If you ever go on vacation with Natalie Andrews Wardel, odds are you’ll be sampling much of the area’s cuisine. That’s because, as Natalie tells it, “I’m the girl who is always saying, ‘Wait! We need to eat!’”

It’s not a fascination with food that has Natalie constantly on the hunt for the next restaurant. Rather Natalie, like half of all migraine sufferers, knows that skipping a meal will trigger a headache.

“I can’t let myself get hungry,” says Natalie, 24, of San Diego. “I can’t skip a meal. I keep a granola bar in my purse for emergencies.”

For many other migraineurs, specific foods can trigger a migraine. Alcohol (red wine in particular) and chocolate are the two most common dietary items that set off a migraine, according to the American Headache Society. Other known culprits include:

• Aspartame sweetener
• Foods like nuts and aged cheese, which contain tyramine, an amino acid that can provoke swelling in the blood vessels that triggers a migraine
• Caffeine
• Snacks, frozen entrees and other foods containing monosodium glutamate (MSG)
• Processed meats that contain nitrates such as bacon, sausages, salami and ham
• Supplements that contain caffeinated ingredients, such as extracts of black tea or guarana

Cut the Caffeine
When registered dietitian Veronica Karolewicz first meets with a migraine patient, the first thing she tells them is to stop drinking caffeinated beverages.

“We really encourage people to avoid caffeine at all costs,” says Karolewicz, of Wheaton Franciscan Comprehensive Headache Care in Racine, WI. But don’t go cold turkey. “If you drink more than two Cokes a day, taper it off over a few weeks,” she advises. “Otherwise you’ll get caffeine withdrawal headaches.”

Karolewicz recommends her patients replace the caffeinated beverages with water because dehydration also can trigger migraine.

Avoid the Additives
Karolewicz advocates a natural food diet for her patients: lots of fresh fruits and vegetables and home-cooked meals that don’t involve processed or prepared foods. This is because many of those processed foods contain MSG, which often is a migraine trigger.

Contrary to popular wisdom, Chinese food isn’t the only source of MSG—it‘s commonly found in potato chips, ramen noodles, frozen entrees, some condiments and frozen meats. Read labels and look for other names MSG goes by, including hydrolyzed protein and “natural flavoring.” And because it is so widely used in fast food restaurants, Karolewicz advises her patients not to eat out more than twice per week.

Even ‘Natural’ Can Cause Problems
Bananas, yogurt, avocados, nuts, cheese—all of these natural foods can cause debilitating pain in some migraine sufferers. That’s because they contain tyramine, an amino acid that can provoke swelling in the blood vessels that triggers a migraine. Tyramine is released in the fermentation, aging and ripening process, which means a rock-hard avocado won’t bother you, but the one ripe enough to make guacamole might.

Adopting a Trigger-Free Diet
In many cases, if red wine, chocolate or cheese is a headache trigger, migraineurs don’t have to completely stop consuming them. Having just a little once in a while may be okay. “I encourage people to have everything in moderation,” Karolewicz says. “There are some people that just aren’t willing to give things up, and that’s okay. Having one or two small pieces of chocolate a week is going to be fine. If you’re getting into large portions of food, I think that’s when it becomes a problem.”

It is very important to recognize what triggers a migraine attack. What triggers a migraine in one person may be completely harmless for another. To find out if you are sensitive to a food, remove it from your diet for two weeks and see if your migraines improve. Sometimes keeping a diary to see if that particular food triggers the migraine attack may help to recognize a trigger food.