What Causes Migraines? A Functional Medicine Look at the Root Causes
Migraines don’t have a single cause. In a recent conversation on The Dr. Mark Hyman Show, UltraWellness Center’s Dr. Todd LePine and Dr. Mark Hyman discuss why a migraine diagnosis describes a symptom pattern rather than a cause — and why two people with the same diagnosis can be dealing with entirely different root drivers, from gut imbalances to hormone metabolism to nutrient status. As they put it, there may be dozens of different factors that can contribute to a migraine, which is why a one-size-fits-all treatment approach so often falls short.
Why Doesn’t a Migraine Diagnosis Explain the Cause?
A migraine diagnosis confirms a symptom pattern — head pain meeting certain clinical criteria — not a mechanism. Conventional care typically responds to that diagnosis with a rotating list of medications: pain relievers, triptans, beta blockers, anti-seizure drugs, sometimes Botox, adjusted by trial and error. In the conversation, Dr. LePine and Dr. Hyman contrast this with the functional medicine approach: starting from what in this person’s physiology is producing the migraine, not just what to call it.
Gut Health and Migraines
One factor Dr. LePine and Dr. Hyman discuss is the role of gut health. Small intestinal bacterial overgrowth (SIBO) can increase histamine production and intestinal permeability — a connection also reflected in the broader research literature (Journal of Headache and Pain, 2024). They describe cases where treating an underlying gut imbalance resolved migraines that medication hadn’t touched.
Food and Chemical Triggers
The conversation also covers food and chemical triggers, including gluten, eggs, and dairy, along with additives like MSG, aspartame, nitrates, and sulfites. Dr. LePine and Dr. Hyman describe using elimination diets and food sensitivity testing to identify a patient’s specific triggers, since — as they note, and as the broader research reflects — food triggers vary significantly from person to person and the evidence for any single food is mixed.
Hormones and Estrogen Clearance
Dr. LePine and Dr. Hyman discuss migraines that cluster around the menstrual cycle, connecting them to how the body processes and clears estrogen rather than just estrogen level on its own. This tracks with the broader pattern in the research: women are about three times more likely than men to experience migraines, largely tied to hormonal fluctuation
Magnesium and Mitochondrial Energy
Another factor raised in the conversation is magnesium status and its role in mitochondrial energy production. Dr. LePine and Dr. Hyman describe patients whose migraines occurred alongside muscle cramps, constipation, and disrupted sleep — a pattern consistent with magnesium deficiency — and note that magnesium is well studied in relation to migraine frequency and severity.
Finding What’s Actually Driving Your Migraines
As Dr. LePine and Dr. Hyman discuss, migraines don’t have a single cause, so they shouldn’t have a single treatment. Identifying what’s actually driving your migraines — gut health, food triggers, hormone metabolism, magnesium status, or some combination — is where a functional medicine evaluation starts.
