If you have been following ACN for a while, you will know that I do not believe there is one single “migraine cause”.
We start with the foundations.
We look at mitochondrial function, inflammation, key nutrients and the neuro-mechanical contribution.
Patients may work through the Basic Migraine Bundle:
Progress to the Advanced Migraine Bundle:
And, where appropriate, complete our migraine Reset Diet.
You can watch the migraine webinar here:
But what about the patient who has done all of that and is still getting migraines?
It may be time to pivot.
And one of the next places I would look is HISTAMINE.
It’s always worth using this visual for you and patients:
Some migraine patients appear to be primed for histamine.
Histamine is not simply the thing that makes your nose run during hay fever.
It is an important signalling molecule involved in the immune system, gut, nervous system and vascular regulation.
There is also substantial evidence linking histamine signalling with migraine biology.
One of my favourite studies demonstrating this is an old one, but a good one.
Krabbe and Olesen infused progressively increasing amounts of histamine into people without headaches, people with muscle contraction headaches and patients with migraine.
Look at the difference.
Of the 13 healthy controls, none developed a pulsating headache.
But among the 25 migraine patients, 24 developed a pulsating headache: 13 severe, 9 moderate and 2 mild. Only ONE failed to develop one.
Even more interestingly, the headache disappeared shortly after the histamine infusion stopped, and an H1 antihistamine rapidly abolished it.
Later research has confirmed that histamine can provoke migraine attacks in susceptible migraine patients, most likely predominantly through H1 receptor signalling.
Same histamine. Very different response.
That is why I like to think of some migraine patients as being “primed” for histamine overload (and thus migraine).
So who should you be thinking about?
I would not necessarily start here with every migraine patient.
Think histamine particularly when:
- They have already worked through the Basic and Advanced Migraine protocols and Reset Diet, but improvement has been limited.
- They have obvious symptoms suggestive of histamine overload/intolerance. Refer back to our Histamine Overload infographic for the full symptom picture.
- Their history screams histamine. Their migraines reliably follow things such as wine, aged cheese, cured meats, fermented foods or other high histamine foods.
In those patients, we can pivot towards reducing the overall histamine load.
The two routes of histamine removal
This is where understanding how we remove histamine becomes useful.
OUTSIDE the cell, particularly within the gut, we rely heavily on DAO: diamine oxidase.
DAO helps degrade dietary histamine in the intestine before it can be absorbed.
Reduced DAO activity has been associated with histamine intolerance and migraine, although serum DAO testing itself is not a perfect diagnostic test.
This is where I use IN Health DAO, usually alongside a low histamine diet.
Think:
Less histamine IN + more breakdown in the gut = lower total histamine load.
But that is only half the story.
Histamine inside tissues and cells is predominantly metabolised by the enzyme HNMT: histamine N methyltransferase.
As the name suggests, this uses methylation.
This is why I pair DAO with IN Health Methyl B Hero, providing nutritional support for methylation pathways with active B vitamins, specifically patented and proven QUATREFOLIC for methyl folate, methyl B12, TMG and B2/B6.
We have discussed this two pronged approach previously at ACN: DAO tackles histamine predominantly outside cells, while HNMT dependent methylation handles intracellular histamine.
So, when the standard migraine approach has got you improvement there, but something is still driving attacks, do not keep doing more of the same.
Look for another piece of the puzzle.
For the appropriate patient, trial:
LOW HISTAMINE DIET + DAO + METHYL B HERO
And monitor migraine frequency, severity and obvious food associations.
I have attached the image below for use with patients
