#207: The Main Risk Factors That Cause Migraines with Dr. Rani Banik

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome.

Well, welcome back, Doc.

Ronnie, to the Gutsy Gynecologist Show.

Thank you so much, Dr. Tabatha. I am so happy to be here.

Yeah, I just can't soak up enough of your wisdom. You are just so knowledgeable when it comes to so many things. And, you know, we finished our eye conversation, and for anybody listening, if you haven't heard that episode, it's number 204, The 3 Biggest Eye Issues Women Experience. Go back, listen to that episode. But we realized we need to talk about migraines because that's another big topic that so many women are frustrated with, and it feels like it's even more common in the perimenopausal menopausal age as well. So I just want to dive into all of that important stuff. So why don't we just start off with like what is a migraine? Because I think a lot of women. relate any headache to equal a migraine, and what's the difference, and does it matter? So break that down for us.

Yeah, absolutely. I think there's a lot of confusion out there about what exactly a migraine is. Some people think it's a headache, but it's actually much more than a headache. There are other symptoms that can happen. There are neurologic symptoms, and then even in between attacks, people may have symptoms. So it's important to distinguish a regular headache from a migraine. So there's actually specific criteria, and I'll just go through kind of very quickly what some of the criteria are. But first of all, there have to be 5 episodes. People have to have at least 5 episodes. If you just had 1, you don't yet qualify for migraine. But the episodes are usually anywhere from 4 to 72 hours. So it can be on the shorter side, but it can last several days. And for some people, their symptoms can even last a week or 2 weeks or even longer. So it's not just, again, like your regular headache, like I haven't eaten today, I have Headache or I have a tension headache. It's quite different than that. And then there are some other symptoms that are pretty characteristic of migraine. So one is that it tends to be unilateral. So for example, one-sided, maybe it's, you know, for your forehead or behind the eye or sometimes even the back of the head, but typically one-sided. It tends to be like a throbbing type of headache or pulsating headache. So think of it like every time your heart beats, you feel like this, like boom, boom, boom. Or sometimes it can be even like a sharp stabbing pain, like someone's like actually stabbing you. So this is a horrible sensation, but like stabbing you with an ice pick.

Mm-hmm.

And the headache is usually moderate to severe. So not just like a mild headache, but it's usually pretty intense and it usually stops people from doing what they normally do. So, for example, if they are doing some activity, particularly physical activity, it can be very uncomfortable. It makes things worse. And then in addition to all of that, to actually meet the criteria for migraine, you have to have a couple of other symptoms. So, for example, light sensitivity or sound sensitivity, nausea or vomiting. So if you put it all together, again, you can see that it's not just having a bad headache. It's so much more. And then there are, you know, it's not part of the diagnostic criteria, but there are over 40 other symptoms of migraine, from ringing in the ears to dizziness to constipation to loose stools. So it can be one or the other. Feeling of being flushed, brain fog. That's a big one that a lot of people experience is They just can't think properly when they have migraines. So there's so much more, and it really is its own entity, and it really is a neurologic problem.

Oh, I love that you explained that so well. And I just think back to when I had migraines. I would start off with the dizziness and the ringing in the ears, and then the pain would come, you know, an hour or 2 later. And so I finally made the correlation and realized, like, oh, here's my warning sign. This is coming on. This is happening. Do you think that that's the most common scenario for women, or does the pain typically come first?

So it can be all combinations, but typically there are 4 stages to migraine. So what you're describing, Dr. Tabatha, is you had almost like a prodrome. You felt it coming. So there's a prodrome phase where something just doesn't feel right. And for me, I have migraine also. For me, my prodrome is I feel like my body's just going to shut down. Like, I feel like I have no energy. I just want to go to sleep, but I don't have the headache yet. So when that happens, now I know, okay, it's probably coming. That's the way my body is responding to this. And then there's the aura phase, which some people have as well, which is some people actually see flashing lights. Like, I don't know if you've ever had a migraine aura, but zigzag flashing lights that can last like anywhere from 5 to 30 minutes. That's a typical aura. Sometimes people get other types of aura. Could be like tingling, which is kind of scary the first time you have it, but like Tingling down your arm that can last again like 5 to 30 minutes before the headache starts. Then there's a headache phase and then there's the postdrome phase, which we sometimes call the migraine hangover. So let's say you've gone through some of these phases, the headache is gone, but you still don't feel well. It's kind of like I've been drained, like, like you've, you know, you've had alcohol and just can't function properly. It's kind of like that.

Yeah.

And the prodrome can last a long time too. Sometimes it can last days or even a week or two, which can be really debilitating. So Yeah, it's not fun having a migraine because there are all these unusual symptoms that can come about, and everyone is different. I tell people, your migraine, even though maybe it runs in your family, maybe other people in your family have migraine also, your migraine is unique to you. It doesn't necessarily have to follow the pattern that other people have. So you kind of have to address it that way as well.

Absolutely. Well, I know for me that Once I cleaned up my diet and I got off the SSRIs I was on and I started sleeping enough, like all of those changes really kind of dissipated. And I got to the point where I can't even remember the last time I had a migraine. It's probably been, you know, 6 or 8 years at this point. Like, it's really rare.

That's good.

But it was a common problem, you know, maybe once a month, once every couple months. So What are the major risk factors, and does the frequency of them tell you anything?

So I'll answer the first question, and we'll get to the second one. So the risk factors. So we know that— I was talking earlier about family history. We know that genetics play a role. So there are over 50 genes that have been associated with migraine. Now, what a lot of those genes do, we still don't understand. But we know that there are at least genetic markers that are very common that go along with migraine. And definitely it runs in families. So, for example, if you have a parent with migraine, there's a 50% chance that the child will have migraine. If you have both parents with migraine, then there's a 75% chance that that child will have migraine. So that's definitely kind of the underlying predisposing factor. But then layered on top of that, there are all of these other kind of dynamic risk factors that come and go, and a lot of them are lifestyle choices or our dietary choices. So, you know, you were talking earlier about how you changed your diet and your migraines got better. I'll just share with you, for me, my migraines really got bad in my 40s, my early 40s, when I was going through a lot of stress. I wasn't sleeping properly. I was— we're doing a home renovation. I was exposed to all kinds of toxic fumes and, you know, just horrible stuff. And I was eating so poorly. I was living off of— and this is— I cringe to think about this now at the time, but I was living off of pizza, ice cream, and Diet Cherry Coke every day during this period. And, you know, my migraines were horrible. And I tried all the medications out there. Nothing was helping. And it never occurred to any of my doctors. And I went to some of the top doctors here in New York City for migraine. None of them ever asked me, what are you eating? What's your stress like? What are you drinking? None of them asked me that. But that was the key to helping gain control of my migraines, is changing my diet. And so once I realized, oh my God, maybe what I'm eating is contributing to my symptoms. And this was like the aha moment. And this is actually what introduced me to functional medicine because I never had even heard of functional medicine before this. And one of my colleagues said, oh, why don't you try an elimination diet?

Mm-hmm.

And I said, well, what's an elimination diet? And so it got me curious, and I ended up starting, you know, taking the courses. I ended up getting certified. So it was really a journey that I went through, kind of realizing that my own choices were contributing to my migraine, but also learning that there's this whole other field out there of functional medicine, a way to approach conditions looking at the root cause and then using natural ways like diet and lifestyle and botanicals and supplements, et cetera, It really changed my life, like that realization that what I was doing was contributing to my migraines. Also, I wasn't sleeping. I was sleeping like 3, 4 hours a night.

Yeah, absolutely.

I was trying to figure out, like, why am I getting these migraines? Like, it didn't occur to me at the time when I was in the worst of it, like, these were all things that were under my control that I could improve on. And once I finally addressed them, things finally started to turn around. Like, after 3, 4 years of having a daily migraine— and you've had migraines, so you know how bad it can be— but I had a migraine every day during this period. And finally, things got better when I started to make changes.

Oh my gosh. And for the listeners, like, they need to understand you are a doctor as well. You went to medical school. We did not have this kind of training. There is no talk about how food impacts the function of your body. And it, it just blows my mind to this day that I practiced so blindly for so long and didn't even question it or think about it, you know, and the fact that You were suffering from a neurological issue, and that's your specialty, and you didn't know. You weren't aware.

That's the irony of it all. Yeah. We're trained, unfortunately, to diagnose and then to write a script. Right. And that's kind of like the knee-jerk reaction. Oh, somebody has this problem. Let's just write a script. But there's really not much— the detective work needs to happen. Like, why is this happening? And I'm so grateful that I discovered functional medicine through this. I mean, it wasn't the best way to do it, but it helped me. And then now I'm able to help other people. But it really does need to be— it needs to be taught, first of all. But people need to be aware of it, even doctors. Now, I, you know, I sometimes tell my colleagues, oh, I have— I got certification in functional medicine. They kind of look at me like a little bit quizzically, like, what is that? Like, I never heard of that before. And so I think we need to raise awareness amongst our colleagues as well. Like, there is this whole other field of medicine that gets to addressing the root cause and asks patients, like, what's going on in your life? What are your stress levels like? What are you eating? How much are you sleeping? What toxins may you be exposed to? It's just so, so important.

Absolutely. And I tell people, don't even be mad at your doctor if they don't. They just— they haven't been exposed. They're in this world of sickness and disease. And I just remember Being shocked that there was a whole world of health and wellness. I knew nothing about it. Like, I was so engulfed in like the world of sickness and trying to survive myself that I didn't watch daytime TV. I didn't see the books on the New York Times bestseller. I didn't. I just wasn't exposed, and it sounds like most doctors just aren't. And so we have to take away that frustration. But I hate to say it. I'm glad you went on that journey because now you're helping so many people with migraines, and you're actually healing them as opposed to just giving more medications and giving new problems and side effects and all those things. So thank you.

Yeah, actually, once I realized, okay, I need to include this approach, the functional medicine approach, in my practice and offer it to my patients, I ended up quitting my job because, you know, I was working in a large academic center. I was seeing patients, teaching, etc., doing research, but I wasn't able to do what I needed to do in that short 10 to 15 minutes that they were giving us with each patient. It's just impossible. And so I think also the whole, you know, way healthcare is delivered needs to change to be able to encompass some of these aspects of health and wellness that Again, don't get the recognition that they really need.

Absolutely. I found that so frustrating. I tried to practice functional medicine as an OB-GYN, and I really just got so much pushback from administration. I wasn't making enough money. I wasn't seeing enough patients. And it only lasted a few months. I don't even know how long, because it's just— it's like we're trying to fix a broken system from the inside out. But The problem is rooted so much deeper. Like, medicine needs a functional medicine approach to fix the system, you know? That is true.

Yeah, I love that. I haven't— I hadn't thought about it like that, but that's definitely true.

Yeah, exactly. So let's talk about these risk factors a little more. If someone is like, okay, I don't know what my genes are, I don't necessarily think it's in my family, what are like the top things that they should start evaluating about their life?

So for people who have migraine, their brains are wired for regularity. Like, our brains love to have a set pattern, and whenever that pattern gets thrown off, that's when people are predisposed to migraines. If you think about it kind of like a migraine threshold, if your migraine threshold is here normally but your schedule is off— let's say you're traveling, you're not sleeping well enough, you're not eating normally on schedule— then your migraine threshold drops down to here. So it's Mm-hmm. So you want to try to get your— keep your migraine threshold as high as possible. So regularity, again, in your mealtimes. So don't skip meals. And I know this is a little bit tricky because I know some people do intermittent fasting, but for some people who have— who are really predisposed to migraine, who are really suffering, I tell them, like, maybe you shouldn't fast for such long periods of time. Shorten your fast because your brain is not functioning well. with a longer fast. So that's something to think about. Don't skip meals. And also, sleep is really important. So having an erratic sleep schedule can definitely trigger a migraine. Again, if you're traveling, if there are changes in time zones, I know it's kind of hard to maneuver that one, but try to go to sleep at the same time every night and wake up at the same time every morning, whether you're during the workweek, during the weekend. Try to have your brain used to that regularity. And then also, this is a big one, hydration.

Yeah.

Mm-hmm. So if our bodies— it's such a simple thing. I mean, like, if your body is not hydrated, there's more of a chance that you will develop a migraine attack. So what happens in migraine? What we think happens— it's crazy that we still don't know exactly what's going on in migraine. It's such an elusive thing that happens in our brain. But we think that initially there's some trigger, some kind of event or body imbalance within the body. And blood vessels in our brain kind of go into spasm, so they constrict. And then when they constrict, that's when certain parts of our brain don't get enough blood flow. That's when people can have an aura, for example. That's when people see those zigzag flashing lights, or they may have the tingling or hear something. That's the aura phase. So after the initial constriction, then the blood vessels dilate. And when they dilate, that's when the pain happens. That's when chemicals get released, neurotransmitters get released that modulate pain, and people have the pain of the migraine. So So, getting back to hydration, when you're dehydrated, your blood vessels tend to have a lower tone. So, they're, they're, they're not as full. Their volume is not as great. So, they're more likely to constrict and go into spasm. That way, if you keep your blood volume up by hydrating, you're preventing that constriction dilation. You're just keeping it more of an even tone. So, that's the whole goal, is to keep your blood vessels from doing this all the time.

Mm-hmm.

You just want to have them even. and have nice, even blood flow. And hydration is by far the best way to do that, especially if you're working out. I've had a lot of patients come in who, you know, they're doing this intense workout, they feel great, but then all of a sudden they get migraine aura, they get the full-blown migraine. They don't really know what triggered it. They think they're having a stroke. It's really scary. But the truth is probably their intense workout led to them being dehydrated, or maybe they weren't hydrated enough with electrolytes to begin with.

Mm-hmm.

And that also may have triggered these blood vessel changes in the brain. So stay super hydrated, especially before workouts, and maybe have something with electrolytes in it to try to prevent that sequence of events in the blood vessels. Another thing is caffeine.

Mm-hmm.

And I know many of us are wedded to our caffeine drinks. I know when I was in the worst of my migraine phase— and again, I'm like cringing to think about this right now— I used to Have 10 to 12 caffeinated drinks a day.

Me too. That's how I passed med school, right? Like, that's how I got through residency.

It's crazy. Like, many people are just so, you know, basically addicted to caffeine. And what caffeine does is it does constrict your blood vessels. So if you don't have caffeine in your diet and you're having a migraine, your blood vessels are dilated. You can use a little bit of caffeine to help constrict them, to help ease the pain. But If you have too much caffeine on a daily basis, your receptors on those blood vessels don't respond to the caffeine. So they basically become inactivated from too much caffeine. And what sometimes happens is you feel like you need more and more and more of caffeine to have the same effect, to have, you know, if you're, you know, before maybe you had 2 drinks that was kind of taking care of your migraine. Now you have to have 4 or 5 or 6, and it just comes, kind of becomes a snowball effect. So. What I typically recommend for people who have or are prone to migraine is that try to limit the amount of caffeine. So have 1 or 1.5 caffeinated drinks at the most in your, in your day. And I know it's hard. And don't— trust me, don't do this. Don't just stop cold turkey.

Yes. Because you're going to have the worst headaches of your life.

So gradually wean yourself off of caffeine. So what I typically tell my patients is if you have a lot, let's say you have like 8 You know, 8 drinks a day, drop it by half a drink per week. So slowly, over the course of a few months, you're going to go down to 1, 1.5 maximum caffeinated drinks a day. And that's what I do now. So I'm down to like 1.5 cups of tea a day, and that's it. That's all I'll have. Versus all the sodas I was drinking with caffeine and coffee and Snapple and, oh my God, I was— So bad with migraines. So I think that's really important for people to realize is it's not that you have to cut it out completely. In moderation is okay.

Yeah.

And I think some people don't realize they're necessarily drinking caffeinated beverages because it seems to be in so many more things nowadays. Like, I hear women say, well, I only have 2 cups of coffee, but then they're drinking like flavored waters with caffeine in it and sparkling waters with caffeine or Tea, they don't realize, has it as well. Iced tea and hot teas and all these different drinks, energy drinks. So you really do need to kind of take stock of what the heck you're putting in your body because you might be surprised, you know?

Yeah, read the labels. So I was actually— after I got off my soda, my diet soda binge, I switched over to kombucha and I was like, okay, this is giving me a little bit of the fizz and also it's giving me a little bit of caffeine. But what ended up happening was I was drinking like 2 or 3 or sometimes 4 kombuchas a day. And then I looked at the label and I realized, oh my goodness, this kombucha has so much caffeine in it.

So I didn't even know kombucha had caffeine. Like, oh my goodness. Yeah.

So it was like a realization. I was like, oh my goodness, I can't believe I just like traded one addiction for another. And then what I ended up doing was I I did switch it out completely. I switched it. I wanted that fizz and I wanted a little bit of probiotics. So I switched that to this apple cider vinegar drink that has no caffeine. But now when sometimes when I feel like I want a little bit of something, I have green tea and green tea has a little bit of caffeine. It has, depending on what you're buying, it can have anywhere from 12 to 24 milligrams of caffeine compared to, you know, like, for example, coffee that can have 80 to 100 milligrams, or like a yerba mate drink. I was looking— my husband bought all this yerba mate the other day, and I said to him, I was like, do you know how much caffeine this really has in it? Like, you wonder why you can't go to sleep. It's got like 80 milligrams of caffeine in this one 12-ounce can. So just look at the labels, and I think you'll be surprised as to how much caffeine is really all around. Like you were saying, so, so common. And even chocolate has caffeine. So I know, you know, many people love chocolate, myself included, but limit it because that can also be adding to your daily caffeine dose and you may not even realize it.

Yeah, I've had multiple patients who complain of migraines and headaches and things, and it was because they were eating too much dark chocolate before their period and not realizing, or they were having trouble sleeping because they were consuming it in the afternoon and evenings. It's like there's You know, it's in there as well. So that's important to know. This is what I do. I drink water. If you guys are watching on YouTube, I have my water and my coffee. And I do the same thing when I used to drink alcohol because I would try to just dilute it. In my mind, I'm thinking, okay, let me just put water, more water in my bloodstream with the coffee because I think— It does help. It does help, absolutely. And I tend to drink less coffee overall because I'm You know, filling my belly with water, right?

I love that. Yeah.

Well, good. Okay, so we got to check out the caffeine. What about sugar? Does sugar play a part in all of this?

So I would say it's definitely— some people are very sensitive to sugar, particularly simple sugars, where you get this rush of, like, you know, energy. So you have this peak, you know, foods that have a high glycemic index, for example. You get this rush of sugar uptick, and then you get the sudden drop. And so that can, for some people, that can affect their migraine threshold. It can put them at a lower migraine threshold. One thing I would love to do, and I actually want to do this for myself, is to get one of those CGM monitors, the continuous glucose monitor.

Yeah.

And just to try it out for a couple of months to see if I can correlate. I still do get migraines, not as often, but maybe once or twice a month compared to every every day that I used to have migraines. But I'm curious to know, like, those days out of the month when I do get my migraine attacks, what my blood sugar is doing around that time. So I'm going to do a little experiment on myself to try to figure that out. Maybe I'll end up publishing it at some point, like as a case report or something. But I'm really curious to know. Then there are other foods also that can trigger migraines. So, for example, there are foods that are fermented. And they have a chemical called— or I believe it's an amino acid called tyramine. And so that can sometimes trigger migraines. So, for example, fermented cheeses, fermented alcohols, particularly beer, other types of foods can also release histamine, which combined with being fermented can also trigger migraines. So I think when it comes to food, there's again no one food that's going to be a trigger for everyone. You kind of have to do a little bit of detective work. Maybe keep a diet diary for a couple of days, like, um, and or maybe even a couple of weeks to try to figure out what foods you may be sensitive to that may be contributing to your migraine. And sometimes what I do, coming from the functional medicine perspective, is I'll actually do like food sensitivity testing. And that's really uncovered some really, I would say, shocking, you know, food sensitivities for some patients, some foods that they absolutely loved they realized that they were sensitive to, and then they ended up eliminating those foods, and it made a big difference in managing their migraine attacks. So it really has to be looked at with an individual lens and going a little deeper for some patients.

Absolutely. We do that in our practice. We try to get food sensitivity on everybody, stool testing, heal their gut. And it's incredible. I'll have patients who didn't even come to me for the migraines. They came for all these other complaints. And then it's like, oh, by the way, I haven't had a migraine in 3 months. And they're just in shock. And it's like, yeah, that is the power of food and healing your gut. So I love that.

There's actually a lot of— there's this research coming out now linking the gut microbiome and gut dysbiosis to migraine also. So I think we're going to be hearing a lot more about that. There may be specific bacteria that are in people's guts that may be predisposing them to migraine. So the research is being done. Hopefully, we'll know in the next few years or so what is that exact link. But I do tell my patients, always try to heal your gut first from using that functional medicine training. And just think of it as it's not just your brain. Remember, our gut, it produces 75% of our neurotransmitters.

Yeah.

Throughout the body. So it's important to have a healthy gut also to have a healthy brain. It's really, really key.

Yeah. Will you speak on that a little more? Because maybe people listening are like, what the heck's a neurotransmitter?

Oh, yes, absolutely. So there are chemicals in the brain that help to modulate neurons and signals and processing, etc. And for example, there's dopamine, there's serotonin, there's There's also acetylcholine and adrenaline, noradrenaline. These are all neurotransmitters. And so much of the neurotransmitters in our body is actually not made by the brain; it's made by the gut. And so keeping the gut healthy can help to modulate healthy levels of serotonin and dopamine, which have also been linked to— abnormal levels have been linked to migraine as well.

Yeah. I will say that When I was having regular migraines, I was on and off SSRIs, these serotonin reuptake inhibitors. And it's because I was struggling with depression, but it literally all stemmed from my gut. I had a terrible gut. I had chronic IBS, like, since childhood. And it really wasn't until I figured out the gut piece, and it was more than just diet, like, I actually had to do some gut healing and kill off of some bad bacteria and a parasite and things like that and teach my gut how to make serotonin again. And it took a long time. It was like this on-and-off weaning process of those medications. And I find that some women really struggle with that piece because you can get withdrawal symptoms. And do you ever see migraines being triggered by withdrawing, trying to get off of these SSRIs?

Yeah. So I'll tell you, like, a lot of my patients who are coming to me for a second, third, fourth opinion, they're on so many drugs for migraine. Like, their doctors have just been prescribing and prescribing.

The Imitrex and the amitriptylines and all the stuff.

It's really— I mean, it's horrible. It's really— it's one of my pet peeves is, like, please do not use polypharmacy for migraine. Polypharmacy is just using multiple drugs. It's basically like Yes. The doctor doesn't know what they're treating, so they're just throwing all these different prescriptions at you. And I've seen patients who are young, in their 20s, 30s, 40s, who are on 10 meds for migraine and nothing's working, or 20. I've seen one patient who was on 25 medications for her migraine, this young woman. It was so sad to see this. And she was walking around like a zombie because of all of the side effects of these medications. And so I told her, I was like, look, I didn't start you on these medications, but what I would like to do is to gradually wean you off. And once you get weaned off, that's when you can really get your body to normalize with all those neurotransmitters. At the same time, in parallel, we can work on diet, we can work on your gut, we can work on your stress, et cetera. But some of it's really, you know, it's really a travesty sometimes when people are on all these medications. SSRIs, like you were saying, amitriptyline. Now there are these newer classes of medications for migraines, CGRP inhibitors. So people are on like so many different agents. And if what I say is if it's not working, then, you know, play with the dose. If the dose isn't working, then stop it and move on to the next thing instead of layering on so many different drugs all at once. Right.

And we need to understand that when we say a medication is safe, it has been tested as that medication. It has not been tested with all the other medications that you're taking. And so you're just a guinea pig because who knows what kind of reaction is happening with all those medications inside of you. Like, it's crazy how much we just pretend in medicine and we just, you know, guessing games and trying to see what works. But really, it's not as evidence-based as a lot of physicians claim and push because that kind of stuff is not being studied. The way people are practicing and prescribing is not being studied. We actually don't know those It's so true.

Yeah. And I was— I mentioned earlier, I was seeing a lot of different headache doctors here before I discovered functional medicine. But this one doctor, she was, she was very sweet, but she would just ask me, okay, so you have your daily headache, and so we're going to give you these 3 medications for your daily headache. And then you have these attacks on top of your daily headache. So we're going to try out these other 2 medications, and then we're going to do a nerve block, and then we're going to do some Botox. And I was like, wait a minute.

Oh my goodness. Why?

Like, I don't want to take that. And it was literally making me feel like a zombie. Like, I could not function. And I know first of all, it's hard. It can make you feel to be on all these drugs and they don't work necessarily.

Right.

So my philosophy is to wean, like you were saying, like weaning off is so important, but to do it slowly because Especially if you've been on it for a long time. Like, let's say you've been on these medications for like a year or 2 years or 3 years. Your body's not going to like just suddenly being taken off of it. Yes, you can have withdrawals. So do it slowly. Work with your provider. Please don't do it on your own, but work with your provider to slowly eliminate medications one at a time. Decrease the dose, decrease the dose, get off one, then move on to the next one and do the same thing. Yeah.

Yeah. I truly believe our bodies were not created to require all these medicines that we put them on. It's just We have to figure out what is our body missing, what's irritating it, you know, what do we need to change? And I love that you are taking that approach. So we got the diet. You mentioned the sleep. That's so important. Changes in your schedules, trying to keep your threshold high, right? Are there any other major triggers?

Yes, the big one, which I'm sure a lot of your audience is going to want to hear about.

Yes.

Hormones going through just your regular menstrual cycle. So what happens during the regular cycle is that our progesterone and estrogen levels rise, rise, rise, and then just as we start menstruating, they suddenly fall. And again, our brain is so used to having regularity. So when you have that high level of hormone, then all of a sudden it's falling really quickly, that can trigger a migraine attack. So a lot of women get what they call Menstrual migraines because they have a sudden drop in their estrogen level. So that's a common, common trigger for many women. But for women who are going through perimenopause, their estrogen-progesterone levels are all over the place, right? So that can also predispose someone to having worse migraines during this period in life. And during menopause too, you would think that finally after menopause, like, everything evens out and we're going to be less predisposed to migraine. But some women— especially in the first few years of menopause, don't do well because their brain is used to getting estrogen and it's not getting estrogen. So that— I mean, it's like you can't win at any stage in life. But there are things that you can do to kind of mitigate all of those hormone sways and keep things more at even keel. So for women who have menstrual migraine, I definitely love phytoestrogens, which are plant-based estrogens, which kind of almost trick your body into thinking that it's getting its estrogen levels. So include some of those phytoestrogen foods in your diet, like seeds, like chia seeds, hemp seeds. They can at least try to mitigate that sudden drop in estrogen levels. Some people do seed cycling during different parts of their cycle. That's something you can consider. And then for women who are in menopause, basically, you can try bioidentical hormones. Again, you have to work with your provider. And for some women, it can be a huge benefit, or even wearing a patch can be a big benefit. But it's something, again, you should discuss with your provider, like, how, how are your symptoms? Like, what are you trying to treat? And is it worthwhile for you to start some of these, these hormone replacement therapies?

Wow, I couldn't agree with you more. Like, we need to reiterate 2 main points here. Perimenopause, I see so much estrogen dominance, and that really triggers migraines when, like you said, that hormone level drops right before the period. And I try to explain to patients that imagine falling from a 1-story building, like, it hurts, you know, you might be a little bruised up. But if you fall from a 10-story building, it's going to hurt a lot worse. And that's what's happening if your estrogen level is really high. and then it drops before your period, those are going to trigger more symptoms, and it's going to feel worse than if you have a nice, healthy estrogen level and it's dropping for your period. So that— I do see those migraines come on during that time. And the other important point, I've had patients who've never experienced migraines. They go into menopause, and that estrogen deficiency is now triggering migraines that they've never experienced. And The doctors are all baffled, like I don't know what's wrong with you. It doesn't make any sense, and it really is that estrogen deficiency. Your brain cells are so used to the protection of estrogen, and they're like, where's my estrogen? You know, and I'm assuming it has something to do with our cardiovascular system in general because we know blood pressure goes up in menopause. Your arteries become stiffer; they're less. You know, elastic and pliant. And that's got to all affect your risk of just developing a migraine.

Yeah, I mean, definitely it could be the blood vessel effect of lacking these hormones, these sex hormones. But also, there are receptors in the brain for estrogen right in the center of the nerve that is associated with migraine. It's called the trigeminal nerve. So it's deep within your brain. And that's the nerve that gives sensation to our face. It's responsible for pain in our face and our scalp, et cetera. But where that nerve comes from, deep in the brain, there are estrogen receptors there. So imagine the brain's used to getting input from these hormones binding, and it's not getting that input anymore, and it can really throw people off. And what you were saying earlier, people who've never had migraine before, suddenly in perimenopause, menopause, they're getting these horrific, horrific migraine attacks. It definitely can happen. But one word of caution is if you've never had a migraine in your life, But now all of a sudden at age, you know, 45 or 50 or 55, you're suddenly getting these, these attacks. Just get them checked out because that's also not normal. And we just want to make sure it's not just hormone related, that it's— we want to make sure it's not something more serious, that it's hormone related. So.

Absolutely. And what is the standard workup for that type of situation?

So it really depends on what you do.

Actually, I would love for you to compare, like, what would a conventional ophthalmologist or neurologist do as compared to a functional one?

Well, the very first thing is if someone, let's say a woman in her 50s, experiences her first migraine and she's got the aura with the zigzag lights and then she develops the headache and she's never had migraine in her life and there's no family history of migraine, I would first start with a traditional approach, which is You need to do a workup. And my workup typically involves the complete eye exam, making sure everything's okay, making sure the visual pathways are okay, doing some testing in the office, but also doing an MRI. If that's okay, then I would talk to her about what's going on with her, her cycle. You know, where is she? Is she in perimenopause, menopause? What is she doing for that? Maybe work with her OB-GYN to, you know, figure out what would be the best option for her. And if it becomes a recurrent problem, then I would do what you were saying earlier. I would do the food sensitivity testing. I would do the stool testing. I would also do a tox screen. I would look for environmental toxins. Could there be something else that's triggering this? And then, of course, talk to her about all the diet and lifestyle changes that she can try to incorporate to try to raise her migraine threshold. So it's important to kind of combine both approaches. You need to have the medical approach, Just to make sure it's not something more serious. And I don't want to scare anyone, but, you know, we just want to be sure it's not a seizure. We want to make sure it's not a tumor in the brain. You know, those are very rare that that would happen, but we want to get those off the table first before saying, oh, this is due to hormonal changes during this period in life.

Absolutely. Okay. Well, let's talk about supplements, because to me, supplements are so helpful just for your basic foundational health. Like, we need basic vitamins, minerals, things to keep our cells functioning. I think God created herbs for us to use and, you know, keep our body balanced. Things like adaptogens, all those things. So I know that I tend to just start with supplementation, and it's something simple like You probably are deficient in magnesium. Like you were saying, our electrolytes get off balance. They get depleted. What are your go-to supplements when it comes to migraine?

Yeah, so I'll just preface this by saying in my practice, I always start with supplements also. And in patients with migraine, I would say 75% of them improve with supplements, and they don't need a medication or they don't need that treatment. So it can make a huge difference if you're suffering with migraine. Magnesium is my go-to as one of the first supplements I put people on. And there are lots of studies to show this. So there is scientific evidence behind using magnesium that can decrease the frequency and severity of migraine. So I love the chelated forms because they have better brain penetration. So the chelated forms are, for example, magnesium glycinate or magnesium malate or magnesium threonate. If you're taking a salt form, which is like oxide or sulfate or citrate, they may not necessarily get into the brain. So that's why I always recommend doing a chelated form. Another supplement that's really shown to be helpful for migraine is vitamin B2, which is riboflavin. So we can eat lots of foods with riboflavin, but sometimes you have to get that extra boost. And so taking it as a supplement form can be really, really helpful. And actually, Not just one B vitamin. We know that for people who are prone to migraine, they have some mitochondrial dysfunction going on. And so supplementing with all the B vitamins can really be helpful. So I typically recommend like a B complex along with the magnesium. And perhaps even there are some herbs also that can be helpful. For example, curcumin, or it's a bioflavonoid, but curcumin or turmeric can be helpful. Feverfew, which is an anti-inflammatory herb, can be helpful. Rosemary. So these are all things that you can try and experiment with. And I also love peppermint. So you can take peppermint as an oil and you can use it topically. Maybe add a drop of peppermint to your foods, not more than a drop because it's very, very potent. But if you're going to use it topically, you can also dilute it and you can use it over your forehead here. in your temples, the back of your neck, and sometimes even when you sleep, the soles of your feet or the palms of your hand. If you use like a peppermint mixture, maybe peppermint with lavender, it can be really calming and really help to alleviate some of the pain and the inflammation that comes along with migraine. So you could try out some of those things. Again, super simple and very effective. I mean, it's really remarkable how much people respond to some of these natural approaches rather than to start a prescription medication.

Yeah, absolutely. And this is not woo woo. It's actually scientifically based. This is physiology. It was my major in undergrad. Literally, that's just how the cells are functioning. It requires these vitamins, it requires minerals, all the things. And you have a supplement line for this, right?

I do. So I have a supplement called— and I'll just share it with you here. It's called Calm. I don't know if you can see that.

OK.

This is specifically custom-tailored for migraine. So it has magnesium malate. It has the riboflavin, which is the B2. It has feverfew. It has turmeric. So it has a lot of the ingredients that you could take them separately, But here you can get them all in one. So this is something that I recommend to a lot of my migraine patients. And then also I have what I call the migraine bundle, which is not just Calm but also a multivitamin that has bioflavonoids in them. So a lot of the bioflavonoids that have been studied for migraine are in the multi. So if you're going to take a multi, you might as well take a multi with bioflavonoids in it, and then also an omega. So omegas are also There's a lot of research behind omega supplementation and migraine. And so we know that omegas have so many wonderful benefits for our bodies. They are anti-inflammatory. And so taking an omega, if you suffer from migraine, can be really, really beneficial also.

Oh, I love that. That makes so much sense. You know, I always think of the myelin sheaths coating our nerves kind of like the plastic coating on a wire. It keeps the wire protected so that the signal can be sent appropriately. And I just imagine, like, Any kind of disruption in our myelin sheaths probably contributes to cell signaling issues in our brain. And that's all just a big fatty coating, right? We need those omegas. It's so important.

We do. Yeah. And so much of our brain is made out of fatty acids, particularly omega-3s. So you're supporting— you're not only helping your migraine, but you're also supporting your brain health when you're taking omegas.

Absolutely. Oh my gosh, so good. Okay, well, I hope that everybody Got something out of this episode. I can't imagine they didn't. Even if you don't suffer directly from migraines, you must know somebody because it's way too common, unfortunately.

But there's yeah, there's a there's a crazy estimate that one in eight people have migraine.

Oh my God!

That's like a billion people in the world have migraines. So you yes, if you don't suffer from them, that's that's wonderful. But you probably know somebody like a friend or family. family member, neighbor who has migraines. So, um, yeah, please share this with them, like this information, because it's so helpful. It can really make such a big difference.

And the fact that 75% of people get better just with supplementation and these lifestyle adjustments, like, that's awesome. That's huge. So I, I always encourage people, like, try something different. Try to just do this basic foundational work that we're ignoring from conventional medicine. And you'll just be amazed at the improvements and the change in the quality of your life, right?

Yeah, it can be so impactful. Simple changes can really move the needle.

Yeah, exactly. Oh my gosh. So where can people find you?

I'm such a believer.

Yeah. So I'm sure people want to get in touch with you and see what all you're doing. So where can they find you?

Sure. So my website's the best way. It's dr.ronniebanik.com. And on my website, you can find the link to my supplement store. And also, I share a lot on Instagram as well. So I share a lot of tips and strategies for migraine and also eye health on Instagram. So I'm @dr.ronniebanik. Awesome.

And we'll have all those links in the show notes for everybody to make it easy. But you're just the go-to person. You're a wealth of knowledge for women when it comes to anything, you know, I think just neurological in general, because I still have yet to meet any real functional neurologist. But at least as an ophthalmologist, you have such a good foundational knowledge about all this and bringing the foundational functional piece into it, that's the game changer.

So it really is my mission now. Now that I've discovered this, I want to share it with as many people as possible. Get the word out because we need to be screaming this from the rooftops.

Yes, exactly. And you are doing the work. You're writing the books. You're contributing to the research, all the good things. So thank you so much. And let's stay in touch. I just— I appreciate you so much.

Thank you so much, Dr. Tabatha.

All right, everybody, I know you love this episode. Drop me a review and tell me what you loved, what golden nugget you took away from this, and what else you want to hear about on this podcast. I am here to serve you, so let me know what interests you. I hope you found this helpful, and like we said, share it with somebody that you know is suffering who needs some help, because this This might be the thing that changes their life. So go out, have an amazing week, and I'll talk to you soon.

Bye.