偏頭痛
本文提出了一個假設，即偏頭痛在很多情況下是一種食源性疾病。常見的致病微生物是一系列細菌，包括用於牛奶和蔬菜發酵以及影響許多食物腐爛的乳酸桿菌菌株。這些細菌會將胺基酸轉換成生物胺。所有哺乳類生物都會使用一些胺作為神經傳導物和免疫系統，並且可以自行合成必要數量的胺。過量的胺，不論是由生物本身產生或是作為食物進入人體，都會被任何哺乳類生物體內的胺氧化酶分解。這些酵素的特殊性是由基因編碼的，因此會因人而異。有些人比其他人能更好地處理隨食物進入體內的胺。這與家族性偏頭痛的現象相符。如果過量的生物胺未被及時分解，在極端情況下會造成食物中毒，甚至致命。在較小的程度上，本文的假設是，管理不善的過量生物胺會導致偏頭痛。
美國 FDA 在其消費者頁面上，將 16 種情況歸類為食源性疾病。 [您需要知道的食源性疾病資訊].其中 14 種由細菌引起，2 種由病毒引起。沙門氏菌感染是最知名的細菌性疾病，而甲型肝炎則是最知名的病毒性食源性疾病。
偏頭痛的傳統觀點將其解釋為一種血管疾病。在先兆階段，人們認為頭骨周圍的血管收縮（或擠壓）。這會減少流向眼睛的血液，造成典型的視覺效果，如閃爍或盲點，或其他感官缺陷。然後血管會不成比例地擴張，對頭骨周圍的神經造成壓力，進而引起疼痛。
原來舊有的科學是錯誤的。在先兆和頭痛階段測量血管時，它們並沒有按照理論收縮或擴張。2009 年，Brain（世界上最重要的神經學期刊之一，自 1878 年起由牛津大學出版社出版）在標題中總結了這一風向的轉變： 「偏頭痛的血管理論 - 一個被事實摧毀的偉大故事[Brain, Volume 132, Issue 1, January 2009]
那麼，偏頭痛和皮質擴散抑制之間有什麼聯繫。對皮層擴散抑制的干擾從未阻止過偏頭痛，也從未可能通過引發皮層擴散抑制來誘發偏頭痛。所有有關皮層擴散抑制的研究都是在兔子和貓身上進行的。甚至無法證明人類存在皮層擴散性抑制，除非一個人的大腦受到嚴重損傷。原因是：皮層擴散凹陷在大腦表面傳播。它不會輕易從腦回（隆起的皺褶）跳過溝（大腦皺褶中的溝）到回；但嚴重受損的大腦不會像健康的大腦一樣有分裂的皺褶，因此皮層凹陷更容易擴散。在人類偏頭痛發作期間，從未測量過皮質擴散凹陷（神經學家為此提出了許多藉口）。 [Persistent questions]
哇 就這樣？
沒錯。
作為偏頭痛的科學解釋，皮層擴散抑鬱症很可能已經經歷了腦死亡。
然而，皮層擴散抑鬱症在神經科醫師的行銷工作中仍然非常活躍。YouTube 上有許多頭痛網站上傳的片段。神經病學家希望您僱用他們的服務......精心的診斷、昂貴的諮詢，他們會向您的保險公司收取費用。大約有 20% 的美國人患有偏頭痛 [資料來源：美國醫院頭痛研究所]： The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies]. 6500 萬名潛在病患。如果只有一半的病人會來看神經病學家，這將會是一筆巨大的財富。
神經科醫師會開神經科藥物，通常都很昂貴。因此，大型製藥公司也加入了神經科醫師的行列。
偏頭痛的血管理論、神經理論和炎症理論著重於偏頭痛發作期間所發生的事情。另一種完全不同的觀點則側重於偏頭痛發作的原因。因能避免偏頭痛發作的原因而痊癒的患者不會太在意發作期間發生了什麼。總之，他們不再受偏頭痛的折磨。
生物胺（主要是酪胺和組胺）一直被認為是偏頭痛的誘發因素。如果劑量夠高，食物中的酪胺和組胺不僅會使偏頭痛患者生病，還會使任何人生病。
在非學術性的網站中，偏頭痛患者禁用和允許食用的食物清單比比皆是。這些列表中有許多都是可疑的。影響偏頭痛患者的不是特定的食物，而是酪胺和組胺的含量。任何食物的酪胺和組胺含量都會因批次而異，並取決於多個參數。
舉個明顯的例子，在同一家店鋪購買相同的金槍魚三明治，但相隔一個星期，金槍魚三明治的組織胺含量可能會相差 1000 倍。也許他們的冰箱壞了，你永遠不會知道。
對於同一種水果，酪胺含量可能相差 100 倍，這取決於水果的採收條件和加工方式。酪胺一旦進入，就無法排出，除非整個果實都注入胺氧化酶，將胺基轉換成氨（NH3）。沸煮、攪拌甚至油炸都無法去除酪胺或組胺，但可以輕易掩蓋味道，否則就會暴露變質。
組胺和酪胺必須量化才有意義。這並不是說乳酪因為含有酪胺而被 「禁止」，而水果和蔬菜則被 「允許」。
人體使用 20 種胺基酸來合成蛋白質。其中 9 種為必需胺基酸，必須來自營養。它們是：組氨酸、異亮氨酸、亮氨酸、賴氨酸、蛋氨酸、苯丙氨酸、蘇氨酸、色氨酸、纈氨酸。另外 11 種可能來自食物，或由人體機器從必需胺基酸衍生出來。它們是：丙氨酸、精氨酸、天冬酰胺、天冬氨酸、半胱氨酸、谷氨酸、谷氨酰胺、甘氨酸、脯氨酸、絲氨酸、酪氨酸。
人體內的酵素或細菌的酵素或存在於我們食用的食物中的酵素，會透過脫羧作用 (移除二氧化碳分子) 將胺基酸轉變成胺。
胺基酸的酵素衍生物包括
Histamine (a crucial amine in the immune system) from histidine
這些胺在人體中大多具有重要的功能。尸胺、腐胺、精胺和精胺，在細胞中需要用來合成蛋白質和膜。然而，在人體病理學中，組織胺和酪胺是最相關的。而這篇文章的重點在於酪胺。
已確定下列細菌可產生酪胺：
最全面的酪胺測量清單由 Gaby Andersen、Patrick Marcinek、Nicole Sulzinger、Peter Schieberle、Dietmar Krautwurst 編寫，並於 2019 年 2 月發表在《Nutrition Reviews》期刊上。Nutrition Reviews [Food sources and biomolecular targets of tyramine ]. 準備好迎接一些驚喜。
乳製品（起司除外）
酪乳，2.2 毫克/公斤，Souci 等人（2016 年）
牛奶，未檢測到，Novella-Rodriguez 等人（2000 年）
奶油，1.7 毫克/公斤，Souci 等人（2016 年）
酸奶油，1.4 毫克/公斤，Souci 等人（2016 年）
夸克，2.4 毫克/公斤，Souci 等人（2016 年）
酸乳酪，1.3 毫克/公斤，Souci 等人（2016 年）
在三項測試中，兩項呈陰性，而完全偵測到酪胺的一項測試只發現極少量的酪胺。但請注意：變質的優格可能含有高達危險水準的酪胺。負責發酵優格的乳酸菌是將酪氨酸轉換成酪胺的冠軍。
乳酪
據報告，乳酪的測量範圍很廣。對於布里 (Brie)，在一個團隊進行的測試中，其含量範圍從未檢出到 260.0 mg/kg；對於帕馬森 (parmesan) 則為 4.0 mg/kg 到 290.0 mg/kg；對於高達 (gauda) 則為 20.0 mg/kg 到 670.0 mg/kg；對於羅克福 (roquefort) 則為 27.0 mg/kg 到 1100.0 mg/kg。至於 Edam，三組的測量結果為 13.5 mg/kg 至 310.0 mg/kg。沒有任何食品的測量結果會像乳酪一樣混亂且不平等。不同品牌或批次的同類型乳酪中的酪胺含量可能是其他品牌或批次的 50 倍以上，而您卻不知道原因何在。這可能是培養過程中的瑕疵、或陳化過程、或運輸過程中的事件。
Appenzeller, 55.0 mg/kg, Souci et al (2016)
布里 (Brie)，無檢出至 260.0 毫克/公斤，Souci et al (2016)
卡門培爾，37.0 毫克/公斤，Souci et al (2016)
切達干酪，350.0 毫克/公斤，Souci et al (2016)
130.0 毫克/公斤，Tarjan & Janossy (1978)
Edam, 310.0 mg/kg, Souci et al (2016)
13.5 毫克/公斤，Lange 等人（2002 年）
25.6 毫克/公斤，Tarjan & Janossy (1978)
Emmental, 42.0 mg/kg, Souci et al (2016)
128.7 毫克/公斤，Tarjan & Janossy (1978)
Feta, 152.0 mg/kg to 246.0 mg/kg, Valsamaki et al (2000)
Gorgonzola，8.0 毫克/公斤，Lange 等人（2002 年）
Gouda, 20.0 mg/kg to 670.0 mg/kg, Souci et al (2016)
Gruyère, 37.0 mg/kg, Souci et al (2016)
Leerdammer，未檢測到，Mayr & Schieberle (2012)
帕瑪森，4.0 毫克/公斤至 290.0 毫克/公斤，Souci 等人（2016 年）
3.75毫克/公斤，Mayr & Schieberle (2012)
羅克福乳酪，27.0 毫克/公斤至 1100.0 毫克/公斤，Souci et al (2016)
152.0 毫克/公斤，Lange 等人（2002 年）
蒂爾斯
肉類
雞肝，100.0 mg/kg, Souci et al (2016)
50.0 毫克/公斤，Tarjan & Janossy (1978)
火腿，煮熟，6.0 毫克/公斤至 108.0 毫克/公斤，Saccani 等人（2005 年）
火腿，乾燥醃製，7.5 毫克/公斤，Lange et al (2002)
4.0 毫克/公斤至 171.0 毫克/公斤，Saccani 等人（2005 年）
洋蔥香腸，32.0 毫克/公斤，Lange 等人（2002 年）
牛肝，270.0 毫克/公斤，Souci 等人（2016 年）
豬肉，新鮮肉，無檢出至 56.0 毫克/公斤，Saccani 等人（2005 年）
臘腸，77.1 毫克/公斤，Mayr & Schieberle (2012)
17.0 毫克/公斤，Lange 等人（2002 年）
魚類
鱈魚，2.0 毫克/公斤，Lange 等人（2002 年）
發酵魚醬，276.0 mg/L 至 357.0 mg/L，Kirschbaum 等人（2000 年）
鯡魚，未檢出，Lange 等人（2002 年）
鯡魚，醃製，無檢出至 3000.0 mg/kg，Souci et al (2016)
鯖魚，25.8 毫克/公斤至 27.4 毫克/公斤，Shakila et al (2001)
鹽醃鯖魚，無檢出，Shakila et al (2001)
鯖魚鹽乾，398.4 毫克/公斤至 413.8 毫克/公斤，Shakila et al (2001)
鮭魚，未檢測到，Lange 等人（2002 年）
沙丁魚，16.2 毫克/公斤至 11.8 毫克/公斤，Shakila 等人（2001 年）
油浸沙丁魚，未檢測到，Shakila et al (2001)
鹽乾沙丁魚，169.5 毫克/公斤至 178.1 毫克/公斤，Shakila 等人（2001 年）
沙丁魚，9.4 毫克/公斤至 10.7 毫克/公斤，Shakila 等人（2001 年）。
海魚，鹽乾，154.2 毫克/公斤至 154.1 毫克/公斤，Shakila et al (2001)
蝦，8.8 毫克/公斤至 12.6 毫克/公斤，Shakila 等人（2001 年）
蝦，鹽乾，693.2 毫克/公斤至 704.7 毫克/公斤，Shakila et al (2001)
金槍魚，0.06 毫克/公斤，Mayr & Schieberle (2012)
油浸鮪魚，0.72 毫克/公斤，Souci 等人（2016 年）
酒精飲料
啤酒，德國 Vollbier，1.8 mg/L 至 12.0 mg/L，Souci et al (2016)
啤酒，無酒精，1.2 mg/L，Souci et al (2016)
6.16 毫克/公升，Kalac 等人（1997 年）
葡萄酒，波特酒，0.51 mg/L，Cunha 等人（2011 年）
葡萄酒，紅酒，未檢測到至 20.0 mg/L，Souci 等人（2016 年）
葡萄酒，白葡萄酒，無檢出至 3.0，Souci 等人（2016 年）
蘋果，未檢測到，Tarjan & Janossy (1978)
蘋果汁，0.1 毫克/升，Maxa & Brandes (1993)
牛油果，23.0 毫克/公斤，Souci 等人（2016 年）
香蕉，7.0 毫克/公斤，Souci 等人（2016 年）
0.9 毫克/公斤，Lavizzari 等人（2006 年）
醋栗，未檢測到，Tarjan & Janossy (1978)
醋栗汁，鮮榨，3.26 mg/L，Maxa & Brandes (1993)
葡萄，691.0 毫克/公斤，Tarjan & Janossy (1978)
葡萄汁，0.04 毫克/公升，Cunha et al (2011)
0.1 毫克/公升，Maxa & Brandes (1993)
葡萄柚汁，鮮榨，0.1 毫克/公升，Maxa & Brandes (1993)
榛子，1.8 毫克/公斤，Lavizzari et al (2006)
柳橙，10.0 毫克/公斤，Souci 等人（2016 年）
柳橙汁，0.21 毫克/公升，Maxa & Brandes (1993)
鮮榨橙汁，0.1 mg/L 至 0.49 mg/L，Maxa & Brandes (1993)
桃，未檢測到，Tarjan & Janossy (1978)
梨，未檢出，Tarjan & Janossy (1978)
李子，未檢出至 6.0 mg/kg，Souci 等人（2016 年）
無檢出，Tarjan & Janossy (1978)
覆盆子，10.0 毫克/公斤至 90.0 毫克/公斤，Souci 等人（2016 年）
覆盆子汁，鮮榨，66.66 mg/L，Maxa & Brandes (1993)
西瓜，460.0 毫克/公斤，Tarjan & Janossy (1978)
蔬菜
甜菜根，160.0 毫克/公斤，Tarjan & Janossy (1978)
捲心菜，670.0 毫克/公斤，Tarjan & Janossy (1978)
大白菜，1.26 毫克/公斤，Simon-Sarkadi & Holzapfel (1994)
捲心菜、酸菜，20.0 毫克/公斤，Souci et al (2016)
高麗菜，發酵汁，37.1 毫克/公升至 73.0 毫克/公升，Kirschbaum 等人（2000 年）
高麗菜，930.0 毫克/公斤，Tarjan & Janossy (1978)
胡蘿蔔，0.001 毫克/公斤，Sulzinger 等人（2016 年）
119.0毫克/公斤，Tarjan & Janossy (1978)
胡蘿蔔汁，0.002 毫克/公升，Sulzinger 等人（2016 年）
花椰菜，400.0 毫克/公斤，Tarjan & Janossy (1978)
黃瓜，250.0 毫克/公斤，Tarjan & Janossy (1978)
苣荬菜，1.60 毫克/千克，Simon-Sarkadi & Holzapfel (1994)
冷凍綠豌豆，8.7 毫克/公斤，Kalac et al (2002)
菜豆，160.0 毫克/公斤，Tarjan & Janossy (1978)
冰山生菜，0.94 毫克/公斤，Simon-Sarkadi & Holzapfel (1994)
味噌，24.6 毫克/公斤至 349.0
橄欖，無檢出，Lange et al (2002)
紅辣椒，266.0 毫克/公斤，Tarjan & Janossy (1978)
馬鈴薯，1.14 毫克/公斤，Sulzinger 等人（2016 年）
840.0 毫克/公斤，Tarjan & Janossy (1978)
法式炸馬鈴薯，生吃，0.77 毫克/公斤，Sulzinger 等人（2016 年）
蘿蔔，2.73 毫克/公斤，Simon-Sarkadi & Holzapfel (1994)
蘿蔔，200.0 毫克/公斤，Tarjan & Janossy (1978)
醬油，17.7 mg/L 至 172.0 mg/L，Kirschbaum et al (2000)
16.1 mg/L 至 1699.0 mg/L，Yen (1986)
大豆，9
其他
巧克力，3.11 毫克/公斤，Mayr & Schieberle (2012)
0.3 毫克/公斤，Lavizzari 等人（2006 年）
咖啡，研磨，1.26 毫克/公斤至 16.14 毫克/公斤，Restuccia 等人（2015 年）
咖啡，沖泡，0.25 mg/L 至 1.89 mg/L，Restuccia et al (2015)
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2023 年 4 月 19 日更新
食源性疾病
偏頭痛發作期間會發生什麼？
醫療行銷
營養誘發因素
氨基酸脫羧
組胺（免疫系統中的重要胺類）來自組氨酸
來自酪氨酸的酪胺；幾種重要的神經傳導物（歸類為兒茶酚胺）也來自酪胺：多巴胺、去甲腎上腺素、腎上腺素
來自精氨酸的阿加明
由精氨酸、穀氨酰胺或鳥氨酸衍生出的普氏氨酸、精胺、精胺
來自賴氨酸、穀氨酰胺或鳥氨酸的鎘氨酸
來自苯乙丙氨酸的 ß-苯乙胺
來自色氨酸的血清素和色胺
革蘭陽性： 蘇雲金芽孢桿菌 Carnobacterium divergens1、Enterococcus durans、Enterococcus hirae、Enterococcus faecalis、Enterococcus faecium、Lactobacillus brevis、Lactobacillus curvatus、Tetragenococcus halophilus。
革蘭陰性菌 Pseudomonas entomophila, Pseudomonas putida, Pseudomonas putida, Gluconacetobacter diazotrophicus, Granulibacter bethesdensis [資料來源： Tyramine and Phenylethylamine Biosynthesis by Food Bacteria
]
酪胺
未檢測到，Mayr & Schieberle (2012)
未檢測到，Novella-Rodriguez et al (2000)
無檢出至 1.2 毫克/公斤，Shakila 等人（2001 年）
啤酒，Pilsner lager，1.4 mg/L，Souci et al (2016)
6.85 毫克/公升，Kalac 等人（1997 年）
1.93 毫克/公升，Mayr & Schieberle (2012)
0.8 mg/L 至 2.6 mg/L，Landete et al (2005)
38.8 mg/L，Tarjan & Janossy (1978)
1.40 mg/L，Marcobal 等人（2005 年）
無檢測到 0.292 mg/L，Anli et al (2004)
3.1 mg/L，Lüthy & Schlatter (1983)
110.8 mg/L, Tarjan & Janossy (1978)
1.2 mg/L 至 22.7 mg/L，Lüthy & Schlatter (1983)
水果
60.66 毫克/公斤，Mayr & Schieberle (2012)
6.0 毫克/公斤，Lange 等人（2002 年）
毫克/公斤，Kirschbaum et al (2000)
橄欖，未檢出至 49.8 毫克/公斤，Yen (1986)
2.0 毫克/公斤，Lavizzari 等人（2006 年）
法式油炸馬鈴薯，烘烤，1.77 毫克/公斤，Sulzinger 等人（2016 年）
參考資料：
20Mechanisms%20and%20Risk%20Factors&
author=G%20Andersen&author=D.%20Krautwurst&author=T%20Farooqui&
author=AA%20Farooqui&publication_year=2016&book=Trace%20Amines%20
and%20Neurological%20Disorders%3A%20
Potential%20Mechanisms%20and%20Risk%20Factors
Pressor_Test_and_the_Safety_of.2.aspx
&author=RR.%20Gainetdinov&author=D%20Krautwurst&publication_year=2017&book=Taste%20and%20Smell
Determination%20of%20biogenic%20amines%20in
%20fermented%20soybean%20foods%20by%20HPLC
&author=GC.%20Yen&publication_year=1986&journal=J%20Chinese%20
Agric%20Chem%20Soc&volume=24&pages=211-217
