What is the Root Cause of Migraine?

Back in my early days of episodic migraine I didn’t give much thought to the root cause of migraine attacks. It wasn’t until I had chronic migraine (defined as 15 or more days per month with headache, with at least 8 days of having headaches with migraine features, for more than 3 months) that I started to wonder what the heck was causing my once full life to get smaller and smaller. Once I was satisfied that it was “just” migraine and not a brain tumor or aneurysm ready to blow, I wanted to know what was wrong with my body so I could fix it. What was my root cause of migraine?

** 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.

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The question of why me and why you? What could be the root cause of migraine?

When acute medications stop working or we need too many each month and/or the commonly prescribed preventive medications don’t work or have too many unpleasant side effects, our interest in finding a root cause sharpens.

For me, as a conventionally trained clinical nutritionist, I looked to conventionally trained doctors. That was mostly a dead end road in terms of my “why”. They could not satisfy my curiosity. They didn’t make me very confident that medication had more than a 50% chance of helping me get 50% better. Sheesh! Is that the best I can hope for?

My doctors were extremely busy and eager to try to help the next person in the waiting room. They didn’t have time to discuss the complexities of migraine with me. So, I went searching for more answers and discovered the world of functional and integrative practitioners. 

Just as my conventional practitioners led with “try this medication,” the functional practitioners led with conversations about finding my root cause of migraine.  Hooray! I wanted my life back. I was finally going to get somewhere and find lasting relief!  Looking for a root cause of migraine sounded so hopeful, so logical. Find the flaw, find the culprit and FIX IT FAST.  Alas!  The solution would be revealed and everything would fall into place.

Spoiler alert – There were no “ah-ha! moments” for me. I figured it out and YOU can figure it out too. Just by educating yourself and finding the right healthcare team.

Causes versus triggers

This is a critically important distinction as we move into a discussion about advice from functional medicine practitioners. Many conventional doctors reach for medications because that is ingrained in their training. Overwhelmingly, they are taught how to diagnose people and find the right medications for what ails their patients.

Many of us with attacks serious enough to seek multiple doctor visits, want more intervention than “try this medication. See you in 3 months”. On the other hand, many functional medicine practitioners will talk about root cause of migraine when they are really addressing triggers.

The reality of migraine

Migraine is the most prevalent primary headache disorder. It is a neurological disease. If you have migraine, you have a neurological condition that means your brain is different, not typical. Your brain over-responds to normal stimulation and has abnormal biochemical reactions. The over-reactions are in response to events or stimulation that people who don’t have migraine barely notice. The biochemical reactions are part of a cascade of changes in your brain that cause the pain and other symptoms of migraine. There is nothing you did to cause migraine. The migraine brain is just more responsive and more easily triggered than the typical brain. While not a complete list, some common triggers are stress, hormonal changes, poor or inconsistent sleep, certain foods/drinks, weather, scents, lighting and sounds. 

Migraine is not caused by triggers but can be managed by controlling them and doing our best to avoid or prepare for the ones beyond our control. The goal is to keep the migraine brain below a trigger threshold.

The value of looking for a root cause of migraine

Most of us start looking for a root cause of migraine when the medication we think should work for us fails. If most of us found relief from our first few doctor visits, we wouldn’t go looking for a root cause.

There are a few things that are valuable about looking for a root cause of migraine. First, it shows you have hope. Without hope we cannot move forward and see beyond the rough patches.

Second, you may feel like you are ready to be your own advocate and unstoppable in your quest for getting your life back. Mindset is very important. Taking control of our health is a empowering.

Lastly, some functional medicine practitioners focus on key elements of what we discuss often from our Treatment Pie –  diet, supplements, de-stressing, appropriateness of medications, sleep and intentional movement. Having help pulling all of this together is excellent (IF that is what is being offered). I encourage you to ask them how much support they give you. Paying someone to hold you to account can be a powerful motivator to make important lifestyle tweaks. Pardon the plug, but much of this information is provided here and in our Facebook group for FREE.  

The whispered sweet nothings

“Nothings” is the operative word. The sad truth is that overwhelmingly, those who promise to get to the root cause of migraine have little to no experience in helping people with frequent and chronic migraine. Many are well-intentioned and insistent that they can get you better. But, more often than not, the eager and often desperate person with migraine will end up paying hundreds and potentially thousands of dollars for testing that is of little or no value.

Many people I know with migraine admit to paying for expensive tests that didn’t help them at all. It’s often hard to say no to the very technical sounding test while you are sitting in the consultation room. We are all prone to the thought, “What if this $500 test gives me the answer I’m looking for”. I hate to be a Negative Nancy, but I promise you the test won’t get you what you want- A root cause that is easy to fix. There are good, conscientious and experienced functional medicine practitioners that can hold their heads high. Unfortunately, they are in a crowded field of people that will not be helpful for most of us.

The problem with looking for a root cause for migraine

Experts in the field will tell you that overwhelmingly, the root cause of migraine is GENETICS. I’ll say that again – the root cause of migraine is GENETICS. Migraine has dozens of genes associated with it. So, depending on your genes and the combination of the genetic variations that are in play, YOUR migraine will behave and respond in a way that is unique to you. Assuming you already know how different we all are in terms of triggers and treatments, you already know how complex migraine is to manage. 

There are exceptions to the rule about migraine being a genetic predisposition. This is when migraine is secondary to other conditions that are important to rule out through proper, conventional medical experts. Examples of some of these diagnoses are brain tumor, aneurysm, Chiari malformation, traumatic brain or spinal injury and cerebrospinal fluid leak. Fortunately, most people who go do the doctor for migraine do not have these conditions.

The most frequent root causes of migraine that are bandied about in functional medicine circles:

Vitamin and mineral deficiency

Whether many of us are deficient or not, there may be evidence-based supplements that can help us find relief. Expensive testing is not necessary as there are simple tests.  

Leaky Gut and Dysbiosis

There is certainly a gut-brain connection that is more of a concern for some of us with migraine than others. Many of us have IBS (irritable bowel syndrome) along with migraine or mild GI distress during attacks. Some of us may have parts of our GI tract that are hyper-permeable (leaky). After some expensive testing that is usually not covered by insurance, functional medicine practitioners often have a cookie-cutter prescribed diet for addressing leaky gut and expensive supplements. Might the diet and supplements work? Yes, as the diet likely omits highly processed foods and focuses on whole foods. 

At the same time, they are probably prioritizing several other healthier lifestyle changes. But, the diet may not be the migraine-oriented approach that will work for you. Finding the right way of eating often takes a while and experience with migraine is important.

Hormonal issues

Migraine specialists will tell you that your hormones are not the problem. But, the migraine brain is often triggered by normal, healthy fluctuations in hormones. Meaning doing lots of expensive hormonal testing is typically unnecessary & not helpful. Does this mean that if you have hormonal migraine attacks you are doomed? Of course not. There are ways of minimizing these attacks that a good functional or conventional doctor can help with. A knowledgeable doctor who understand the nature of what is triggering the attack as well as the migraine brain can recommend treatment strategies to ease symptoms.

Mitochondrial dysfunction and ionic dysfunction

There is some research that shows that on a molecular level, some people with migraine have specific differences that may explain the abnormal chemical reactions that occur in their brains. Some of the commonly prescribed medications, evidence-based supplements and diets probably help some people by addressing these quirks in metabolism. A dietary approach that may help with mitochondrial and/or ionic dysfunction is the ketogenic diet with careful attention to electrolyte balance.

Food sensitivities

I believe that most, not all, people with migraine can be helped by diet. Practitioners looking for root causes nearly always require a costly food sensitivity test. Migraine-oriented elimination diets are the way to go to figure out your food triggers. Food is the most controllable trigger so place a big effort on figuring out your possible food triggers. I also like the Mediator Release Test (MRT) in some situations but I’m not a fan of the IgG-based test. This will be a topic of a future blog.

Should you pursue finding your root cause of migraine?

Yes and no.

I think of myself as having one foot in conventional medicine and one foot in functional/integrative medicine. Both approaches have their strengths and weaknesses. Personally, both have helped me find relief. I hope I can clarify my opinion so you can continue to do your own research including listening to your doctor’s opinion. 

Yes, seek well-qualified expertise including a conventional doctor so that you have the correct diagnosis. Find a doctor to partner with you that helps you find lasting relief with minimal unpleasant side effects. If you have been with the same doctor for an extended period of time and aren’t significantly better, seek the next level of expertise. If you are already seeing a headache specialist, consider a different one or a headache center that may offer another approach. Those living in the US also have access to an excellent online migraine clinic staffed with headache specialists that will have you seen in a matter of days. If you’re interested in learning more, our Neura Health review by a person living with complex migraine is a must-read.

Many of us (not all) with frequent attacks, will need medication to do the heavy lifting. Sometimes it’s short-term. You have not failed if your body needs the help of medication. Migraine is not your fault nor a sign of an unhealthy lifestyle.

Expensive Rabbit Holes

Rather than going down rabbit holes that are potentially very expensive, educate yourself about migraine threshold and migraine triggers. Learning your triggers and how to raise your threshold is empowering. You have no control over your genetic code but can learn how to optimize the hand you have been dealt.

If you want to consult a functional medicine practitioner, learn about his/her background first. Some are MDs or DOs while others are chiropractors, naturopaths or even nutritionists. Finding a provider that listens to you and helps support you in making healthy changes is most valuable. Be cautious of requirements before you agree to expensive tests or buy his/her supplements. Take advantage of possible personalized attention regarding how you can prioritize your well-being. Beware of functional medicine practitioners that require a lot of money upfront.

Migraine is complex and figuring out how to get better takes time, but it is possible. Genetics play a big role in migraine disease. But with a strong team, you can absolutely find the right combination of treatment strategies to significantly reduce the frequency and intensity of attacks you experience.

This article has been updated and refreshed since the original publication date in October, 2019.