Iron deficiency is an often overlooked factor that may be just one more detail in your overall health status that may make a difference for you by reducing frequency and/or intensity of migraine attacks. There is evidence surrounding anemia migraine, for sure. As a registered dietitian with special interest in everything-migraine, let’s take a good look at anemia and headaches so you can see what actions, if any, you may consider.
There are several different types of anemia. The scope of this article will only focus on iron deficiency anemia and its potential role in headaches and migraine.
Please note that the evidence discussed has to do with correcting a deficiency. Supplemental iron is not considered a nutritional supplement to help manage migraine like magnesium, riboflavin, coenzyme Q10, ginger, turmeric, or fish high in omega-3 fatty acids.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
What is iron deficiency anemia?
Iron deficiency anemia, simply put is a lack of adequate iron in your body. Based on a recent study in the Lancet about 17% of premenopausal women are iron deficient based on current guidelines (1). The blood protein that is used to define this type of anemia is called ferritin. Many people are not aware of their ferritin level as it’s often not assessed, but it is the main way the body’s iron stores are measured.
Chances are, you are more familiar with your hemoglobin and hematocrit levels, especially if you’ve been told your levels are low in the past. Hemoglobin and hematocrit are commonly checked by doctors through a routine lab ordered, the CBC (complete blood count). If your levels are abnormally low they may assume you have iron deficiency anemia and follow it up with a ferritin level.
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Is there a problem with the current ferritin guidelines?
The short answer is maybe. Some researchers (2) are calling for more studies, but believe “new thresholds could help better identify individuals with health problems stemming from iron deficiency, treat patients at an earlier stage to prevent anemia, and help researchers better understand the health impacts of the early stages of iron deficiency.” (3) Perhaps more of us, especially premenopausal women, have inadequate iron stores to keep our circulating iron consistently adequate throughout the year.
The most common symptoms of iron deficiency anemia
Common symptoms include:
- Headache
- Lack of energy and fatigue that is unexplained
- Generalized weakness
- Being pale
- Dizziness
- Restless leg syndrome (RLS)
- Shortness of breath or chest pain
- Tinnitus
- Pica (cravings for ice, clay or other non-food items)
- Hair loss
- Brittle nails
- Smooth or sore tongue
- Fast heartbeat
While the above list is common to many conditions including those of us diagnosed with migraine, it certainly should make you curious enough to check your most recent labs and discuss the topic with your doctor.
Dietary iron, severe headache and migraine
In 2021, a study was published that looked at the diet analysis of a nearly 8000 adults to specifically evaluate low iron intake, headaches and migraine (4) . It was notable than in women ages 20-50, dietary iron intake was inversely associated with reports of severe headache as well as the criteria for migraine. So, the less iron in the diet, the more headaches and migraine were reported. Adult women with higher dietary iron reportedly had fewer headaches and migraine attacks.
As you know, association does not equal causation, but there are studies that suggest there is a cause and effect for anemia and headaches. (5)(6)
Iron deficiency headache, migraine and dopamine
Headache is listed above as a common symptom. Based on a review of recent scientific literature, there seems to be a plausible explanation for the anemia and headaches link and perhaps the anemia-migraine relationship – dopamine. Perhaps if you’re low in iron, you may be more prone to have a drop in dopamine.
Dopamine is a critically important neurotransmitter in the body. Iron plays a role in the metabolism of dopamine. According to a study about fluctuations of dopamine in migraine patients, “Dopamine is one of the main neurotransmitters controlling sensory sensitivity. Therefore, a drop in dopamine could produce increased sensory sensitivity to that normally painless or imperceptible sensory signals from skin, muscle and blood vessels could become painful.” Dopamine levels have been noted to drop during migraine episodes.(7)
Restless leg syndrome, iron deficiency headache and dopamine
Further bolstering the iron deficiency headache and migraine relationship to the iron-dopamine relationship is the association of restless leg syndrome and migraine. Johns Hopkins has a fascinating article citing interesting findings from studies (8). In particular, it was stated that the single most consistent finding and the strongest environmental risk factor associated with RLS is iron insufficiency. When the iron deficiency is treated, RLS symptoms are markedly diminished or resolved entirely. Medications that increase dopamine metabolism seem to help RLS.
Is it a too much of a leap to connect the dots between the following information? – low iron intake is associated with severe headaches and migraine; there is an association of anemia and headaches; RLS is more prevalent in migraine (9); dopamine may be an important part of both RLS and migraine; the metabolism of dopamine may be negatively impacted by the lack adequate iron. I believe it’s worth looking into.
What should you do if you are personally curious about iron deficiency headache and migraine?
Contact your doctor and make an appointment. Your doctor will further evaluate you and order the appropriate labs like a CBC (complete blood count) and ferritin.
If you have iron deficiency, correcting it is a priority. Not only might it help your headaches and migraine episodes, you may improve your overall wellness and feel more energetic.
When I posed the question about improvement after correcting anemia to the private Migraine Strong Facebook group, the success was mixed regarding migraine improvement. It’s worth noting that interpreting the responses in migraine groups is far from a solid scientific process. Most people whose migraine attacks have improved substantially don’t provide the positive feedback as they no longer participate in the groups. So, the positive results may be better than they appear.
Getting enough iron
Dietary iron and its challenges
Most women do not get the recommended amount of iron in food. The most obvious step you can take is be more mindful of getting good sources of iron in in your meals and snacks.
Getting enough iron can be challenging as the body absorbs 2-3 times the amount of iron from animal sources than plant sources. Yes, there are lots of plant sources of iron but it’s not as available to us. This is a great resource for maximizing dietary iron intake. My favorite tip is to have a good source of vitamin C with your good source of dietary iron as they work together to be absorbed by your intestines.
Supplementing with iron
If you are anemic, close to being anemic or if you know you just don’t get enough iron, your doctor may suggest supplementing with iron.
Oral options
The main challenge with iron supplements is that some types can cause significant cramping and other gastrointestinal distress.
Our always-helpful Facebook group confirmed that many have had trouble with iron supplements and had to try a few types/brands. Some that worked well were Solgar Gentle Iron, Pure Encapsulations Liquid Iron, and Vitanica Iron Extra. One person has had luck with supplementing with a children’s chewable. Our dispensary has a variety of iron supplements and many other items at a discount.
Iron infusions and shots
Depending on your degree of anemia as well as other factors, your doctor may prescribe some iron infusions or, in some cases shots. Fortunately, for those who have a hard time tolerating oral supplements as well as for those who have not been able to correct anemia orally, infusions are often very helpful.
Summary
Iron deficiency headaches is certainly something to consider as it’s easy to address. If you have anemia, replenishing and maintaining your iron stores can help your overall wellness and hopefully help manage head pain and other symptoms of migraine.
References
(1) https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00168-X/fulltext
(2) https://www.oatext.com/iron-deficiency-without-anemia-common-important-neglected.php
(3) https://www.cuimc.columbia.edu/news/are-we-underestimating-prevalence-iron-deficiency
(4) https://www.frontiersin.org/articles/10.3389/fnut.2021.685564/full
(5) https://link.springer.com/article/10.1007%2Fs00508-015-0740-8
(9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475739/
Hi!
Thank you for a good post!
I’m wondering , since I think the guidelines in Sweden differ from the rest of the world , which is the number for anemia based on ferritin. I do have a ferritin level on 14 and in Sweden the reference is 13-130. I have a deficiency of folate, but I take supplements to fix that .
Hi Lina. You question is a good one but I’m not qualified to answer it from here in the United States. What is similar between the range in Sweden and the US is that the range is wide. My personal assumption, if I was on the lower range of normal, would be that there was room for improvement, but I’d do my own research and ask my doctor. I suggest that you do the same and see if supplementing a bit would be wise for you. Good luck to you.
I just had an iron infusion done 2 weeks ago, my ferritin was at a 2..how long would I be able to tell if my head pain/dizzy feeling had to do with that and not every other thing 7 doctors have mentioned in the past 7 months?
Yikes! 2 is quite low. I’m glad you had an infusion. Predicting how long it would take for you to find relief would be a guessing game. I wish I could give you more certainty about your dizziness and pain. I assume it will help your overall sense of wellness soon. I hope your level comes up quickly and you can maintain it. If you haven’t already, you might find some helpful info from Jennifer Bragdon’s blogs. – Danielle