Ms. H is a 40-year old patient who was recently promoted to a supervisory position on her job. She earns more, but she goes to work early and comes home late. She relates that the tension created by her new job is not worth the extra pay, but she has no alternative other than to accept the position.

Living in a two-fare zone and traveling on public transportation is rough. Her daughters, ages 14 and 17, are in high school and are doing well. In fact, they are a pleasure to come home to and are extremely supportive, with dinner usually waiting for Ms. H and her husband when they arrive home.

Ms. H had been given an antidepressant medication for her headaches, although she said she had not felt depressed. The medication made her sleepy and tired. In fact, it was interfering with her work. Several medications had also been advised.

I asked Ms. H about her eating habits. She told me that she was aware that certain foods can cause allergic headaches. In fact, the neurologist had suggested that she discontinue certain foods that have been implicated in causing headaches, such as, chocolate and ripe cheese. Fresh yeast products, too, can cause headaches due to a naturally occurring chemical called tyramine, which causes dilation of the arteries in the brain.

Ms. H knew that citrus fruits (such as orange juice), caffeine, fermented foods, pickled foods, vinegar, yogurt, cheese, cured meats, nitrites and MSG (monosodium glutamate) can cause vascular headaches. She had noticed when she discontinued the use of MSG, her headaches were less intense and almost subdued. She had to be very careful to read all labels, since MSG is substituted for regular table salt (sodium chloride) in many food preparations and seasonings. When she ate at a Chinese restaurant, she would always instruct the waiter to leave out the MSG in her order.

Yet, despite her health awareness and diet restrictions, for the past three months she still had been experiencing a return of the headaches. I asked Ms. H about her eating habits on the job. She related that when she didn’t bring her lunch, she usually ate at a fast-food restaurant. Her recent diet consisted of chicken or fish with a salad. In fact, she could recall that after eating her lunch, the headache would start within a few hours and would peak while waiting for the bus on her way home.

I decided to call the fast-food restaurant where Ms. H had her meals. I questioned the manager regarding the ingredients used to season the chicken. He told me he was not aware of the seasonings used in the food preparations because he received the finished product from another supplier. I then called the vendor and was told that MSG was one of the main ingredients in the chicken seasonings and probably was included in other dishes as well. Of course, Ms. H was told of this and her headaches subsided.

It is important that any headache that remains constant should be medically evaluated by your physician. Even medications that you are taking may cause frequent headaches and should be reported to him.

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