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

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 30 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 Dr. Hyman.com. Welcome to Office Hours. This is our dedicated 101 space to go deeper, get clear, and explore what truly moves the needle for your health. I'm Dr. Mark Hyman, and each week we're going to pull back the curtain and share the insights, the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health, and for many of you, your family's health too. And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here. This episode is brought to you by Function Health, empowering you to live 100 healthy years with over 160 lab tests for just $365 a year and use the code MARK2026 to get $50 a year. 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 it. 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 concludes 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 and 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 ship the conversation. Instead of asking, how do we stop the 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 multi-process 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. 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 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. And that's why many women 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 imbalances of gut bacteria, leaky gut where the intestinal lining becomes more permeable, and food-sensitive stibies 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. 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 fixed 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, who was a resident who had intractable migraines as she was on narcotics. And he'd nausea pills that were looking like 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 B2. And also coenzyme Q10 is important in mitochondrial function. And that can be a factor also in migraines. There's 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 that could be mitochondria. You know, you 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 over stimulation. 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? Well, medications can be helpful for sure and they can be life saving. 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. The first is stabilize your blood sugar. One of 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. Trying not to skip meals, you know, especially early in the day, long gaps without food can set you up for these drops of 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. 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 want to 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. If it was like gluten, that's a big one. And that would be an easy one 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 the sulfites. Highly processed foods, there's a lot of additives, chemicals, things that could be all serious triggers. The challenge is these reactions aren't always immediate. Sometimes there's a late response, which kind of makes it harder to connect the dots. So you might eat something 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 then you re-induce them potentially, you can actually start to see how your body responds and that awareness is really powerful. In fact, we have something called the 10-day detox diet. You can go to 10-daydetoxdiet.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. The next thing would be to reduce inflammation. 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? So you want to eat a wide variety of colorful plants, vegetables, fruits, herbs, nuts, seeds, all of these provide antioxidants to support your system. And 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 sicker's bar, once in a 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, the dictionary, which is something that supports the diet. So you can get rid of all the foods, vegetables, herbs, nuts, seeds, all of these provide any food by the definition, the dictionary, which is something that supports the health of an organism, which these don't. So because 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 want to 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 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, foods, 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, bungalow overgrowth, bacterial overgrowth, all need to be addressed, parasites, they can be factors. And they can be treated with a good functional medicine doctor. And the big idea, and by the way, we're at the Ultra Wellness Center, we have a great practice and lots of great doctors, you can come see us in Lennox, Massachusetts. Now the big idea is this, when your gut improves, your brain often falls. And for many people, this is just a key part of reducing migraines. All right. 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. And we see about 70% of people with deficiencies in nutrients, including B12, including magnesium, including Omega 3s, and CoQ10, all the things that are really quite important. And you can look at magnesium, you can look at riboflavin, you can look at CoQ10, 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 and diagnosis for certain conditions, and more likely to leave the doctor's office without real answers. Too often, the women navigating all of this are being evaluated one or two basic markers and then sent home with nothing. And this is especially true in midlife when the stakes are highest and hormone shifts and instant 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 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 160 lab tests every year, including advanced lipoprotein testing. It's time to stop guessing. Check your health with function. Go to functionhealth.com. And if you're one of the first 1000 people this week, use the code Mark 2026 for a $50 credit toward your $365 a year membership. That's functionhealth.com. And use the code Mark 2026 today. All right, the next thing we want to 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. And this, how do you regulate your nervous system? Because migrants 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, over stimulated, overloaded, always quote on, it lowers your threshold for triggers, meaning things that wouldn't normally cause a migraine while 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 of slow control breathing can help shift your body out of that stress response. Consistent sleep is 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 is to eliminate stress completely, 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 and you're like a bucket. Stress fills the bucket. Poor sleep fills the bucket. Diggers 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 bounds. And while medications are going to help, they're not the whole answer. When you become the CEO of your own health and you focus on reducing inflammation, bouncing 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, tell us about some of your cases that you've had experience with, that it really kind of changed your thinking and it helped you understand. 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 when you have a history of somebody who's having headaches, and it's not normal for a five year old to have headaches, that makes me sort of think, okay, this person may have a mitochondrial issue and that may be what's going on early on in their story. Also interestingly, the patient noticed 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, it was a caffeine withdrawal headache. Right. Now, this is probably one of those things that, because caffeine is a double edged sort. 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 on there 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 withdrawal effect from the caffeine. So it was like a cat chasing a sale. Yeah. That's not great because that's got talent. Well, it's great for the company because they keep selling it, right? Because liver problems. Right. Yeah, exactly. Yeah. So 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 that's that you can shoot from the hip and just do that. And 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, why, you know, what's going on? Why did the LSN develop an egg allergy? In addition to that, the patient said that they would develop the itching with eggs and then also add itching with bananas. Oh, wow. 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 migraines. What is histamine, Todd? Well, histamine is the drug or not the drug. It's the compound that is naturally found in the body. And it is actually a neurotransmitter. It's also involved in allergies. So when we have spring allergies or allergic rhinitis, we treat that with an antihistamine. Right. All right. Now, this is sort of interesting. And I'll talk about this one. And it's made by your white blood cells. It's also made by gut bacteria. It's found in food. It's made by the white blood cells, specifically the mast cells, exactly. And there are certain 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. You ever take benadryl? Right. That's that benadryl puts you to sleep. So histamine actually activates the body. It wakes the body up. So it's actually works as an neurotransmitter. So it's involved in allergies and itching and things like that. So histamine is one of these things. You can get hives or things like that. 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. And with their... So how do you approach a patient with who's got histamine sensitivity? Well, you... How do you diagnose it first? Yeah. Well, they treat it. And 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 have... You can be high in histamine. Normally, our 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. Yeah. Yeah. I've seen histamine treatment when you do it in the right patient by both dialysis and dietary changes. Also there's all kinds of supplements that can help, like Bersetin, even medication like Chromalin and people that take orally, histes, which is very supplemented, help with modifying the histamine response and getting the diet low on histamine. People can really have radical transformations in their health and stuff. That's something most doctors think about or do. And it's tricky to do, but it can be really effective. 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 they would say, well, I worked with a dietitian. A regular dietitian is, they're not really all that helpful. Having a nutritionist who's 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 testing, had low normal magnesium, was technically normal, but it was on the low side of normal. So these are all the different things that you can fix. And then on stress testing, had high levels of cortisol. Interesting. It was very, very interesting. And then the other thing that I found on the patient, I'm not really sure because I'm actually still working on that because I was going to deal with that later, is high levels of mercury, very high levels 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 more prone towards the effects of stress. It was a particular gene called HTR1A, 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, like good detox genes, good COMT genes, et cetera, but had problems with stress. And the patient's history was consistent with that stress was one of the big triggers for that particular patient. So stress management is huge for everything that we see in patients who walk through the door. I mean, everybody is affected by stress. You watch the news and you get stressed, right? That's why I don't have a television. Exactly. 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, huge. 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 30 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 drheimann.com. Thanks for joining me for office hours. I love diving into these topics with you. Remember, you are the CEO of your own health and every choice you make can move you closer to healing and vitality. I want to keep these episodes as relevant and useful as possible. So tell me, what do you want to explore next? What questions are you wrestling with? What breakthroughs are you chasing? Share your ideas in the comments on social media or through the link in the show notes. I'm listening. Until next time, keep taking charge, keep asking questions, and keep showing up for your health. If you love this podcast, please share it with someone else you think would also enjoy it. Also, give me a call on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guest's opinions, neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com, and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.