food allergies. Lancet 1978; 2: 581-2.

4 Grant ECG. Food allergies and migraine. Lancet 1979;1:966-69.

5 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance .J Nutr Environ Med 1998;8:105-116.

Competing interests: No competing interests

02 September 2018
Ellen C G Grant
Physician and medical gynaecologist
Kingston-upon-Thames, Surrey, UK