Migraine headaches, as any sufferer
will tell you, can be debilitating, painful, and inconvenient, affecting 17% of
females, 6% of males. While over a dozen genetic markers have been identified
that predispose to migraine headaches, this condition is clearly
multifactorial, i.e., there are typically a combination of factors at
work, factors that are genetic, environmental, nutritional, and hormonal. It
also means that, rather than “treating” headaches with drugs that only provide
pain relief or address a single aspect of the condition (e.g., vessel spasm or
pain relief), trying to pinpoint the causal factors that can be
corrected may be a more rational approach.
People with migraine headaches are
susceptible to other health conditions more than would be expected by chance,
such as high blood pressure, sinus inflammation/infections, asthma, insomnia
and sleep disorders, mood disorders, and fibromyalgia. In particular,
gastrointestinal disorders have been associated with migraines, including Helicobacter
pylori infection, irritable bowel syndrome,
gastroparesis, hepatobiliary diseases, celiac disease and dysbiosis. This
suggests either a shared cause for migraines and gastrointestinal disorders
and/or overlap involving conditions such as dysbiosis/small intestinal
bacterial overgrowth. The frequency of overlap of migraines headaches with
irritable bowel syndrome (IBS) may be especially revealing, given that as many
as 84% of people with IBS also have small intestinal bacterial overgrowth
(SIBO), an association that has caused some experts to believe that IBS and
SIBO are one and the same condition.
In this Undoctored Advanced Concepts:
Preventing Migraine Headaches, we shall discuss several strategies that have
been shown to reduce the frequency and severity of migraine episodes. These
strategies are meant to correct the factors that allow migraine headaches to
emerge and are therefore not meant to be acute treatment for active
headache, but as strategies to consider to prevent future episodes.
Based on both clinical trials and
substantial anecdote, several basic practices have been shown to reduce
severity/frequency of migraines. Such practices include:
- Reduced carbohydrate intake that leads to avoidance of reactive hypoglycemia (low blood sugars that follow high blood
sugars—low blood sugar rarely occurs on its own) reduces migraine frequency.
- Avoidance of caffeine.
- Avoidance of vasoactive factors—-such
as tyramine and pheylethyalmine from foods such as wine, cheese, chocolate, and citrus fruits.
- Avoidance of aspartame—An effect of chronic, less with acute, ingestion. (A reflection of the dysbiosis provoked by aspartame?)
- Aerobic exercise—Aerobic exercise has
been shown repeatedly to reduce migraine frequency by approximately 40% with
the effect beginning within 4 weeks, although the mechanisms is unclear.
There are associations of migraines
with other conditions, associations that may suggest shared causes, as well as
It has been established that people
with celiac disease also have a higher incidence of migraine headaches, as well
as abnormalities of brain white matter seen on MRI. In one small study of
people with both gluten sensitivity and migraine headaches, 90% obtained relief
from headaches by following a gluten-free diet. (We have observed a similar
high rate of relief in the worldwide Wheat Belly experience of grain
A preliminary study of participants
with both migraine and IBS suggested that IgG food sensitivity testing followed
by elimination of foods associated with high IgG levels reduced headache
severity, duration, and need for medication by half. Other studies have
demonstrated reduction in frequency of migraines with various food
eliminations, most notably wheat; oranges; eggs; coffee, tea, and chocolate;
dairy products; beef; corn products; yeast-containing products; mushrooms;
However, we need to keep in mind that
many food sensitivites are acquired due to factors that increase
intestinal permeability, such as grain consumption and the development of small
intestinal bacterial overgrowth, in which case the real solution is not avoidance
of food associated with higher antibody levels, but correction of the cause.
Because part of the migraine headache
process is vasospasm, i.e., spasm of the arteries of the brain, a process that
can be provoked by magnesium deficiency that modulates arterial tone, magnesium
administration has been investigated as a potential means of treating
and/preventing migraines. People with migraines also have lower blood levels of
magnesium than people without migraines. Unfortunately, most studies have used
doses of magnesium, both intravenous and oral, that we would regard as too low,
even trivial. Nonetheless, while study results have varied, the studies as a
whole have demonstrated reduction and relief of migraine headaches administered
both acutely and chronically.
Magnesium restoration is therefore
among the cornerstones of the Undoctored approach to migraine relief. While
magnesium is already a component of the Undoctored Wild, Naked, Unwashed
program, because migraines can be so debilitating and many people are eager for
relief, coupled with the slow process of magnesium restoration that typically
requires years (because of the limiting factor of gastrointestinal
tolerance with moderate to higher doses resulting in diarrhea), we stress
magnesium restoration with our recipe for Magnesium Water, working to
increase tolerance and increasing the dose over time. (See discussion below.)
Assessment of magnesium status is also flawed, since most magnesium is stored
in bone and inside the tissues and cells of the body, therefore not well
reflected by serum or RBC levels that are commonly tested and underestimate the
severity of deficiency (though if low levels are measured, deficiency is
profound). Magnesium toxicity/overdose is also exceptionally rare, developing
only in people who purposefully ingest large amounts of magnesium-based
antacids over a prolonged period. For these reasons, we push the limits of
magnesium restoration to achieve migraine relief, as well as to obtain other benefits
including reduction of blood pressure and strengthening of bone/protection from
Higher homocysteine blood levels are
associated with migraine headaches, while reduction of homocysteine with B vitamins
(folates, B12, B6, and B2) correlates with reduction in severity and intensity
of migaines. (Note that higher blood homocysteine levels also predict greater
likelihood of depression and cognitive impairment/dementia.) In addition, the
fairly common MTHFR gene variant, C677T, carried by 12-25% of people, causes
poor absorption of folate (vitamin B9), reflected by increased blood levels of
homocysteine. People with migraines have a greater likelihood of carrying the
C677T gene variant and are therefore more susceptible to the effects of low
folate and higher homocysteine levels.
In one study, for example, a
combination of folic acid 2 mg + vitamin B6 25 mg + vitamin B12 400 mcg vs.
placebo was shown to reduce migraine frequency by 75%, severity by 25%, along
with 39% reduction in homocysteine from a starting level of 10.8 micromol/L (a
level regarded as “normal” in most lab reports). Benefits were most marked in
carriers of the MTHFR C677T genotype. Riboflavin has also been shown to reduce
migraines; see below in the discussion re: mitochondrial dysfunction.
Unfortunately, the methyl-form of
folate that is more effective in increasing blood folate levels in people with
MTHFR C677T has not been explored in any clinical study, but should be expected
to be more effective in both reducing homocysteine and frequency/severity of
migraine headaches than synthetic folic acid or folates and side-steps the
suspected increased cancer rate that may occur with folic acid (due to higher
blood levels of unmetabolized folic acid).
Interestingly, SIBO is not uncommonly
associated with poor absorption of folate and B12, potentially magnifying
deficiency of these nutrients, especially in those with the MTHFR C677T
Several nutrients that participate in
mitochondrial energy generation have been shown to reduce severity/frequency of
migraines, most notably coenzyme Q10 and riboflavin.
Doses of coenzyme Q10 (CoQ10) as
ubiquinone that provide headache relief range from 100 to 300 mg per day. The
ubiquinol form of CoQ10, as compared to the more common ubiquinone, is better
absorbed and can allow lower doses to be used, e.g., 50-100 mg per day. There
may also be advantages in more than once-per-day dosing (doses divided into
twice- or three-times-per-day).
Riboflavin, vitamin B2, a factor in
mitochondrial energy generation (as well as its contribution to homocysteine,
above), has been shown in several clinical studies to reduce frequency and
severity of migraines. (Because riboflavin is found in higher quantities in
organ meats, especially liver, as well as meats and eggs, could this apparent
increased need for riboflavin simply be a reflection of our modern failure to
consume organ meats?) The dose most commonly used in clinical trials has been
400 mg, but 100-200 mg per day has also shown effectiveness.
The combination of CoQ10 with
riboflavin appears to be more effective than either alone.
There is axcess of H. pylori
infection of the stomach in people with migraines. A meta-analysis of five
studies and over 900 participants demonstrated that H. pylori was
present in 45% of people with migraines, 33% in those without migraines.
Migraine sufferers also have higher levels of antibodies (IgM and IgG) against H.
pylori, suggesting a uniquely amplified immune response against this
organism, though for unclear reasons. Accordingly, antibiotic treatment of H.
pylori infection yields reduction in migraine frequency/severity in
approximately a quarter of people treated.
There is another layer to this
conversation, however. H. pylori is also a common cause for hypo- or
achlorhydria, i.e., low or absent stomach acid. Stomach acid is an effective
barrier to microorganisms that can ascend up from the lower intestine. With
inadequate stomach acid, bacteria can more readily ascend up from the colon,
ileum, then jejunum and duodenum and, finally, the stomach—this is small
intestinal bacterial overgrowth (SIBO). You may recall from our discussions
about SIBO that irritable bowel syndrome (IBS) and SIBO are likely one and the
same, or at least have extensive overlap and that up to 84% of people with IBS
have SIBO, even with flawed methods of diagnosis. It therefore stands to reason
that people with migraine headaches who have markedly greater likelihood of
having IBS (and vice versa) are also very likely to have SIBO. This therefore
suggests that addressing SIBO may be another path to follow to obtain relief
from migraine headaches.
In addition to the basic practices
listed above that are worth exploring for anyone with migraine headaches, the
elements of the Undoctored Wild, Naked, Unwashed program that have beneficial
effects on migraine headaches include:
Grain elimination/carb limitation
There are several ways in which our dietary approach can
reduce, sometimes eliminate, migraine headaches: weight loss and reduction in
insulin resistance, elimination of hyperglycemia/hypoglycemia cycles provoked
by grains and sugars, removal of the gliadin protein of wheat and related
grains (“gluten-free”), restoration of magnesium absorption through elimination
of grain phytates.
Magnesium is front and center, the centerpiece of any
migraine-preventing effort after the diet. You are strongly urged to use Magnesium
Water as the preferred source for magnesium, as it is the most absorbable
form available, magnesium bicarbonate. Because it requires years to restore
tissue magnesium levels, anyone with migraines ideally uses the Magnesium Water
form that accelerates magnesium repletion.
We begin with four ounces (1/2 cup)
twice per day. Each serving provides 90 mg of elemental magnesium; four ounces
twice per day therefore yields 180 mg per day. It is important to increase the
dose over time to eventually achieve 8 ounces (one cup) twice per day to
provide 360 mg per day.
Yield : 2 liters
2-liter bottle of seltzer/carbonated water (not tonic water,
i.e., containing no sugar)
3 tablespoons unflavored milk of magnesia
Naturally flavored extracts and/or sweetener
Uncap the seltzer and pour off a few tablespoons. Shake the milk
of magnesia and pour out 3 tablespoons. (Most brands come with a handy little
measuring cup that works perfectly.) Pour the milk of magnesia into the seltzer
slowly, followed by the extract and sweetener.
Cap the bottle securely, and shake until all the sediment has
dissolved. Let the mixture sit for 15 minutes and allow to clarify. If any
sediment remains, shake again. Drink as instructed above.
By itself, vitamin D appears to not be effective for
migraine prevention. However, a subset of people experience improved
responsiveness to other therapies when vitamin D is added, an effect that is
likely driven by genetic variation.
As a sole agent, the omega-3 acids have only a modest
effect that appears to mostly achieve a reduction in duration of migraines, but
not in frequency or duration. However, in the context of all other strategies,
the benefits may be magnified.
Correction of dysbiosis
The basic Undoctored bowel flora-cultivating efforts of
introducing a high-potency, multi-species probiotic, fermented foods, and daily
prebiotic fibers corrects dysbiosis in most people. However, if you prove
intolerant to prebiotic fibers, you will need to explore SIBO; more on SIBO can
be found in the Undoctored Inner Circle video library. There is also an
Undoctored Protocol for SIBO.
If the above strategies do not provide
full relief from migraine headaches, consider:
If homocysteine is elevated,
particularly above 8 micromol/L, methylfolate 800 mcg + methyl-B12 1000 mcg can
be considered. Also consider 50 mg of pyridoxal-5’-phosphate (a form of vitamin
B6) and riboflavin 100-400 mg per day.
The above regimen should also be
considered if the MTHFR C677T variant is identified.
Taking both riboflavin and CoQ10 in
combination is likely more effective than either alone.
Riboflavin (vitamin B2) 100-400 mg per
Coenzyme Q10 (ubiquinone)—100 mg per
day, increase to 300 mg per day to gauge effect. If ubiquinol is used, 50-100
mg per day is the dose. Ideally, ubiquinone or ubiquinol doses are divided into
two or three doses.
H. pylori and SIBO
Undergo assessment for H. pylori,
followed by eradication therapy
Undergo assessment for SIBO or
initiate empiric therapy (as discussed in the SIBO Undoctored Protocol)
Migraines and metabolic distortions
Carotenuto M, Altieri L et al. Migraine and obesity: metabolic
parameters and response to a weight loss programme. Pediatr Obes. 2015;10:220–5.
Gluten/grains and migraines
Bürk K, Farecki ML, Lamprecht G et al. Neurological symptoms in patients with biopsy
proven celiac disease. Mov Disord. 2009;24:2358–62.
Hadjivassiliou M, Grünewald RA, Lawden
M et a;. Headache and CNS white matter abnormalities associated with gluten
sensitivity. Neurology. 2001;56:385–388.
Lionetti E, Francavilla R, Maiuri L et al. Headache in pediatric patients with celiac disease
and its prevalence as a diagnostic clue. J Pediatr Gastroenterol Nutr.
Migraines and exercise
MB, Bond DS, Lipton RB et al. Aerobic Exercise for Reducing Migraine Burden:
Mechanisms, Markers, and Models of Change Processes. Headache 2016 Feb;56(2):357-69.
Migraines and magnesium
Chiu HY, Yeh TH, Huang YC, Chen PY.
Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis
of Randomized Controlled Trials. Pain Physician 2016 Jan;19(1):E97-112.
Mauskop A, Varughese J. Why all
migraine patients should be treated with magnesium. J Neural Transm 2012
Omega-3 fatty acids and migraines
Maghsoumi-Norouzabad L, Mansoori A,
Abed R, Shishehbor F. Effects of omega-3 fatty acids on the frequency,
severity, and duration of migraine attacks: A systematic review and
meta-analysis. Nutr Neurosci 2017 Jun 30:1-10.
Vitamin D and migraines
A, Turan MI, Tan H. Effect of vitamin D therapy in addition to amitriptyline on
migraine attacks in pediatric patients. Braz J Med Biol Res 2014
Mitochondrial dysfunction and
Boehnke C, Reuter
U, Flach U et al. High-dose riboflavin treatment
is efficacious in migraine prophylaxis: an open study in a tertiary care
centre. Eur J Neurol. 2004;11(7):475–77.
Langsjoen PH, Langsjoen AM. Comparison
study of plasma coenzyme Q10 levels in healthy subjects supplemented with
ubiquinol versus ubiquinone. Clin Pharmacol Drug Dev 2014 Jan;3(1):13-7.
Sandor PS, Di Clemente L, Coppola G et
al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled
trial. Neurology 2005 Feb 22;64(4):713-5.
Shoeibi A, Olfati N Soltani Sabi M et
al. Effectiveness of coenzyme Q10 in prophylactic treatment of migraine
headache: an open-label, add-on, controlled trial. Acta Neurol Belg 2017
Yorns WR, Hardison HH. Mitochondrial dysfunction in migraine. Semin Pediatr Neurol
Migraines, homocysteine, and MTHFR
Lea R, Colson N, Quinlan S et al. The
effects of vitamin supplementation and MTHFR (C677T) genotype on
homocysteine-lowering and migraine disability. Pharmacogenet Genomics 2009
Menon S, Lea R, Roy B et al. Genotypes
of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine
disability in response to vitamin supplementation. Pharmacogenet Genomics
Oterino A, Toriello, Valle N et al.
The relationship between homocysteine and genes of folate-related enzymes in
migraine patients. Headache 2010 Jan;50(1):99-168.
IBS and migraine headaches
EI, Dikmen PY, Tiftikci A et al. IgG-based elimination diet in migraine plus
irritable bowel syndrome. Headache. 2013;53:514–25.
FY, Lu CL. Irritable bowel syndrome and migraine: bystanders or partners? J
Neurogastroenterol Motil 2013 Jul;19(3):301-11.
JA, Rothman KJ, Cabral HJ et al. Migraine, fibromyalgia, and depression among
people with IBS: a prevalence study. BMC Gastroenterol. 2006;6:26.
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H pylori and migraine headaches
Ansari B, Basiri
K, Meamar R et al. Association of Helicobacter
pylori antibodies and severity of migraine
attack. Iran J Neurol. 2015;14:125–9.
Savi L, Ribaldone DG, Fagoonee S, Pellicano R. Is Helicobacter
pylori the infectious trigger for headache?:
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probiotics, and migraines
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Ecologic®Barrier on migraine: results of an open-label pilot study. Benef
to Forum discussion.
Many people obtain complete relief from their chronic migraine headaches just by engaging in the Undoctored basic Wild-Naked-Unwashed program. In particular, wheat and grain elimination can provide complete relief, or partial relief, from migraine headaches in a lot of people. But there's an occasional person who does everything right in the basic program, but still may be left with at least some headaches — maybe less frequent, less duration, or less severe; but still have headaches. What can you do in that situation? Well, there are additional steps you can take. This is all detailed in the Undoctored Advanced Concepts for preventing migraine headaches.
Among the strategies we talk about there is using magnesium a little differently. We're all deficient in magnesium at the start of your program. That's why we advocate everybody taking magnesium supplement. But magnesium is restored over years. If you start a magnesium supplement on Monday, you're not restored by Wednesday. It takes years to restore tissue magnesium, including sufficient magnesium to modulate the vasospasm, the vessel spasm that is part of the cause of migraine headaches.
Magnesium Water Recipe
So I urge you to use the magnesium water recipe because that's the best we have. That simple recipe yields magnesium bicarbonate, that is by far the most absorbable form of magnesium ,and raises magnesium tissue levels faster. Even that's slow — it's not as fast as say intravenous magnesium I used to give people in the hospital when they had life-threatening heart rhythms — because that works within minutes — very rapidly; mega dose magnesium within minutes. We can't do that, of course, at home on your own, so we go to the next best, which is magnesium water — far better than the tablet or capsule forms of magnesium. You build a dose up over time and this alone is a very big advantage.
Homocysteine, MTHFR C677T
Another strategy to consider is to have your homocysteine levels drawn, because the higher your homocysteine the more likely it's a part of the list of causes of your migraine headaches — especially if you have a gene called MTHFR C677T. That specific gene, that impairs your capacity to absorb folate or folic acid, and B12 to some degree, can amplify your potential for migraine headaches. So we talk about how to address that issue, and how to correct it. Those strategies alone also provide a lot of people with relief from migraine headaches.
There are what I call mitochondrial strategies. It's clear that many people with migraine headaches have a genetic variant in their mitochondria (the energy producing little components within all your body's cells). Some people respond very well to nutrients like riboflavin and Coenzyme Q10, because those are both involved in mitochondrial energy generation.
There are some other strategies to consider, but that's the basic menu of items to consider if you have migraine headaches that persist even though you've done all the basic components of the Undoctored Wild-Naked-Unwashed program.