Dr. Mark Hyman Explains How to Handle Your Migraines — And Banish Them for Good

One billion people suffer from migraines worldwide, making it the third most common disease in the world, according to the American Migraine Foundation. But with so many potential triggers, how can you determine the primary cause of your migraines? Are they hormonal? Caused by stress? Or could one too many cups of joe in the morning be causing that splitting pain?

We talked to author, physician, and wellness expert Dr. Mark Hyman to get expert tips on how you can halt your headaches once and for all.

I read that migraines affect three times as many women as men. Do we know why?

Migraines have many causes, including hormonal imbalances. Our lifestyle — including diets high in sugar, processed food, lack of exercise, alcohol use, and chronic stress — tends to result in an increase in estrogen levels and an imbalance of estrogen and progesterone. This often gets worse as women are in their late 30s and 40s, because of changes in the menstrual cycle. This leads to premenstrual migraines. Fixing some lifestyle factors will often help improve the estrogen/progesterone balance, and natural supplements can also come in handy — herbs or vitamins like chasteberry and B6 can both help balance hormones, too.

In your experience as a “medical detective,” what have you found to be the most common root cause of migraines?

The most common causes of migraines include food sensitivities — and the most common of those are gluten, dairy, eggs, and soy. They can also be triggered by a magnesium deficiency, which affects 45% of people and is caused by chronic stress, caffeine, sugar, and alcohol intake.

As I said earlier, an estrogen/progesterone imbalance in the body can be another root cause of migraines, and that’s often fixed by lifestyle changes, herbs, and sometimes taking progesterone pills — especially in the second half of cycle when there are pre-menstrual migraines. And finally, some people experience migraines because of imbalances in their gut flora or microbiome.

Here’s a more comprehensive breakdown of the various causes, to help people find and cure what’s 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 in certain cases. Tyramine-containing foods like chocolate and cheese are also frequent 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. But 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 even osteopathic treatment to fix structural problems in the body.

What are your thoughts on a 2019 study that linked drinking three or more caffeinated beverages per day to migraines? Give us your take on the caffeine/headache connection.

Caffeine is often used in medication in small doses to treat migraines, but it also may trigger migraines in chronic headache sufferers. Drinking more than three cups a day seems to be associated with a higher incidence of migraine headaches, so the current medical advice for chronic migraine patients is to taper off caffeine.

What’s the number one tip you’d give to migraine sufferers to begin the road to recovery?

First, do an elimination diet to find out what your food triggers might be — I offer lots of options and a roadmap in my book, 10 Day Detox Diet. And another simple way to start would be taking a magnesium supplement, to rule out a deficiency like I mentioned earlier. Start by taking 400 to 600 mg a day — ideally magnesium citrate if you experience constipation, or magnesium glycinate if your bowel movements are normal.

If you feel a migraine coming on, can anything be done to stop it from progressing?

Preventing a migraine is more effective than treating it, so sometimes you need to use migraine abortive treatment such as Imitrex. Taking Advil or Tylenol can also help if you catch it early. It might be a longshot for some, but if you can get intravenous magnesium, that will also help a lot.