Dr. Mark Hyman on How to Handle Your Migraines

Could one too many cups of joe be causing your headaches? A group of Harvard researchers found that drinking three or more caffeinated beverages a day can trigger migraines. Thirty nine million Americans suffer from migraines, and it’s the sixth most debilitating disease in the world, according to the Migraine Research Foundation. Read my conversation below with Mark Hyman, director of the Cleveland Clinic’s Center for Functional Medicine, to get his expert tips on how you can halt your headaches once and for all! 


Katie Couric: What are your thoughts on the recent study linking three or more caffeinated beverages per day to migraines? Give us your take on the caffeine/headache connection…
Dr. Mark Hyman: Caffeine is often used in medication in small doses to treat migraines, but it also may trigger migraines in chronic headache sufferers. Over 3 cups a day seems to be associated with a higher incidence of migraine headaches. The medical advice for chronic migraine patients is to taper off caffeine.

Katie: I read that migraines affect three times as many women as men! Do we know why?Mark: Migraines have many causes including hormonal imbalances. Our lifestyle including diets high in sugar, processed food, lack of exercise, alcohol use, chronic stress all tends to increase in estrogen levels and an imbalance of estrogen and progesterone. This often gets worse as women are in their late 30’s and 40’s because of changes in the menstrual cycle. This leads to premenstrual migraines and fixing lifestyle will often help improve the estrogen/progesterone balance. Sometimes herbs such as chasteberry and B6 can help balance hormones.

Katie: In your experience as a “medical detective,” what have you found to be the most common root cause of migraines?
Mark: The most common causes of migraines include the following:

  • Food sensitivities – the most common are gluten, dairy, eggs and soy.
  • Magnesium deficiency – this affects 45% of people and is caused by chronic stress, caffeine, sugar, and alcohol intake
  • Estrogen/progesterone imbalance often fixed by lifestyle, herbs and sometimes progesterone in the second half of cycle when there are pre-menstrual migraines.
  • Imbalances in the gut flora or microbiome

Katie: I know you’ve said that a big problem with migraine treatment is that we most often treat the symptoms and not the cause. How should migraines be managed?
Mark: Here’s a great breakdown for everyone to get help finding and curing the causes at the root of their migraines…

Food Allergy/Bowel and Gut Imbalances

  • The symptoms: Fatigue, brain fog, bloating, irritable bowel syndrome, joint or muscle pain, postnasal drip and sinus congestion, and more.
  • The testing: Check an IgG food allergy panel and also check a celiac panel because wheat and gluten  are among the biggest causes of headaches and migraines. Stool testing and urine testing for yeast or bacterial imbalances that come from the gut can also be helpful.
  • The treatment: An elimination diet — getting rid of gluten, dairy, eggs, and yeast — is a good way to start. Corn can also be a common problem. Getting the gut healthy with enzymes, probiotics, and omega-3 fats is also important.

Chemical Triggers

  • The causes: A processed-food diet including aspartame, MSG (monosodium glutamate), nitrates (in deli meats), sulfites (found in wine, dried fruit, and food from salad bars) is to blame. Tyramine-containing foods like chocolate and cheese are also triggers.
  • The treatment: Get rid of additives, sweeteners, sulfites, and processed food. Eat a diet rich in whole foods and phytonutrients.

Hormonal Imbalances

  • The causes: Premenstrual syndrome with bloating, fluid retention, cravings, irritability, breast tenderness, menstrual cramps; use of an oral contraceptive pill or hormone replacement therapy; or even just being pre-menopausal, which leads to too much estrogen and not enough progesterone because of changes in ovulation.
  • The testing: Blood or saliva hormone testing looks for menopausal changes or too much estrogen.
  • The treatment: Eat a whole-foods, low-glycemic load, high-phytonutrient diet with flax, soy, and cruciferous vegetables such as broccoli, cabbage, Brussels sprouts and cauliflower. Use herbs such as Vitex, along with magnesium and B6. Avoid alcohol, caffeine, sugar, and refined carbohydrates. Exercise and stress reduction techniques  also help.

Magnesium Deficiency

  • The symptoms: Anything that feels tight or crampy like headaches, constipation, anxiety, insomnia, irritability, sensitivity to loud noises, muscle cramps or twitching, and palpitations.
  • The testing: Check red blood cell magnesium levels. Even this can be normal in the face of total body deficiency, so treatment with magnesium based on the symptoms is the first choice.
  • The treatment: Magnesium glycinate, citrate, or aspartate in doses that relieve symptoms or until you get loose bowels. If you have kidney disease of any kind, do this only with a doctor’s supervision.

Mitochondrial Imbalances

  • The symptoms: Fatigue, muscle aching, and brain fog, although sometimes the only symptom can be migraines.
  • The testing: Checking urinary organic acids can be helpful to assess the function of the mitochondria and energy production.
  • The treatment: Taking 400 mg of riboflavin (B2) twice a day and 100 to 400 mg a day of co-enzyme Q10 can be helpful, as can as other treatments to support the mitochondria.

Keep in mind that sometimes a combination of treatments is necessary. Other treatments can be helpful in selected cases, such as herbal therapies (like feverfew and butterbur,) acupuncture, homeopathy, massage, and osteopathic treatment to fix structural problems.

Katie: If you feel a migraine coming on, can anything be done to stop it from progressing?Mark: Preventing it is more effective than treating it. Sometimes you need to use migraine abortive treatment such as Imitrex.  Taking Advil or Tylenol can also help if you catch it early. If you can get intravenous magnesium it will also help a lot.

Katie: What’s the number one tip you would give to migraine sufferers to begin the road to recovery?
Mark:

  1. Do an elimination diet like the 10 Day Detox Diet
  2. Take magnesium 400-600 mg a day (ideally magnesium citrate if constipated or magnesium glycinate if normal bowels.

Katie: Thanks so much, Mark!

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