Office Hours: 6 Root Causes of Migraines (And How to Fix Them)

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a sixteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

Connect with Mark

Podcast Facebook Twitter Instagram Youtube

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman  0:00
If you've ever had a migraine, you know this isn't just a headache. It's the pounding pain, the nausea, the sensitivity to light and sound. Sometimes it's so severe, you can't function at all. And for many people, the message they get is simple. Take medication, avoid your triggers, learn to live with But here's the problem.

That approach may help manage symptoms, but it doesn't explain why this is happening in the first place. Because migraines aren't random, they're not just genetic, and they're not just about your head. Migraines are a whole body issue. They involve inflammation, hormones, blood sugar control, gut health, your nervous system, and lots more. So today, I want to walk you through a functional medicine approach to migraines.

Not just how to treat them, but how to understand and prevent them at the root. So what is a migraine? Well, let's start with the basics. A migraine is not just a headache. It's a neurological event.

It can include throbbing or one-sided pain, nausea or vomiting, sensitivity to light and sound, visual disturbances like an aura, and often brain fog or fatigue. So what's actually happening? Well, the brain becomes more sensitive and more reactive. There's inflammation. There's dysregulation in blood vessels and nerve signaling.

And the nervous system is more activated than it really should be. And here's the point. Migraines are a signal. They're not the problem. What are the root causes of migraines?

Well, this is where we shift the conversation. Instead of asking, how do we stop a migraine? We ask, what's driving it? So let's walk through the most common root causes. Inflammation.

Chronic low grade inflammation is one of the biggest drivers of migraines. This can come from ultra processed foods. It can come from food sensitivities like gluten or dairy, poor gut health, and environmental toxins. Inflammation makes the brain more sensitive. It lowers your threshold for a migraine.

Blood sugar imbalance, well, that's one of the most overlooked triggers. If your blood sugar is constantly spiking and crashing, your brain feels it. Skipping meals, eating a lot of refined carbs or sugar, or going long periods without food, all of these can trigger migraines. Your brain needs steady fuel. And when that fuel becomes unstable, it creates stress in the system.

This episode is brought to you by Function Health, empowering you to live a 100 healthy years with over a 160 lab tests for just $365 a year, and use the code Mark twenty twenty six to get $50 off your membership. The next thing that can often be a factor is hormone fluctuations, especially for women. Now many women notice that their migraines follow a pattern, and that's not a coincidence. Migraines most commonly happen right before their period starts in the few days leading up to menstruation. So why did that happen?

Because that's what estrogen levels drop sharply. Estrogen plays a big role in the brain. It helps regulate neurotransmitters like serotonin. It has anti inflammatory effects. So when estrogen suddenly falls, it can increase inflammation.

It can disrupt brain signaling. It can make the nervous system just more sensitive. That combination can trigger a migraine. Some women also experience migraines around ovulation when hormones shift again, or during menopause when estrogen levels become more unpredictable, and so does progesterone. So it's not just about having too much or too little estrogen.

It's about fluctuations and instability. And hormones influence inflammation, influence brain chemistry. They influence how you react to your system is. And that's why many women who experience migraines on a cyclical basis. And why actually tracking your cycle can be one of the most powerful tools for understanding your triggers, and then you can actually do something about it.

The next big factor is gut health. Now there's a powerful connection between your gut and your brain. It plays a major role in migraines. In fact, we often call this the gut brain axis. Your gut is constantly communicating with your brain through the nervous system, the immune system, and even chemical messengers like neurotransmitters.

So when something is off in the gut, your brain feels it. Common issues we see include dysbiosis, which is an imbalance of gut bacteria, leaky gut where in the intestinal lining becomes more permeable, and food sensitivities, which can trigger immune reactions and brain inflammation. All of these can increase inflammation throughout the whole body, and inflammation is one of the biggest drivers of migraines. But it doesn't stop there. About 90% of your serotonin, a key neurotransmitter involved in mood and pain regulation, is actually produced in the gut.

So when your gut's out of balance, it can disrupt your brain chemistry, it can lower your threshold for stress, and it can make your nervous system just more reactive. And that's why so many people with migraines also experiencing bloating, irritable bowel syndrome, or other digestive symptoms. Now your gut is not just about digestion. It's a central hub for your immune system, your hormones, your brain. And when you start to heal the gut, you often see improvements not just in digestion, but in migraines as well.

And I've had many patients I treated with serious gut issues that fix their migraines, so it really works. The next big factor in migraines could be nutritional deficiencies, and there's a few critical ones for brain health. One is magnesium. And I had a patient who was a radiation oncologist from Mayo, a resident who had intractable migraines, and she was on narcotics, and they had nausea pills that were like but they get chemo patients. It was bad.

And turned out she just had a magnesium deficiency, and we treat her magnesium deficiency, and her migraines went away. It's not always that simple, but for her it was. Also, b vitamins are really important, especially riboflavin or b two, and also coenzyme q 10 is important in mitochondrial function, and that can be a factor also in migraines. They're not just one kind of migraine. And migraines are not because of the side they're on or where they are, but because of the cause.

So it could be hormones. It could be gut. It could be nutrients. So you've got to figure out what the issues are. Could be mitochondria.

And they nutrients basically support energy production in the brain, and they help regulate nerve function. So when you're low, your whole system becomes more vulnerable. Another big factor is nervous system dysregulation. This is a big one. You know, stress doesn't just trigger migraines.

It lowers your resilience. Your body's constantly in fight or flight mode. You're more sensitive to everything. You're sensitive to poor sleep, to chronic stress, to overstimulation. All of this keeps your nervous system activated, and that makes it much easier for migraine to happen.

So why does conventional medicine not work so well? Where does it fall short short? Well, medications can be helpful for sure, and they can be lifesaving. And for some people, they're necessary, but they don't address the root causes. They don't fix the inflammation.

They don't stabilize blood sugar. They don't heal the gut. They don't regulate the nervous system. In some cases, they can even lead to rebound headaches, meaning you take the drug and you get another headache. So if you don't change the underlying terrain, the pattern continues.

So what can you actually do? What helps? Let's walk through a functional medicine approach. First is stabilize your blood sugar. One the most overlooked drivers of migraines is just unstable blood sugar, which affects so many Americans.

When your sugar spikes and then crashes throughout the day, it just creates a stress in the body. And for some people, that's enough to trigger a migraine. So it's one of the simplest and the most effective places to start. So how do you do that? We'll focus on protein with every meal, good fats.

The protein helps slow digestion, helps your energy more stable. Try not to skip meals, you know, especially early in the day. Long gaps without food can set you up for these drops in blood sugar. And be mindful of refined carbs and sugar like pastries, white bread, sugary snacks because they cause quick spikes and then you get crashes in your blood sugar. And for many people, stabilizing blood sugar alone can really dramatically reduce the frequency of migraines.

So if that doesn't work, what else can you do? Well, you wanna identify food triggers. Another key piece is identifying your personal food triggers because migraines are highly personal. What triggers one person may not affect someone else in the same way. So there are some common patterns we see.

Foods like gluten, that's a big one, and that would be an easy one to to to get rid of to see if your migraines go away. Dairy, another big one. Wine, especially, alcohol in general, but wine especially because of sulfites. Highly processed foods. There's a lot of additives, chemicals, things that can be all serious triggers.

The challenge is these reactions aren't always immediate. Sometimes there's a late response, which kinda makes it harder to connect the dots. So you might eat some on Monday, but you get your migraine on Wednesday. Right? And that's where an elimination diet can really be helpful.

If you get rid of all the common triggers for a period of time and you reintroduce them intentionally, you can actually start to see how your body responds, and that awareness is really powerful. In fact, we have something called the ten day detox diet. You can go to 10daydetoxdiet.com, and it guides you through a whole elimination diet. It can be very powerful, and often that is enough to get rid of your migraines, just that alone. Next thing would be to reduce inflammation.

Now at a deeper level, migraines are really about inflammation in the body. So the goal is to create an internal environment that's calmer, more stable, and that starts with your overall diet. Right? Whole real foods, lots of good fats, omega threes, fatty fish, walnuts, flaxseeds, help counter inflammation. So you want to eat a wide variety of cultural plants, vegetables, fruits, herbs, nuts, seeds, all of these provide antioxidants to support your system.

At the same time, you want to get rid of the ultra processed food. There's no world in which we should be eating any of that. I think the safe limit is zero in my view. I mean, if you have a Sickers bar once in while, it's not going to kill you, but I'm just telling you that this is not part of a human diet. These are not actually technically food by the definition of the dictionary, which is something that supports the health of an organism, which these don't.

So because they they tend to drive inflammation, they really disrupt your body's overall balance. So when you lower the overall inflammation in the body, you often lower the thresholds for migraines as well. Okay. The next big thing you wanna do is support the gut. Your gut plays a much bigger role in migraines than most people realize.

There's a huge connection between gut health and brain health. And I I remember one patient where I literally treated her migraines with antibiotics to clear out the bad bugs in her gut, and her migraines went away. So it can be something that obvious or simple, which traditional doctors generally don't do. So supporting your gut can have a really powerful impact on how often migraines occur. So how do you do that?

Well, lots of fiber, vegetables, fruits, nuts, seeds help feed the beneficial bacteria, prebiotic foods, fermented foods, things like sauerkraut, kimchi, yogurt, all help a healthy microbiome. Now but for some people, there may be more serious issues at play, dysbiosis, food sensitivities, inflammation from other factors, infections, those need to be addressed. Yeast overgrowth, fungal overgrowth, bacterial overgrowth all need to be addressed. Parasites, they they can be factors, and they can be treated with a good functional medicine doctor. Now the big idea and by the way, we're at Ultra Wellness Center.

We have a great practice and lots of great doctors who can come see us in Lenox, Massachusetts. Now the big idea is this. When your gut improves, your brain often follows. And for many people, this is a key part of producing migraines. Alright.

What can we do besides all that? Well, put back the nutrients that are missing, and testing is really important here because you don't want to guess, you want to test. You want to know what your body actually needs. So getting comprehensive labs like we do at function health can help you understand your nutrient levels and identify what you're deficient in. And we see about seventy percent of people with deficiencies in nutrients, including b twelve, including magnesium, including omega threes, co q ten, all the things that are really quite important.

And you can look at magnesium. You can look at riboflavin, including co q ten. You can look at some of these key nutrients that are critical for brain energy and proper nerve function. And when your levels are low, well, your system becomes way more vulnerable to migraines. Here's a statistic that should bother you.

Women are more likely to be told their labs are normal, more likely to experience delays in diagnosis for certain conditions, and more likely to leave the doctor's office without real answers. Too often, the women navigating all this are being evaluated with one or two basic markers and then sent home with nothing. And this is especially true in midlife when the stakes are highest in hormone shifts and insulin sensitivity changes and cardiovascular risk rises. Let this Mother's Day be different, not a gift that disappears by next weekend, but a gift that actually changes their life. The gift of data.

Function gives you access to over a 160 lab tests annually including deeper hormone metabolic and heart health markers and more. The strongest woman you know deserves real information. It's time to stop guessing, check your health with function. Function gives you access to over a 160 lab tests every year, including advanced lipoprotein testing. It's time to stop guessing.

Check your health with Function. Go to functionhealth.com/mark. And if you're one of the first 1,000 people this week, use the code Mark twenty twenty six for a $50 credit toward your $365 a year membership. That's functionhealth.com/mark, and use the code Mark twenty twenty six today. Alright.

The next thing we wanna do is regulate your nervous system. It's a little hard in our modern world, but, you know, it's one of the most important and pretty overlooked areas in this how do you regulate your nervous system. Because migraines aren't just physical. They're deeply connected to how your body processes stress. So if your nervous system is always in a heightened state, overstimulated, overloaded, always quote on, it lowers your threshold for triggers.

Meaning, things that wouldn't normally cause a migraine, well, they suddenly do. So learning how to regulate your nervous system is essential. And the good news is it doesn't have to be complicated. Simple consistent habits can make a real difference. Things like breath work, even just a few minutes slow controlled breathing can help shift your body out of that stress response.

Consistent sleep's also really important because your nervous system resets when you sleep, and irregular sleep can make everything more reactive. Also exercise, regular movement, not crazy intense exercise, but steady daily movement helps your body get rid of stress. And just overall stress reduction, creating small moments in your day where your system can actually relax. Because the goal here isn't to eliminate stress completely, it's not realistic, obviously. It's to build resilience.

You're not just reducing stress, you're increasing your capacity to handle it. So when your nervous system becomes more regulated, your body is less reactive, and that can play a powerful role in reducing your migraines over time. Alright. So I want you to get into a prevention mindset. Here's the shift I want you to make.

Migraines don't come out of nowhere. They happen when your system reaches a threshold. They hear like a bucket. Stress fills the bucket. Poor sleep fills the bucket.

Food triggers fill the bucket. Hormone changes fill the bucket. Nutrient deficiencies fill the bucket. And when it overflows, well, that's when a migraine happens. So the goal is simple.

Lower the load, increase your resilience, and if you only take one thing away from this whole conversation, let it be this. Migraines are not random. They are your body's way of telling you something is out of balance. And while medication is gonna help, they're not the whole answer. When you become the CEO of your own health and you focus on reducing inflammation, balancing your blood sugar, supporting your gut, and regulating your nervous system, you change the environment the migraines depend on.

It's not about perfection, it's about understanding your body and making small consistent changes. Because you don't have to just manage migraines. You can reduce them at the root. No two migraine patients are the same, and this is really where functional medicine shines. To bring this to life, here's a clip from a previous episode with my colleague Todd Lapine from the Ultra Wellness Center.

In this clip, he walks through a unique case study and gives you a firsthand look at how we dig deeper to uncover the root cause. If you want to go even further on migraines, you can find the full episode linked in the show notes. So really, like, tell us about some of your cases that you've had experience with that have really kind of changed your thinking and have helped you understand.

Dr. Todd Lapine  14:31
Well, I had a patient who came in and his story was that he first developed migraines starting around at the age of five, which is interesting. So so when when you have a history of somebody who's having headaches, I mean, not normal for a five year old to have headaches. That makes me sort of think, okay, this person may have mitochondrial issue and that may be what's going on early on in their story. Also, the patient noticed in the the when he was telling me his story that he would get the worst headaches on the weekends. And on further asking him, it turned out that on the weekends he didn't drink coffee.

So what he was getting was a caffeine withdrawal Right. This is probably one of those things that because caffeine is a double edged sword. We actually use caffeine to treat migraines. And if patients take like over the counter medications like Excedrin migraine, guess what's one of the major ingredients in there is? Caffeine.

Caffeine. In fact, I had a patient, I'll never forget this, it was a woman who had refractory migraines. And it turned out that she actually was getting rebound headaches from daily use of Excedrin migraine. And so she would have to take the Excedrin migraine to prevent the the withdrawal effect from the caffeine. So it was like a cat chasing a stick.

Dr. Mark Hyman  15:46
So That that's not great because that's got Tylenol or anything.

Dr. Todd Lapine  15:49
Well, it's great for the company because they keep selling it.

Dr. Mark Hyman  15:51
Right? Cause liver problems. Right.

Dr. Todd Lapine  15:53
Yeah. Exactly. Yeah. So so this this patient was caffeine sensitive. So some of the treatments, you can actually abort a migraine with caffeine, but you can also trigger a migraine.

So, it's this sort of a double edged sword in terms of the effect of caffeine. But typically, if I have somebody who's got migraines, I get them off of all alcohol, all caffeine, and give them some magnesium just so you can shoot from the hip and just do that and, you know, you can make a big a huge impact. So that was an interesting with the patient. And this particular patient also had a history of developing an egg allergy at age 21, which was interesting. Like, you know, what's going on?

Why did all of a sudden develop an egg allergy? In addition to that, the patient said that they would develop the itching with eggs and then also had itching with bananas.

Dr. Mark Hyman  16:40
Oh, wow.

Dr. Todd Lapine  16:40
Right. Which then sort of makes me think about is there a problem with histamine and histamine detoxification. There are specific genes in the body that have to do with histamine synthesis and also histamine detoxification and you can do some esoteric testing on that to see. Because histamine, I definitely think, plays a big role in in migraines.

Dr. Mark Hyman  17:00
So what what is histamine, Todd?

Dr. Todd Lapine  17:02
Well, histamine is the drug or not the drug, it's the compound that is naturally found in the body and it is a actually a neurotransmitter. It's also involved in allergies. So when we have, you know, spring allergies or allergic rhinitis, we treat that with an antihistamine. Right. Alright.

Now this is sort of interesting, and I'll talk about this one.

Dr. Mark Hyman  17:26
And it's made by your white blood cells.

Dr. Todd Lapine  17:28
It's right. It's well, yeah. It's made by it's also made by gut bacteria. It's found in food. It's it's made by the the white blood cells, specifically Exactly.

The mast And certain there receptors for histamine. So, there's, I think, like, there's like four receptors for histamine. And interestingly, when you block histamine, what happens to you? You fall asleep. Ever You ever take Benadryl?

Right? That Benadryl puts you to sleep. So histamine actually activates the body. It wakes the body up. So it actually works as neurotransmitter.

Also, it's involved in allergies and itching and things like that. So, histamine is one of these You

Dr. Mark Hyman  18:07
get hives or things like that.

Dr. Todd Lapine  18:08
You can get hives, exactly. Yeah. So, histamine definitely plays a It's one of the things that can play a role in migraine headaches. With their

Dr. Mark Hyman  18:16
So, how do you approach a patient who's got histamine sensitivity? Well, How do you diagnose it first?

Dr. Todd Lapine  18:24
How do

Dr. Mark Hyman  18:24
you treat it?

Dr. Todd Lapine  18:25
Well, one of the things that you can do is put somebody on a low histamine diet because a lot of the foods that we take in can be high in histamine. Normally, body will just sort of deal with excess amounts of histamine. But when the gut bacteria is out, like if you have SIBO, you'll have problems with histamine breakdown or histamine degradation or certain bacteria will actually be making high levels of histamine, which in turn can affect the brain and your neurological system. Incredible.

Dr. Mark Hyman  18:54
Yeah. Yeah. I've seen histamine treatment when you do it in the right patient by both dietary changes. Also, there's all kinds of supplements that can help like Bersetin. Yep.

Even medication like Cromalin and people can take orally, know, Hist Hist Histies, Hist which is very supplements that help with modifying the histamine response and

Dr. Todd Lapine  19:15
Yep.

Dr. Mark Hyman  19:15
Getting the diet low in histamine. People can really have radical transformations in their health. It's not something most doctors think about or do. Yep. And it's tricky to do, but it can be really effective.

Dr. Todd Lapine  19:24
Yeah. Yeah. And this particular patient, when I did the testing on him, lo and behold, he had significant sensitivity to gluten, which he was totally unaware of, and had never really worked with a nutritionist. Sometimes, you know, they'll say, well, I worked with a dietitian, and, you know, a regular dietitian is, they're not really all that helpful. Having a nutritionist who is trained in functional medicine can really look at the diet beyond just calories and the macronutrient proteins, fat and carbohydrates is very very important.

So in this particular patient, the organic acid testing showed a higher need for the B vitamins, showed some evidence of dysbiosis, which is imbalances of the gut bacteria, had significant gluten sensitivity, some leaky gut on on testing, had low normal magnesium, was technically normal, but it was on the low side of normal. So these are all the different things

Dr. Mark Hyman  20:19
that Yeah.

Dr. Todd Lapine  20:20
That you can fix. And then on stress testing, had high levels of cortisol. Interesting. It was very, interesting. And then the other thing that I found on the patient, I'm not really sure because I'm I'm actually still working on that because I I was gonna deal with that later, is high levels of mercury.

Very high levels of of inorganic mercury in this particular patient. And then the other thing which is also really interesting is I did genetic testing. I like to do genetic testing because it can really sort of, it's like lifting the hood on your car, it can sort of tell you what's going on below the scenes. And the thing about genetics of migraine is there's not really one migraine gene and we can test for these snips and variations. But this particular patient had a variation in the genetics, the polymorphisms of a g coupled protein, which has to do with serotonin and stress resiliency.

So this person's genetic makeup was such that he was let he was more prone towards the the effects of stress. It was a particular gene called h t r one a, which is on the testing that we do with a DNA mind test. And I found that really sort of interesting. Otherwise, the patient had good genes, had like good detox genes, good COMT genes, etcetera, but had problems with stress, and the patient's history was consistent with that, that stress was one of the big triggers for that particular patient. So, you know, stress management is huge for everything that we see in in patients who walk through the door.

I mean, we're all every everybody is affected by stress. You know, we just you watch the news and you get stressed. Right? Right. That's why you don't have a television.

Right. And and so anything that we can do to help people to manage and modulate and detoxify the stress goes a long long way. Huge. Huge.

Dr. Mark Hyman  22:09
What if brain fog, anxiety and mood swings aren't simply all in your head? What if the health of your mind actually starts deeper in your body, in your gut, in your hormones, metabolism, and your immune system? Well, let me tell you, the connection is real and it affects how you think and you feel every single day. And that's why I created Brain Shaping Academy, a six week program that shows you how healing your body can help you heal your mind. Brain Shaping Academy relies on the same target nutrition and lifestyle strategies that I've used for thirty years to help my patients improve their mental, emotional and cognitive health.

So if you want to feel calmer, clearer, and more in control, and stay sharp, and protect your brain as you age, check out Brain Shaping Academy at doctorhymen.com/brainshaping. That's doctorhymen.com/brainshaping. If you love that last video, you're gonna love the next one. Check it out here.