FAQ Episode 23 What is the relationship between anemia and migraine?

FAQs for Natural Migraine Relief

Hi! Jeff Baker here again, as the physician host for Frequently Asked Questions about Natural Migraine Relief for Women. I recently had an office follow up for a patient who was an excellent illustration of the condition we will discuss today. She had several co-factors promoting her migraines, and anemia was one of the most prominent. With a ~20% improvement in both blood count and iron stores over the last 3-4 months her migraines this last month have backed down significantly in both intensity and frequency. So far, so good! We are also expecting more daytime stamina and exercise tolerance for her in the weeks ahead.

In the U.S. somewhere between 30-40% of women under 50 are iron deficient and ~10-15% are clinically anemic.  It’s interesting to note that in the same age group of males, anemia is one half to one third this level at ~5% incidence.  And we know that women experience migraines at ~3 times the incidence of men.  Coincidence?  Or maybe some causal connection?  Let’s investigate further.

Anemia occurs when the volume of red blood cells is low.  It is often related to iron deficiency, which can occur with or without anemia.

Headaches in general and specifically migraine are more common in those with iron deficiency or anemia and several studies show that people with iron deficiency anemia have a higher rate of migraine.   

Some of the studies that showed this connection include:

-A 2022 study estimates that nearly 80% of people with iron deficiency anemia also experience headaches. 1

-A study from 2022 showed that 23.3% of people with migraine also had anemia.2

-Another study compared rates of iron deficiency anemia in people with and without migraine. In the migraine group, 21% of people had iron deficiency. Among the control group-those without migraine, only 10% had iron deficiency.3

-Another study found a connection between ferritin levels and migraine. Ferritin is a measure of iron stores in the body. In women under 50, those with low ferritin levels were more likely to experience migraine.4

A randomized controlled trial from 2020 showed that people with anemia who supplemented with iron reported a significant improvement in their headaches.5

There are several reasons that anemia or iron deficiency could be promoting factors for migraines:

-reduced red cell mass and low hemoglobin means lower oxygen carrying capacity.  As the brain has a high second-to-second oxygen demand, a low grade but chronic under delivery of oxygen could diminish brain energy production and repair capacity.  I talk a lot about additive root cause factors underlying the expression of migraine headaches.  This certainly can be one of those root causes.

- iron is a cofactor in the enzyme pathway making serotonin, a key chemical messenger in the brain. As reductions in serotonin have been associated with migraine headaches, this may be a contributing factor for those with anemia.

-iron is also used in multiple other energy producing physiological processes such as oxidative phosphorylation, mitochondrial function, and ATP production.

So why are women more prone to anemia than men?

The main reason would be loss of blood through monthly menses. After menopause, the rate of iron deficiency goes down significantly. Pregnancy and lactation can also draw down iron reserves. And many women eat less red meat or other iron rich foods than do males. We should note that after menopause women may accumulate iron and at some point could have excessive iron and some exposure to the same iron excess symptoms that cause men to have more vascular plaque events than women do in their 50s and 60s.

Symptoms of anemia can include:

-fatigue

-difficulty concentrating

-weakness

-shortness of breath

-a fast or irregular heartbeat

-feeling lightheaded or dizzy

-skin that is paler than usual

-headaches including migraines

Some of the most common causes of anemia and iron deficiency include:

-low dietary iron intake

-higher iron needs due to growth, pregnancy, or another health condition

-iron loss due to bleeding, especially heavy or prolonged menstrual periods.

-poor absorption of iron due to a gastrointestinal condition or kidney disease.

Evaluation and Diagnosis

The simplest start for those with symptoms suggestive of anemia would be testing for: 1) a CBC to look at the total red cell count as well as the red cell size and iron content and 2) a serum ferritin level for iron stores.  There are other tests to consider, and a check with your personal physician to discuss your headaches, potential anemia symptoms and blood work up would be recommended.

If you want to get ahead of this process, you can get some tests done initially direct-to-consumer at www.lifeextension.com. Click the Lab Testing tab and pick 1) the Complete Blood Count (# LC381822) for $35 and the 2) Ferritin level (# LC004598) for $28.  Generally they have this done at a local Labcorp office. See the details on the Life Extension website.

There are also correlations between migraine and restless leg syndrome (RLS), and between RLS and iron deficiency. If you have either migraines with RLS or RLS alone it would be advisable to check for both ferritin levels and anemia.

Treatments for anemia and iron deficiency for migraine patients

Dietary changes:

A person may focus on getting more iron sources in their diet. Good sources include meat, chicken, fish, nuts, seeds, eggs, and beans.

Iron supplements:

These come in several forms.  One of the easiest for self-care is a typical prenatal vitamin, found at any drugstore.   These have iron along with support B vitamins to enhance the bone marrow production of red cells.  You should also consider taking a Vitamin C dose of 500 mg at the same time, as it will significantly increase iron absorption.  The Vitamin C can also help to take the edge off the potential tendency for constipation that you can get with oral iron supplementation.

Manage estrogen dominance issues.  

If you are prone to heavy periods, and especially if you have late cycle ‘PMS’ symptoms that suggest the estrogen is having undue influence on the amount of menstrual blood lost each month, taking progesterone daily, or specifically additional amounts during the latter 4-7 days of the cycle before the period begins may help to lessen the volume of monthly blood loss.

Treatments for iron deficiency anemia help to stabilize iron levels so the body can:  1) build normal amounts of red blood cells to deliver optimal oxygen supplies to the brain and 2) have the iron facilitate the optimal enzyme production of brain serotonin.

These measures to correct iron deficiency or anemia , or more likely, in concert with the correction of other migraine root cause factors could help you to ease or clear your migraines.

Correction of iron deficiency and related anemia is only one of 90 non-drug therapy options I’ve found useful for migraine headaches.  If you would like to understand the broader range of root cause factors that drive your migraines and then individualize the many possible therapy options, you should take a look at my comprehensive Natural Migraine Relief for Women course and its unique Migraine Action Plan system.   See www.naturalmigrainerelief.online for more details.

Also, remember to subscribe to this Substack blog to get regular postings on Frequently Asked Questions about Natural Migraine Relief for Women.

References:

1. “Headache as a Neurologic Manifestation of Systemic Disease” Alexandra N. Cocores, et.al. Curr Treat Options Neurol. 2022; 24(1): 17–40. doi: 10.1007/s11940-022-00704-9

2. “Comorbidities in patients with migraine in Japan: a cross-sectional study using data from National Health and Wellness Survey” Shoji Kikui, et. al. BMJ Open. 2022; 12(11): e065787. doi: 10.1136/bmjopen-2022-065787

3. “Is There Any Correlation between Migraine Attacks and Iron Deficiency Anemia?” A Case-Control Study Ali Tayyebi, et. al. Int J Hematol Oncol Stem Cell Res. 2019 Jul 1; 13(3): 164–171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801325/

4. “Association Between Dietary Iron Intake and Serum Ferritin and Severe Headache or Migraine” Shu-Han Meng, et.al. Frontiers in Nutrition doi: 10.3389/fnut.2021.685564

5. “Risk of migraine in iron deficiency anemia patients with or without iron supplementation usage: a nationwide database analysis” Herng-Sheng Lee et.al. Archives of Medical Science DOI: https://doi.org/10.5114/aoms/124191