House Call Highlight: The Functional Medicine Approach To Ending Migraine with Dr. Todd LePine

Hi, I'm Kaya Perowich, one of the producers of the Doctor's Pharmacy. If you or someone you love suffers from migraines, I don't need to tell you how debilitating they can be. In fact, they are one of the most common reasons people end up in the emergency room. When you're experiencing a migraine, your primary focus is on how to make it stop. But as migraines are usually a recurring issue, functional medicine really looks at what's causing the migraines in the first place. Dr. Hyman sat down to talk about this with Dr. Todd LePine. This is one of our all time most listened to episodes from the House Call series, and we're re-airing it today to help spread the word on ending migraines once and for all.

Now onto the episode. Hey everyone, it's Dr. Mark.

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Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, that's Pharmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And if you ever, ever had a headache, you better listen up, especially if you had a migraine, 'cause today we're having a special episode of the Doctor's Pharmacy called House Call with my colleague and friend, Dr. Todd LePine here at the Ultra Wellness Center in Lenox, Massachusetts. And we see so much migraines. Todd has been a colleague of mine for over 25 years, worked with me at Canyon Ranch, now at the Ultra Wellness Center for 10 years. And we've we've just been at the forefront of this whole movement of functional medicine. And I would say migraines are among the worst condition that people can suffer from, but from a functional medicine perspective, they're probably the easiest things to treat. Wouldn't you say Dr. Lippe?

Absolutely, yeah, exactly.

So how do we think about this condition in traditional medicine? What is the normal approach to diagnosis and treatment and what's wrong with it?

Well, the interesting thing is when I look back, I can remember when I was practicing mainstream medicine, looked at migraine patients. And there were so many different things that were offered by mainstream medicine for migraines. And it sort of made me question, like, there's no such thing as one migraine. There's so many different flavors of migraine. You can have a patient who has periodic migraines. You can have someone who's got menstrual migraines. So to me, that was telling me that migraines, there's a lot of pathways to developing what we call a migraine or another, you know, they also call it a vascular headache. And I I found it really is an interesting approach to know that each individual, their presentation for migraine is unique. The interesting thing is I would never treat two migraine patients the same because they all have different features.

So that speaks to a very central idea in functional medicine, which is this. Just because you know the name of your disease, it doesn't mean you know what's wrong with you, right? You have a migraine that just describes people who have a certain type of headache with certain types of symptoms, like light sensitivity, noise sensitivity, maybe on one side, maybe visual pre-aura symptoms, nausea, vomiting. These are just the typical things. Okay, you have a migraine. And then we divide into classical migraine and this migraine. And they're all just different ways of describing the kind of migraine, but none of them tell you the cause. So functional medicine is about focusing on the cause, which is what you're talking about, these different flavors. Exactly. There may be up to 29 different factors that can drive a migraine and traditional medicine just uses a one size fits all approach. So what is the typical approach to treating migraines?

Well, in mainstream medicine, it's really just basically abortive therapy. You know, you might take Advil or Aleve or an Excedrin. You might take a triptan. You might take an opioid.

Like Imitrex or something.

Imitrex, yeah, Imitrex, exactly. Or opioids in severe cases, steroids in other cases. So it's basically treated abortive therapy, which is that when you get an attack, you treat that attack. And for people who get them more frequently, it's about trying preventive therapies. And they're all over the place. I found that actually quite interesting when I was looking at, you know, how do neurologists approach migraines? You know, these headache neurology specialists. And they use everything. They throw everything in there. They'll throw in beta blockers. They'll throw in calcium channel blockers.

To prevent migraines.

To prevent migraines, exactly. So the preventive role, is really important, I think, because when you look at someone who's suffering from migraines, I mean, people can lose a lot of work over migraines.

They can.

Debilitating. Oh, it's absolutely, and sometimes for some people, it might be two, three days or a whole week that's lost. They're just like, you know, they gotta stay in bed and turn the lights off and just, you know, wait till the whole episode passes. And then other medications that are used in mainstream medicine are anti-seizure medications.

You know, I mean, you know, it's. So, antidepressant seizure medications, blood pressure medications.

Citalopram, yeah, all the stuff.

That they're kind of throwing it against the wall.

Tricyclic antidepressants, you name it.

And there's no way to actually figure it out. You sort of like, it's like spaghetti on the wall. These doctors, just try this, try that, try this. And I can't tell you how many.

Patients I've seen who've been through the whole mill of these medications, and it.

Might help a little, it might- Botox.

They're using Botox now.

They're using botulinum toxin. Yeah, well, that's just to paralyze the muscles in the back of the head, right? Exactly, yeah.

Right.

So, and it's a terrible condition. I've had people who've had chronic daily migraines or 20 days a month.

It's just so awful for people.

Especially in women, women tend to have a little more, I think in general women, I'd probably see more women with migraines than as opposed to men. And then women also get menstrual migraines, which is another sort of flavor of migraines, which is another probably related to estrogen detoxification. So it really is, and it's actually it really keeps me on my toes in functional medicine when I see a migraine patient, because it's not like, oh, here's your problem, you know, just do this and it's fine. I've got to like play detective. I've got to figure out what are the factors that are driving that person's unique presentation of their migraines.

That's absolutely right because what we do in traditional medicine is okay, you have this type of headache and I ask these questions and it meets these criteria for what a migraine headache is according to the neurological society criteria. But once you make the diagnosis, there's no more thinking involved. It's like, okay, here's the cocktail of drugs I get to pick from. Start with these, try this, that doesn't work, we'll try this. And it's just like, it's kind of a merry-go-round of drugs and it often is so difficult for people to get better because they're not asking the right questions. So in functional medicine, we don't just name and blame, which is what our mentor, Sydney Baker talks. We name it, blame it and tame it. You name the disease, say, oh, you have a migraine, that's why your head hurts. No, that's not why your head hurts, that's just the name of why your head hurts. and then we try to tame it with a drug instead of actually figuring out the cause. So let's talk a little bit from a functional medicine perspective about what the causes are, and then let's get into some cases because I think we've both seen so many cases. It's one of the most satisfying things for me as a doctor to actually treat because it's so easy usually, and people do so, so well with simple approaches that deal with the root causes.

Yeah, absolutely.

So tell me what are the things that you think of when you're coming to see these patients that could be driving the migraines?

Well, one of the things that I think is missed by a lot of mainstream doctors, even neurologists, is to understand the role that mitochondria play in migraines. So interestingly, mitochondria, which are the powerhouses of the cell, they basically is where our body consumes food, we produce energy from that food in the form of ATP. and mitochondria are not really tested by mainstream medicine. They are not well understood, something that you learn about in medical school and then you forget about it. And the interesting thing is that people who have migraines also have a higher incidence of seizures. And that's why to some degrees, anti-seizure medications can actually have efficacy in some patients who have migraines. So there's a, there's the real important to realize that connection between mitochondrial dysfunction.

And mitochondria make energy in your cells.

Make energy in your cells. In fact, I've actually seen some patients, interestingly, who, and I don't see, I don't treat children, but I've seen some adults. When I go into their history, they had a history of what is called cyclic vomiting syndrome. And so that's where a young kid is vomiting for no particular reason. And it turns out, cyclic vomiting syndrome is actually a mitochondrial problem. And as a person gets older, they sort of grow outgrow that vomiting. episodes, but they actually then present with migraines. And interestingly, the gut is connected to the brain. So a lot of people can have what we call abdominal migraines. Yes, exactly.

Right, right. Yeah. This reminds me, Todd, I had a patient who struggled with headaches and migraines, and she had terrible SIBO, which is overgrowth of bad bugs in your small intestine that was causing all this fermentation and creates these toxic byproducts that were clearly creating inflammation in the brain.

And we treated her gut with antibiotics to cure migraine. But who would, who would thought of.

That as a neurologist, right?

Exactly. And it's also the other interesting, we're going to talk about that in one of the upcoming episodes is on histamine, the role of histamine. And that's actually a very interesting thing when you look at histamine because people who have SIBO, they actually have bacteria that are producing toxins like you're talking about. And one of the problems is excess amounts of histamine. So normally our bacteria will degrade histamine. and we have enzymes that do that and there's all different these different pathways. And when you look at some people who have migraine headaches, there are certain foods which can trigger a migraine. So is it the food that's doing it or is it something in the food or it's how the food is actually being metabolized? So that's a really a key important feature is that the connection between the gut, our food and the brain.

Yeah.

I mean, it is such a big problem, Todd. the amount of people with migraines, over 10 million people have migraines. It costs about $17 billion a year to society and healthcare costs, just direct healthcare costs, that's medications, emergency room visits, hospitalizations, doctor visits, testing, and then even managing the side effects. And then the loss of productivity to employers because like you said, is $15 billion, about half that's- oh, huge. due to absenteeism and the other half is due to just people being on the job but not being at the job but not on the job. You know, they're just sort of there but not functioning. Absolutely. And so, you know, over the years of functional medicine, I've seen so many patients and like you said before, there's so many different flavors. Tell us about some of the other flavors because we went through the mitochondria and let's just go to code down the list of what are the most common things because, you know, like there could be 29 things, but there's a few that are really common. Stress.

Stress. Stress. Okay. Tell us about stress in my. So stress. Stress by itself does not cause any diseases, but stress can turn the volume up on all different kinds of conditions. We see that in autoimmune conditions. So how our bodies respond to stress, and some people have, I always call it a genetic predisposition, to be more stress resilient. And some people don't. And some people are more prone to the effects of stress. And time after time, you see these people who they'll go through a very stressful period and all of a sudden they get a full-blown migraine. Well, what is that? What's going on there? and I think it is how that person perceives the world and how they detoxify their stress. Absolutely. And that's why beta blockers, which block adrenaline, which you get high levels of stress, makes a big difference.

So things like yoga, meditation.

Exactly. And then also sometimes when you have patients who have migraines and you measure their cortisol levels, they've got higher levels of cortisol. So that's telling you they have more chronic stress. And they sometimes will be type A, where they're very, very driven. those kinds of things.

So you mentioned gut issues a little bit earlier, and I think that's another big one and not just SIBO, but there are a lot of symptoms that people get that could be related to leaky gut and food sensitivities, which seem to be a huge factor with migraines that are really undiagnosed. We know traditionally that people say scientists and doctors say stay away from tyramine foods, cheeses, foods that contain certain chemicals like MSG or aspartame. So there are some recommendations, chocolate, Fe and there are doctors who do say some of these things and that can be helpful for some patients, but it goes much deeper than that. There's like food sensitivities and gluten. So tell us about, you know, how that, how that works.

Yeah.

Well, I think that, you know, the connection between the gut and the brain is huge and the, the leaky gut component. You oftentimes will see leaky gut in patients who have increased risk for, for migraines. It, it, there's a, there's definitely a two-way communication that's going on there. And again, you sleep is another thing that plays a huge role. So lack of sleep is huge in migraines. So when you look at, when somebody comes to see me, you know, I ask them, how's your stress level? How are you sleeping? And what are you eating? And who are you feeding? Which is, you know, what's going on with the gut bugs. Yeah. You have patients who will tell you that when they eat certain types of foods, like sugar, they'll have, they'll trigger a migraine.

Yeah.

It's huge. And, I suspect that some of those foods are actually affecting the gut microbiome in a very rapid fashion that's causing migraines.

Yeah.

One of the biggest things I've seen.

I'm sure you probably noticed this too, is that gluten tops the list when it comes to migraines. If anybody has a migraine, the simplest thing to do is an elimination diet. Absolutely. To get rid of the most common allergens like gluten, dairy, eggs, and I've seen so many people, I had one woman, married to a mafia don and she had headaches for 40 years. It was incapacitated in bed very often and it turned out that it was eggs. Now, we found this on a food sensitivity test and that's not to say everybody's migraine is caused by eggs but hers seemed to be triggered by eggs. She stopped the eggs and her migraines in a way. So, I think everybody's different like you said. We have to treat the person, not the disease. I think Thomas I mean, what is it? William Ulcer said that, you know, we should treat the person who has the disease, not the disease that the person has. And I think that's the mistake we make in medicine. So doing elimination diet, getting food sensitivity testing, checking for gluten, that's all important. The chemical triggers, you know, we talked a little bit about that. Talk more a little bit about some of these chemical triggers that we notice with migraines.

I mean, like exogenous chemicals.

Things like aspartame, artificial sweeteners, food additives. monocytes, for example.

Yeah, I would say that, you know, the, those are basically excytotoxins. There are certain types of foods which can cause excess activity, like monosodium glutamate. You get, you know, excess glutamine in the, in the brain because glutamine gets converted into glutamate, which is an excytotoxin. So, yeah, definitely there, you know, those, those types of foods. And even if you actually, if you give somebody glutamine, which we use a lot to help with, I've had these patients who they'll, they'll they'll metabolize their glutamine directly into glutamate, and you'll get taking glutamine. It'll be just like taking MSG.

They'll get very, you know, agitated and get a headache. Aspartame is bad.

I've seen so many patients who, oh, aspartame. Yes.

Swig back those diet sodas. And they, we have somebody in the White House who does about, I think, about 10 a day. I don't know if he's getting migraines, but he's giving everybody else a headache. But I think that, that I think you're right. I think we, we have to really look at these things, the nitrates that are in, for example, deli meats, sulfites that are commonly added to salad bars. You know, maybe not know you're just keep the vegetables fresh or the dried fruit and wine, tyramine was in chocolate, cheese. These are really significant. So getting rid of all the processed food, all those chemicals, super important.

Yep.

Let's talk about. About hormonal factors because these are really common.

Yeah.

And. And often, you know, women, we see this whole phenomena of premenstrual migraines. How do you know if this is an issue for you with your patients?

Oh, just by history. I mean, the history will tell you that. And I typically will see that those types of patients who have menstrual migraines tend to have problems with estrogen detoxification.

Yeah.

So, you know, as men, you know, our hormones tend to stay relatively stable. We are, they go up in the morning, but they're pretty stable. Women's hormones, you know, they go up and down like the tides. And, and, and that's normal. That's, that's part of the, the menstrual cycle. So when women are menstruating, they have these, some women have great fluctuations in hormones. And when the body is done with those hormones, unless you're pregnant, the body has to detoxify those hormones. And there are certain Pathways that help with estrogen detoxification. And when women have problems with those Pathways, one of the, one of the, the, the genes that's important in there is the a catalyze, methyl transferase or C-O-M-T Gene.

Yeah.

And typically that Gene is oftentimes associated. with increased sensitivity to pain. It's also associated with increased sensitivity to migraines, seizures and headaches. Yeah. So it's definitely one of those pathways that you want to support for the detoxification or the methylation of- With B.

Vitamins like B6, B12- Magnesium.

Magnesium.

And often the classic story that I've seen with these premenstrual migraines is is women get like PMS symptoms. So they get bloating, fluid retention, they get cravings, irritability, breast tenderness, menstrual cramps, and they get heavy bleeding. And these are signs of sort of too much estrogen and not enough progesterone. And I remember one patient who had a migraine, literally in my office, and I had a sample tube of topical progesterone that I had been given by the, you know, the company that made it. and I literally said, well, let's just try this. And I took the progesterone, I just put a little cream on her arm, rubbed it in, and her headache went away, like right there in the office. It was the most striking thing I'd ever seen. And I think, you know, we often will prescribe topical progesterone or other things to help. We'll prescribe dietary changes, help with PMS. He helps help detoxifying these hormones can be really helpful. And also using, using an overall strategy of, of diet and exercise and stress reduction to balance women's hormones, because I.

Think they're totally influenced by diet.

Even the microbiome.

Well, it's interesting you say that because I remember distinctly when I had a patient when I was practicing mainstream medicine who had menstrual migraines and the only thing that worked for her was Xanax. Now, Xanax is a benzodiazepine, which is a tranquilizer. Yeah, like Valium. Exactly. And it works on the GABA receptors. And guess what? Progesterone works on that system.

That's why progesterone is so powerful. So, just to recap that, what you're saying is basically progesterone is women's natural valium. Exactly. And it works in the brain on these receptors called GABA that valium works on and makes you relax, which is actually helps women sleep, calms her nervous system, deals with some of this mood fluctuations that happen with high estrogen. And by the way, our whole lifestyle drives estrogen, right? Sugar, stress, lack of exercise, bad gut microbiome, environmental toxins, all these things will drive dairy, for example, drives excess hormone and estrogen production, being overweight, sugar. All those things can be managed easily with lifestyle and diet. Okay, let's talk about some of the nutrients because there are some key nutrients that are often low in people who have migraines. What's the number one nutrient that you.

Would be thinking of? I would say magnesium. Yeah, magnesium. Now, the interesting thing, this is also another thing where you can sort of connect the dots here is magnesium, which is such a powerful, you know, it's involved in like 500 enzyme pathways in the body, is magnesium when you get to a high enough level is actually a calcium channel blocker. And guess what doctors use to prevent.

Migraines, calcium channel blockers. It's a natural muscle relaxant. It's actually, I remember when I was an ER doctor, it was one of the things we used. None of the drugs worked.

We would use IV or intravenous magnesium for migraine patients. Remember that? Absolutely. And not only that, but we use in the ER, we use IV magnesium for heart arrhythmias, life-threatening ones like torsades de pointes and B-TAC. We also use it for status asthmaticus. Yeah. All right? You use it for preeclampsia. It's a very powerful element.

It's a relaxant. And what you're saying is funny to me because I remember, you know, when you learn these ACLS courses, the advanced cardiac life support and how to run a code and bring people back from death when their heart's not working and they use all these drugs, drug, drug, drug, drug, drug. And the last thing, if nothing else works, they use magnesium. Why don't you use it first?

Right?

And then, like, if someone's heart is not beating right, you give magnesium and it fixes it. Or people are coming in in preterm labor or have this preeclampsia, which is high blood pressure in pregnancy with seizures. They use IV magnesium. They use an asthma, like you said, to relax the lungs. They use IV magnesium. It's pretty funny. Even for people who are constipated, they give them milk of magnesium. So, it's funny doctors don't really think about it. And most of us, about 40% of us, are low or deficient in magnesium. And I remember this one patient I who was a radiation oncology resident back when we were at Canyon Ranch, and she was just debilitated with migraines. She had the worst migraines. She was on narcotics and Zofran, which is like a chemo drug that she used for nausea. It was that severe. She could barely work. And she came to see me and I started asking her questions. And this is how you find things out in functional medicine. You try to connect the dots. So usually you can find out from a story if it's a premenstrual migraine, if it's a food related migraine, if it's a, this is why you're saying we can actually figure this out as functional medicine doctors. And, and it turned out, you know, I started asking her questions and she had muscle cramps, she had constipation. I said, how can you go to the bathroom? Are you regular? She goes, yeah, I'm regular. I said, how can you go? She was like, go every week. I said, that's not regular. She says, regular for me, I go every week. You know, severely constipated. Muscle cramps, headaches, insomnia, irritability, anxiety, palpitations, sensitive and loud noises. these are all symptoms of low magnesium. And so it turned out she needed like normal dose is 200, 400 milligrams. She needed like 2,000, 3,000 milligrams a day of magnesium and literally her migraines went away. Yeah. And that's sort of her constipation, all those other symptoms.

So it's often really often very simple.

If you know what to do. Yeah, absolutely. Yeah. Are there other nutrients that you would.

Think of that might be helpful? Because you mentioned mitochondria. There's a couple of nutrients there that can really help.

Yeah.

I mean, there's, there's some, the, the one of the, I think some of the key nutrients are vitamin, vitamin B2, riboflavin. Yeah, vitamin B6 and also CoQ10. Those are probably some of my key mitochondrial nutrients that, that really can have an impact along with magnesium. Yeah.

So really, like, tell us about some of your, your cases that, that you've had experience with that, that have really kind of changed your thinking and have helped you understand.

Well, I had, I had a patient who came in and his story was that he he first developed migraines starting around at the age of five, which is interesting. Okay. So when you have a history of somebody who's having headaches, I mean, 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 in 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. Now this is probably one of those things that, 'cause caffeine is a double-edged sword. We actually use caffeine to treat migraines, and if patients take 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 withdrawal effect from the caffeine.

So it was like a cat chasing a steak.

That's not great because that's got tylenol in it.

Well, it's great for the company because.

They keep selling it, right? Cause 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 somebody's got migraines, I get them off of all alcohol, all caffeine, and give them some magnesium. Just that's what 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, why, 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.

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, 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 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 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 Benadryl puts you to sleep. So histamine actually activates the body, it wakes the body up. So it's actually works as a neurotransmitter. Also, 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. so histamine definitely plays. It's one of the things that can play a role in, in migraine headaches. And how do you approach a patient.

With who's, who's got histamine sensitivity?

Well, you, you, you.

How do you diagnose it first?

Yeah, well, yeah, well, yeah.

And how do you treat it?

His. 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, that we take in are, can have, they 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, so 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, your neurological system.

Incredible.

Yeah. Yeah.

I've seen, you know, 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 quercetin, even medication like Cromolyn. and people can take orally, histamine, which is very supplements that help with modifying the histamine response and getting the diet low in histamine. People can really have radical transformations in their health. And 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, in 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 it never really worked with a nutritionist. Sometimes, you know, they'll say, well, I worked with a dietician and, you 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. 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 SNPs 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, 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 patients who walk through the door. I mean, we're all, everybody is affected by stress. You know, we just, you watch the news and you get stressed, right? That's why you 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.

I think that's right. But you know, this case brings up something really important about functional medicine because you listed a whole litany of things. It wasn't just magnesium, wasn't just the gut, it wasn't just histamine, it wasn't just this and that. It was a lot of different things.

Exactly.

And you know, functional medicine is really about being a medical detective. and looking for all the various factors. Because traditional medicine is okay, you have this one disease that you treat with one drug. Instead of saying, oh, where are all the imbalances in the system? Let me correct all those. Because if you correct two out of six, patient might get a little better, but not really. You have to deal with all six. Exactly. And I think that's really the beauty of functional medicine. We're not treating the disease, we're treating the patient and all their unique variations in their story and there are no two people who are the same. So when someone comes to the migraine, it's a blank slate. Then I have to figure out what kind of migraine and what are the various factors and is it hormonal, is it magnesium, is it the gut, is it the mitochondria, is it food additives, and is it histamine and maybe all of them. Exactly.

Right? Yeah.

And so this is really what's so beautiful about our approach here at the UlTrawellness Center, which by the way now during COVID we're taking all virtual patients. We can see people from anywhere in the world. you have to schlepp all the way here. And we know we have an incredible team of physicians here and physicians assistant, nutritionists. We've all been doing this for close to 30 years now, which is scary to say. And we're still learning.

And we're still learning.

And it's just, you know, that's the thing about functional medicine. It's just, it's constantly pushes you to discover and learn because you're not just learning a rote approach to this diagnosis. Like that patient who had the migraine, with all the magnesium deficiency and all those other symptoms, she was at the Mayo Clinic. She saw the top doctors there. She went around all the headache clinics in the world. I mean, she saw everybody, did everything, and all they cared about was her headache. They didn't want to know about her constipation or her muscle cramps or her.

Irritability or her insomnia or any of that.

Or stress being married to a mafia don. Well, no, that was somebody else. That was not the doctor. That was somebody else. It was one of the good fellows. and so it's really important for people to understand we're suffering out there from headaches and even regular headaches can respond to this as well. But, you know, migraines are the most severe and disabling kind of headaches. And I just remember this patient I saw was a 24 year old young woman who was a nurse who wanted to become a nurse practitioner, brilliant young woman who was in bed because she had vestibular migraines, which is a certain kind of migraine that makes you not only have a headache and be nauseous, just. But, like, the room spins around. Like, when you're on your beach and you spin around circles so you can't stand up anymore. It's like that. And she was just miserable. Now, she got every treatment for the migraines, every kind of headache drugs, every neurologist. Nothing worked. So I started asking her about, like, other stuff. Well, she was very depressed. She was anxious. She had severe bloating. She had acne. She had fluid retention. She had all these other symptoms. And it turned out she had really severe. SIBO or bacterial overgrowth and severe food sensitivities, as well as a bunch of other stuff and magnesium and this and that. And I literally just really focus on treating her gut and her food sensitivities and supporting her a little bit of magnesium and some other things. And literally within a very short time, within six weeks, she not only like had all her migraines go away.

Yeah.

Not only did she lose 20 pounds, but her depression, anxiety and everything else went away.

Yeah.

I mean, the gut can lead to all that stuff. so it's so unfortunate that we don't think in this comprehensive way with traditional medicine because so many people suffer unnecessarily.

Yeah, it's interesting to talk about that because it reminds me, I've actually, I think I've seen it in a couple of cases, is there are some patients who have H. Pylori, which is specific bacteria, and H. Pylori, if you clear H. Pylori in some migraine patients, their migraines go away, which is sort of very, very interesting. It doesn't happen in everyone. but if you do the testing for H pylori and if you find it and a patient's got migraine, you go ahead and treat it and it can make a big difference.

Yeah.

So I just think you're right, Todd. I mean, it's really just spending the time to ask the right questions, to do the right kinds of tests. So what are the kind of top tests that you might think you wanna...

Well, like we said, checking for magnesium and specifically red blood cell magnesium because magnesium needs to be the intracellular so a lot of times patients are tested for regular magnesium. It's the RBC magnesium is what you really should check for. And then we'll do the testing for gluten sensitivity. The Cyrex 3 is my favorite. And then we'll also do testing for increased intestinal permeability, organic acids, gut microbiome testing can be helpful. I mentioned genetic testing, but there really is the genetics play a smaller role, but it's an interesting because there really is no one gene for migraines. The only the only thing I would tend to say is that if you, if you're suspicious for mitochondrial issues, checking for mitochondrial function, that can be helpful. That can be very hormonal testing.

Yeah. Hormonal testing. Exactly. Hormonal testing. Yeah. So we have a lot of tricks.

And tests that you wouldn't necessarily see.

At a regular doctor's office to help us sort through what's going on. Cortisol testing. Cortisol testing. Exactly. Hormone testing, nutritional testing. Absolutely. Food sensitivity testing. I mean, it's, it's so, it's so, so important. So I, I feel like when I see a migraine patient, I'm so happy. Yeah, right. Because I'm like, oh, slam dunk, this is easy, you know, and they're gonna be so happy and they make me look good. But it really isn't that we're that smart. It's just that we're looking through a different lens that allows us to see the problem in a unique way that's.

Individual to that patient.

Exactly. And personalized medicine. It's the epitome of personalized medicine 'cause there are probably no two migraine patients that I will treat the same. They're all unique and I'll do a little, you know, there's a sort of a basket of things that you'll do, but you tweak that to that individual patient based upon their history, their testing and everything else. And that's the fun part about it.

So what's like if you're just saying to somebody who's listening and they're like, well, I don't really know any functional medicine doctors. I want to just try some stuff on my own. What would be like the top few things you would tell a patient to try? Let's say, you know, your cousin had.

Migraines and they didn't want to come in and see you. What would Colum? Well, first thing is get good sleep. Most people are sleep deprived and actually, because lack of sleep is a stressor. And we talked about stress being a big trigger for migraines. So getting into a good sleep wake cycle, modulating and detoxifying stress, meditation, whatever different forms that you use for, excuse me, relaxation. Relaxation. Exactly. adding magnesium and then the simple dietary changes, gluten, sugar, dairy, those are the big three. If you remove those from a patient's diet, it can make a huge difference. I think those are probably some of the key things that you can do. Yeah, I agree.

I think it's so simple. Just clean up your diet, gluten, dairy.

Sugar, processed food, all the additives, chemicals. Yeah, you're absolutely right because the excitotoxins, a lot of those things that are added to foods that you may not even be aware of. The best thing to do is buy food that doesn't have labels on it. There you go. Right, there you go.

An avocado doesn't have a nutrition facts label or an ingredient list. It's just an avocado. I agree. So that's something people can try, an elimination diet. We have something called the 10-day reset, which is really easy to do. You can go to getpharmacywithanf.com, that is a really simple approach to just cleaning up your diet for a week or 10 days. And often you'll know very quickly. I mean, if your migraines are two or three times a month, you might have to do it longer. But if you get regular migraines every week or more, you'll see a difference. Magnesium's super slam dunk, easy thing to do.

Getting stress reduction in sleep, so easy. And the other thing is that oftentimes for some people who have really bad migraines, you don't, sometimes you know, it's not as though they're never gonna have a migraine the rest of their life. But if they do get a migraine, it's not disabling. It might be very infrequently and if they get it again, it's very mild and it may be triggered by something, but it's really nowhere near as bad as when they first started. So it's not like I'm going to cure your migraines. This individual may be susceptible to having migraines. For sure. And when you make all these changes, their life is much better because they cannot function. And if they get a migraine, it's not disabling, it's mild, it's infrequent, it's.

Not a big deal.

And then they learn what are the triggers for that.

And they can avoid them.

Yeah.

Interesting. Have you ever had migraine? I have not. I've had some headaches, but I've never had a migraine.

Thank God. It's interesting. It's fun. I can imagine. Yeah, I very rarely get a headache and I've never had a migraine. However, when I was working at Canyon Ranch, there was one time, it was right before lunch, I all of a sudden had these jagged, sparkling lines in my field of vision.

Yeah.

And I'm like, where does this come from?

Having a stroke.

What's going on?

Right.

So I was actually having, because migraines, you can have an aura with a migraine. An aura is like what get before you get a migraine. And for whatever reason, it was, I only had it once. I had a migraine aura and I never did, I didn't get a headache, but I knew exactly what it was. And I said, oh, this is interesting. Now I know what the patients are experiencing before they get a migraine. And I had it once, didn't have a headache, never had it again. Don't ask me why I had it. You know, I could have been, maybe I was, you know, low in blood sugar or, I don't know, stressed out or I don't know what, but it was, it just started sitting there and I was in it. It was, it was, it was, it.

Was a good experience because now I can understand what it's like for a person to have a migraine aura. Well, if you've been listening to this podcast and you've had headaches or migraines, don't fret because following these simple ideas can have a profound effect. If you get stuck and you need more help, we're here at the Ultra Wellness Center to help you. Just go to ultrawellnesscenter.com, we can see you virtually. And, it really sometimes is a bit of a detective job, but simple things to try, like we said, diet, elimination diets, magnesium, sleep, stress reduction, certainly a place to start. It is something that is causing so much suffering. I mean, 10 million people have it. Probably collectively it costs $50 billion a year to society. It's a big deal. And some things are hard to deal with. If you have certain cancers, that's really tough. But migraines are easy slam dunk for functional medicine. So if you have a migraine, I hope you never have to have it again after listening to this. And all the instructions we gave. And if you love this podcast, we'd love you to share with your friends and family on social media. We love you to leave a comment, share your experiences about having migraines and what's worked for you, and subscribe wherever you get your podcast. And we'll see you next time on the Doctor's Pharmacy.

All right, thanks Mark.

Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter, I'll only send it to you once a week on Fridays, nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode.

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