The Dr. Hyman Show - 6 Root Causes of Migraines (And How to Fix Them)

Episode Date: May 4, 2026

Migraines aren’t just headaches and if you’ve ever had one, you know how debilitating they can be. But they’re not random, and they’re not just genetic. Migraines are a signal that something deeper is out of balance in your body and if you only treat the symptoms, you miss the real opportunity to prevent them. In this episode, I break down what’s really driving migraines, including: • The root causes most people miss—from inflammation and blood sugar swings to hormones, gut health, and nutrient deficiencies • Why migraines are a full-body neurological event, not just a head issue, and what that means for treatment • How your cycle, stress levels, and nervous system can lower your threshold and make migraines more likely • A functional medicine approach to prevention—simple shifts in diet, lifestyle, and nutrients that can reduce frequency and severity Migraines don’t come out of nowhere—they happen when your body hits a threshold. When you lower the load and support your biology, you don’t just manage migraines—you can actually start to prevent them. To go deeper on this topic, check out my past episode with Dr. Todd LePine: https://youtu.be/hnmCIGNko64. Visit ⁠functionhealth.com for 160+ lab tests at just $365 a year. Have a question you’d love answered on Office Hours? Submit it here   **The waitlist is open** Sign up for Dr. Hyman’s Brainshaping Academy to learn how to nourish the biological systems that support your mental, emotional, and cognitive health  Click here to sign up. (0:12) Introduction and overview of migraines (0:58) Understanding migraines and functional medicine approach (2:08) Root causes of migraines: hormones, gut health, nutritional deficiencies, nervous system (7:00) Practical steps for migraine prevention (12:35) Regulating the nervous system (14:44) Case study with Dr. Todd Lapine (22:49) Introduction to Brain Shaping Academy and mental health

What if brain fog, anxiety, and mood swings aren't simply all in your head? What if the health of your mind actually starts deeper in your body, in your gut, in your hormones, metabolism, and your immune system? Well, let me tell you, the connection is real, and it affects how you think and you feel every single day. And that's why I created Brain Shaping Academy, a six-week program that shows you how healing your body can help you heal your mind. Brain Shaping Academy relies on the same targeted nutrition and lifestyle strategies that I've used

for 30 years to help my patients improve their mental, emotional, and cognitive health. So if you want to feel calmer, clear, and more in control, and stay sharp and protect your brain as you age, check out Brain Shaping Academy at Dr.heimann.com, 4.com slash brainshaping. That's Dr.heimen.com, for slash brain shaping. Welcome to office hours. This is our dedicated one-on-one space to go deeper, get clear, and explore what truly moves the needle for your health. I'm Dr. Mark Hyman, and each week we're going to pull back the curtain and share the insights,

the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health. And for many of you, your family's health too. And you might not feel it all the time, but you have far more power in agency than you realize. I'm glad you're here. This episode is brought to you by Function Health, empowering you to live 100 healthy years with over 160 lab tests for just $365 a year and use the code mark 2026 to get $50 off your membership. If you've ever had a migraine, you know this isn't just a headache.

It's the pounding pain, the nausea, the sensitivity to light and sound. Sometimes it's so severe, you can't function at all. And for many people, the messages they get is simple. Take medication, avoid your triggers, learn to live with it. But here's the problem. That approach may help manage symptoms, but it doesn't explain why this is happening in the first place. Because migraines aren't random.

They're not just genetic, and they're not just about your head. Migraines are a whole body issue. They involve inflammation. hormones, blood sugar control, gut health, your nervous system, and lots more. So today, I want to walk you through a functional medicine approach to migraines, not just how to treat them, but how to understand and prevent them at the root. So what is a migraine? Well, let's start with the basics. A migraine is not just a headache. It's a neurological event. It can include throbbing or one-sided pain, nausea, vomiting, sensitivity to light and sound, visual disturbances like an aura, and often brain

fog or fatigue. So what's actually happening? Well, the brain becomes more, sensitive and more reactive. There's inflammation. There's dysregulation and blood vessels and nerve signaling. And the nervous system is more activated than it really should be. And here's the point. Migrants are a signal. They're not the problem. What are the root causes migraines? Well, this is where we ship the conversation. Instead of asking, how do we stop the migraine, we ask what's driving it. So let's walk through the most common root causes. Inflammation. Chronic low-grade inflammation is one of the biggest drivers of migraines. This can come from ultra-process foods. can come from food sensitivities like gluten or dairy, poor gut health, and environmental toxins.

Inflammation makes the brain more sensitive. It lowers your threshold for a migraine. Blood sugar imbalance, well, that's one of the most overlooked triggers. If your blood sugar is constantly spiking and crashing, your brain feels it, skipping meals, eating a lot of refined carbs or sugar or going long periods without food, all of these can trigger migraines. Your brain needs steady fuel. And when that fuel becomes unstable, it creates stress in the system. The next thing that can often be a factor is hormone fluctuations, especially for women. Now, many women notice that their migraines follow a pattern. And that's not a coincidence.

Migrants most commonly happen right before their period starts in the few days leading up to menstruation. So why does that happen? Because that's what estrogen levels drop sharply. Estrogen plays a big role in the brain. It helps regulate neurotransmitters like serotonin. It has anti-inflammatory effects. So when estrogen suddenly falls, it can increase inflammation. it can disrupt brain signaling and can make the nervous system just more sensitive.

That combination can trigger a migraine. Some women also experience migraines around ovulation when hormones shift again or during menopause when estrogen levels become more unpredictable and so does progester. So it's not just about having too much or to the Lestrogen. It's about fluctuations and instability. And hormones influence inflammation, influence brain chemistry. They influence how you reactive your system is. And that's why many women who experience migraines on a cyclical basis.

and why actually tracking your cycle can be one of the most powerful tools for understanding your triggers, and then you can actually do something about it. The next big factor is gut health. Now, there's a powerful connection between your gut and your brain. It plays a major role in migraines. In fact, we often call this the gut-brain axis. Your gut is constantly communicating with your brain through the nervous system, the immune system, and even chemical messengers like neurotransmitters.

So when something is off in the gut, your brain feels it. Common issues we see include dysbiosis, which is, and imbalance of gut bacteria, leaky gut where the intestinal lining becomes more permeable, and food sensitivities which can trigger immune reactions and brain inflammation. All these can increase inflammation throughout the whole body. And inflammation is one of the biggest drivers of migrates. But it doesn't stop there. About 90% of your serotonin, a key neurotransmitter involved in mood and pain regulation,

is actually produced in the gut. So when your gut's out of balance, it can disrupt your brain chemistry, it can lower your threshold for stress, and it can make your nervous system just more reactive. And that's why so many people with migraines also experiencing bloating, irritable bowel syndrome or other digestive symptoms. Now, your gut is not just about digestion.

It's a central hub for your immune system, your hormones, your brain. And when you start to heal the gut, you often see improvement it's not just in digestion, but in migraines as well. And I've had many patients I treated with serious gut issues that fix their migraine. So it really works.

The next big factor in migraines could be nutritional deficiencies. And there's a few critical ones for, brain health. One is magnesium. And I had a patient who was a radiation oncologist from Mayo, as a resident, who had intractable migraines. And she was on narcotics and it had nausea pills that were like, but they get chemo patients. It was bad. And turned out she just had a magnesium deficiency. And we treat her magnesium deficiency and her migrants went away. It's not always that simple, but for her it was. Also, B vitamins are really important, especially riboflavin or B2. And also

coenzyme Q10 is important in mitochondrial function. And that can be a factor also. in migraines. They're not just one kind of migraine. And migraines are not because of the side they're on or where they are, but because of the cause. So it could be hormones, it could be gut, it could be nutrients. So you've got to figure out what the issues.

It could be mitochondria. And nutrients basically support energy production in the brain and they help regulate nerve functions. So when you're low, your whole system becomes more vulnerable. Another big factor is nervous system dysregulation. This is a big one. You know, stress doesn't just trigger migraines. It lowers your resilience.

Your body's constantly in fight or flight mode. You're more sensitive to everything. your sensitive to poor sleep, to chronic stress, to over-stimulation, all of this keeps your nervous system activated. And that makes it much easier for a migraine to happen. So why does conventional medicine not work so well? Where does it fall short? Short. Well, medications can be helpful, for sure, and they can be lifesaving. And for some people, they're necessary. But they don't address the root causes. They don't fix the inflammation. They don't stabilize blood sugar. They don't heal the gut. They don't regulate the nervous system. In some cases, they can even lead to rebound headaches,

meaning you take the drug and you get another headache. So if you don't change the underlying terrain, the pattern continues. So what can you actually do? What helps? Let's walk through a functional medicine approach. First is stabilize your blood sugar. One of the most overlooked drivers of migraines is just unstable blood sugar, which affects so many Americans.

When your sugar spikes and then crashes throughout the day, it just creates a stress in the body. And for some people, that's enough to trigger a migraine. So it's one of the simplest and the most effective places to start. So how do you do that? We'll focus on protein with every meal, good fats. the protein helps slow digestion, helps your energy more stable, trying to skip meals, you know, especially early in the day,

long gaps without food can set you up with these drops in blood sugar, and be mindful of refined carbs and sugar, like pastries, white bread, sugary snacks, because they cause quick spites, and then you get crashes in your blood sugar. And for many people, stabilizing blood sugar alone can really dramatically reduce the frequency of migraines. So if that doesn't work, what else can you do?

Well, you want to identify food triggers. Another key piece is identifying your personal food triggers because migraines are highly personal. What triggers one person may not affect someone else in the same way. So there are some common patterns we see. Foods like gluten, that's a big one. And that would be an easy one to get rid of to see if your migrants go away. Dairy, another big one.

Wine especially, alcohol in general, but wine especially, because of sulfites, highly processed foods. There's a lot of additives, chemicals, things that can be all serious triggers. The challenges, these reactions aren't always immediate. Sometimes there's a late response, which kind of makes it harder connect the dots. So you might eat something on Monday, but you get your migraine on Wednesday, right? And that's where an elimination diet can really be helpful. If you get rid of all the common triggers for a period of time and the reintroduce them intentionally,

you can actually start to see how your body responds, and that awareness is really powerful. And in fact, we have something called the 10-day detox diet. We can go to 10-Detox diet.com, and it guides you through a whole elimination diet. It can be very powerful, and often that is enough to get rid of your migraines, just that alone. Next thing would be to reduce inflammation. Now, the deeper level migraines are really about inflammation in the body, So the goal is to create an internal environment that's calm or more stable. And that starts with your overall diet, right?

Whole real foods, lots of good fats, omega-3s, fatty fish, walnuts, flax seeds, all help counter-inflammation. So you want to eat a wide variety of colorful plants, vegetables, fruits, herbs, nuts, seeds, all of these provide antioxidants to support your system. And the same time, you want to get rid of the ultra-processed food. There's no world in which we should be eating any of that. I think the safe limit is zero, in my view. I mean, if you have a sinker's bar once in a while, it's not going to kill you, but

I'm just telling you that this is not part of a, human diet. These are not actually technically food by the definition, the dictionary, which is something that supports the health of an organism, which these don't. So because they tend to drive inflammation, they really disrupt your body's overall balance. So when you lower the overall inflammation, the body, you often lower the threshold for migraines as well. Okay, the next big thing you want to do is support the gut. Your gut plays a much bigger role in migraines than most people realize. There's a huge connection between gut health and brain health. And I remember one patient where I literally treated her migraines with antibiotics to clear out the bad bugs in her gut and her migraines went away. So it

be something that obvious or simple, which traditional doctors generally don't do. So supporting your gut can have a really powerful impact on how often migraines occur. So how do you do that? Well, lots of fiber, vegetables, fruits, nuts, seeds, help feed the beneficial bacteria, prebiotic foods, fermented foods, things like sauerkraut, kimchi, yogurt, all help a healthy microbiome. Now, but for some people, there may be more serious issues of play, dysbiosis, food sensitivities, inflammation from other factors, infections. Those need to be addressed.

yeast overgrowth, bungal overgrowth, bacterial overgrowth, all need to be addressed. Parasides, they can be factors. And they can be treated with a good functional medicine doctor. Now, the big idea, by the way, we're at Ultra Wellness Center. We have a great practice and lots of great doctors. You can come see us in Lenox, Massachusetts. Now, the big idea is this. When your gut improves, your brain often follows.

And for many people, this is just a key part of reducing migraines. All right, what can we do besides all that? Well, put back the nutrients that are missing. And testing is really important here, because you don't want to guess. want to test. You want to know what your body actually needs. So getting comprehensive labs, like we do at Function Health, can help you understand your nutrient levels and identify what you're deficient. And we see about 70% of people with deficiencies in nutrients, including B12, including magnesium, including omega-3s, and COQ10, all the things that are really

quite important. And you can look at magnesium, you can look at riboflap and you include CO-10. You can look at some of these key nutrients that are critical for brain energy and proper neurofunction. And when your levels are low, well, your system becomes way more vulnerable to migraines. Here's a statistic that should bother you. Women are more likely to be told their labs are normal, more likely to experience delays in diagnosis for certain conditions, and more likely to leave the doctor's office without real answers. Too often, the women navigating all this are being evaluated one or two basic markers and then set home with nothing. And this is especially true in midlife when the stakes are highest in hormone shifts and insulin sensitivity

changes and cardiovascular risk rises. Let this mother's day be different. Not a gift that disappears by next weekend, but a gift that actually changes their life, the gift of data. Function gives you access to over 160 lab tests annually, including deeper hormone, metabolic, and heart health markers, and more. The strongest woman you know deserves real information. It's time to stop guessing. Check your health with function. Function gives you access to over 160 lab tests every year, including advanced lipoprote testing. It's time to stop guessing. check your health with function.

Go to functionhealth.com slash mark, and if you're one of the first 1,000 people this week, use the code Mark 2026 for a $50 credit toward your $365 a year membership. That's functionhealth.com slash mark and use the code Mark 2026 today. All right, the next thing we want to do is regulate your nervous system.

It's a little hard in our modern world, but, you know, it's one of the most important and pretty overlooked areas. And it's how do you regulate your nervous? nervous system. Because migraines aren't just physical, they're deeply connected to how your body processes stress. So if your nervous system is always in a heightened state, it's overstimulated, overloaded, always quote on, it lowers your threshold for triggers, meaning things that wouldn't normally cause a migraine while they suddenly do. So learning how to regulate your nervous

system is essential. And the good news is it doesn't have to be complicated. Simple, consistent habits can make a real difference. Things like breath work, even just a few minutes of slow, control breathing can help shift your body out of that stress response. Consistent sleep is also really important because your nervous system resets when you sleep and irregular sleep can make everything more reactive. Also, exercise, regular movement, not crazy intense exercise,

but steady daily movement, helps your body get rid of stress. And just overall stress reduction, creating small moments in your day where your system can actually relax. Because the goal here is to eliminate stress completely, not realistic, obviously. It's to build resilience.

You're not just reducing stress, you're increasing your capacity to handle it. So when your nervous system becomes more regulated, your body is less reactive, and that can play a powerful role in reducing your migraines over time. All right, so I want you to get into a prevention mindset. Here's the shift I want you to make. Migraines don't come out of nowhere. They happen when your system reaches a threshold. They hear like a bucket.

Stress fills the bucket. Poor sleep fills the bucket. Food triggers fill the bucket. Hormone changes fill the bucket. Nutrient deficiencies fill the bucket. And when it overflows, well, that's when a migraine happens. So the goal is simple. Lower the load, increase your resilience.

And if you only take one thing away from this whole conversation, let it be this. Migrants are not random. They are your body's way of telling you something is out of balance. And while medication is going to help, they're not the whole answer. When you become the CEO of your own health and you focus on reducing inflammation, bouncing your blood sugar, supporting your gut, and regulating your nervous system, you change the environment the migraines depend on. It's not about perfection.

It's about understanding your body and making small, consistent changes. Because you don't have to just manage migraines. you can reduce them at the root. No two migraine patients are the same. And this is really where functional medicine shines. To bring this to life, here's a clip from a previous episode with my colleague Todd Lapine from the Ultra Wellness Center.

In this clip, he walks through a unique case study and gives you a firsthand look at how we dig deeper to uncover the root cause. If you want to go even further on migraines, you can find the full episode linked in the show notes. So really, like, tell us about some of your cases that you've had experience with that have really kind of changed your thinking and it helped you understand.

Well, I had a patient who came in and his story was that he first developed migraines starting around at the age of five, which is interesting. 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 right now this is probably one of those things that because caffeine is a double-edged sword we actually use caffeine to treat migraines and if patients take like over-the-counter medication like excetrient migraine, guess what's one of the major ingredients in there is? Caffeine. In fact, I had a patient, I'll never forget this, it was a woman who had refractory migraines. And when it turned out that she actually was getting rebound headaches from daily use of

excetrient migraine. And so she would have to take the excetting the caffeine. So it was like a cat chasing a stale. So that's not great because that's got talent. Well, it's great for the company because they keep selling it, right? Lever problems. Right. Yeah, exactly.

Yeah. So this patient was caffeine sensitive. So some of the treatments, you can actually abort a migraine with caffeine, but you can also trigger a migraine. So it's this sort of a double-edged sword in terms of the effect of caffeine. But typically, if I have somebody who's got migraines, I get them off of all alcohol, all caffeine, and give them some magnesium. Just that's that you can shoot from the hip and just do that.

And, you know, you can make 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 migraines.

So what is histamine, Todd? Well, histamine is the drug, or not the drug. It's the compound that is naturally found in the body. And it is actually a neurotransmitter. It's also involved in allergies. So when we have spring allergies or allergic rhinitis, we treat that with an antihilitary. 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 right. It's also made by gut bacteria. It's found in food. It's made by

the white blood cells specifically, the mass 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 get hives or things like that. You can get hives, exactly. Yeah. So histamine definitely plays, it's one of the things that can play a role in migraine headaches. And how do you approach a patient with who's got histamine sensitivity? Well, you, you, how do you diagnose it first? Yeah, well, and you treat it.

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, we can be high in histamine. Normally our body will just sort of deal with excess amounts of histamine. But when the gut bacteria is out, like if you have SIBO, you'll have problems with histamine breakdown or histamine degradation or certain bacteria will actually be making high levels of histamine, which in turn can affect. the brain and your neurological system. Incredible. Yeah. Yeah, I've seen histamine treatment when you do it in the right patient by both dietary changes. Also, there's all kinds of supplements that can help like versetin, even medication like cromolin

and people that take orally, you know, histis, which is very supplements that help with modifying the histamine. And getting the diet low in histamine, people can really have radical transformation from their health It's not something most doctors think about or do. Yeah. And it's tricky to do, but it can be really effective. Yeah. Yeah.

And this particular patient, when I did the testing on him, lo and behold, he had significant sensitivity to gluten, which he was totally unaware of. And it never really worked with a nutritionist. Sometimes, you know, they say, well, I worked with a dietitian. And, you know, a regular dietitian is, you mean, they're not really all that helpful. You're having a nutritionist who's trained in functional medicine, it can really look at the diet beyond just, you know, calories and the macronutrient proteins, fat, and carbohydrates is very, very important.

So in this particular patient, the organic acid testing showed a higher need for the B vitamins, showed some evidence of dysbiosis, which is imbalances of the gut bacteria, had significant gluten sensitivity, some leaky gut on testing, had low normal magnesium, was technically normal, but it was on the low side of normal. So these are all the different things that you can fix. And then on stress testing had high levels of cortisol. Interesting. It was very, very interesting.

And then the other thing that I found on the patient, I'm not really sure because I'm actually still working on that, because I was going to deal with that later, is high levels of mercury, very high levels of inorganic mercury in this particular patient. And then the other thing, which is also really interesting, is I did genetic testing. I like to do genetic testing because it can really sort of

It's like lifting the hood on your car. I can sort of tell you what's going on below the scenes. And the thing about genetics of migraine is there's not really one migraine gene. And we can test for these snips and variations. But this particular patient had a variation in the genetics, the polymorphisms, of a G-coupled protein, which has to do with serotonin and stress resiliency. So this person's genetic makeup was such that he was, he was, he was more prone towards the effects of stress. It was a particular gene called HTR-1A,

which is on the testing that we do with a DNA mind test. And I found that really sort of interesting. Otherwise, a patient had good genes, they had like good detox genes, good COMT genes, etc. 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, everybody is affected by stress. You know, we just, you watch the news and you get stressed, right? That's why I don't have a television.

Exactly. And so anything that we can do to help people to manage and modulate and detoxify the stress goes a long, long way. Huge, huge, huge. What if brain fog, anxiety, and mood swings aren't simply all in your head? What if the health of your mind? actually starts deeper in your body, in your gut, in your hormones, metabolism, and your immune system. Well, let me tell you, the connection is real, and it affects how you think and you feel

every single day. And that's why I created Brain Shaping Academy, a six-week program that shows you how healing your body can help you heal your mind. Brain Shaping Academy relies on the same targeted nutrition and lifestyle strategies that I've used for 30 years to help my patients improve their mental, emotional, and cognitive health. So, if you want to feel calmer, clear, and more in control and stay sharp and protect your brain as you age, check out Brain Shaping Academy at Dr.hyman.com or slash brain shaping. That's Dr.heimen.com or slash brain shaping. Thanks for joining me for office hours.

I love diving into these topics with you. Remember, you are the CEO of your own health. And every choice you make can move you closer to healing and vitality. I want to keep these episodes as relevant and useful as possible. So tell me, what do you? you want to explore next? What questions are you wrestling with? What breakthroughs are you chasing? Share your ideas in the comments on social media or through the link in the show notes. I'm listening. Until next time, keep taking charge, keep asking questions, and keep showing up for your health.

If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Hyman show wherever you get your And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health, where I am chief medical officer. This podcast represents my opinions and my guest's opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other

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Thanks so much again for listening.