FAQ Episode 28: Acid blockers and migraine
FAQ Episode 28: Acid blockers and migraine
FAQs for Natural Migraine Relief
The most popular medication used to suppress excess stomach acid is the seventh most prescribed drug in America, and more than 20 million people use this general class of drugs to prevent reflux or heal ulcers. And this isn’t just in the U.S. A recent study in Iceland found more than an astounding 33% of adults surveyed there took acid blocking medications.1
Unfortunately, the process of stomach acid suppression has an association with migraine headaches, as reviewed by an article to be published June 2024 in the journal Neurology Clinical Practice.2 Data from 11,818 US adults in the 1999–2004 National Health and Nutrition Examination Survey found that those using prescription strength PPIs (proton pump inhibitors)3 had a 70% higher rate of migraine or severe headache. Those on full dose H2 blockers4 were 40% more susceptable. (!) For reference H2 blockers are not as effective at blocking acid secretion as the PPI family, which may explain the variable rates of excess headache described above.
The study did not specify the underlying reasons for the association, and recommended further research. What does seem clear is that a 40-70% increase in migraine with the use of these drugs is more than a casual relationship.
Lets consider what root cause factors could be at work in this relationship between acid blockade and migraine:
Reduced stomach acid reduces nutrient absorption of all kinds. There are multiple nutrients whose deficits can be implicated in migraines, including magnesium, Vitamin D, CoQ10, B12, zinc and iodine.
Reduced stomach acid results in reduced B12 absorpsion. This becomes even more important in those who may not activate (methylate) their B vitamins well (those with MTHFR gene deficits.) Lack of B12 or the other methylated Bs (B6 and folate) can result in reduced cellular energy production, as well as, heightened inflammation-both of which can be key root cause factors in migraine.
Reduced stomach acid changes the downstream bowel microflora, which can enhance gut and immune inflammation from leaky gut syndrome. Cumulative inflammations from several potential sources including the gut can drive a vicious cycle of recurrent migraine.
Action considerations for this FAQ:
If you are on regular OTC or prescription strength acid blocking medication:
ask your doctor if these medications are still needed, either: a) routinely, or b) at that same strength.
long term-consider working to attain a lower BMI/body weight. Much of acid reflux is due to pressure of truncal and visceral fat against the stomach contents —> reflux…what a surprise.
consider getting your B12 level checked, and if its in the lower third of normal or below (like <400), consider taking a daily sublingual 1000 mcg dose, or potentially even a B12 injection on a monthly basis, if needed to get levels up to the upper third of normal range.
you may also want to confirm that you are getting enough of the active, methylated version of the B12, as well as, for B6 and folate. An useful test to verify that you adequately methylate your B’s is a homocysteine blood test. Homocysteine is an useful marker for methylation adequacy, as well as, having powerful inflammatory effects in blood vessels and the brain when its in excess.
If the homocysteine level is over 10-12, you should consider taking additional methylated B vitamins daily. Your homocysteine will drop when your methylated B level and activity improves.
There are several good versions available. The one I take is Life Extension’s “Homocysteine Resist” at about $9/month. If your level is over 15, you may benefit from having medical supervision of your homocysteine/methylation situation.
consider that if you have some degree of malabsorption you may need a higher than reccomended dose of several key nutrients for migraine management, including magnesium, Vitamin D3 and CoQ10.
You may also benefit from a blood test to identify food sensitivities and/or candida overgrowth. See FAQ Epsode 20 in this Substack blog series for details.
Last thought on this subject: if you are over 50, it might be surprising to learn that it may be as much too little, as it is too much stomach acid, that is the problem.
Think of it this way: food in the stomach is there to be digested. If you make too little stomach acid and digestive enzymes, that batch of food waiting to be digested may spend a prolonged stretch of time in the stomach while that process is completed. That gives it more time to potentially be refluxed up into the esophagus and cause inflammation there, especially if that digestion and emptying process delays into the hours of lying horizontal while sleeping.
One seemingly paradoxical approach to reflux symptoms would be to take a digestive enzyme with the HCL acid precursor betaine with your meals. If you digest more effectively, and empty faster:
you will absorb more of the nutrients from the food you eat.
a mealtime food (and acid) spends less time being emptied… so becomes less likely to be refluxed later
the well digested food is less likely to be maldigested downstream in the bowel, which potentially means less irritable bowel type symptoms as well.
Look for a combination digestive enzyme/betaine like the brand NOW “Super Enzymes“ as one example, and take one (small meal) or two (regular meal) capsules during the mealtime. If you are thinking, “but what about the dose for a large meal?” then we are onto another root cause of the reflux problem. Stop right there…if you want to get off acid blockers…cancel the large meals!
If you are able to reduce reflux, heartburn, acid blocker meds and migraines all at the same time, that would be a winning combination!
Please post your questions or comments below.
Proton-pump inhibitors among adults: a nationwide drug-utilization study. Óskar Ö. Hálfdánarson, et. al. Therap Adv Gastroenterol. 2018; 11: 1756284818777943. Published online 2018 May 30. doi: 10.1177/1756284818777943 PMCID: PMC5977421 PMID: 29872455 https://doi.org/10.1177%2F1756284818777943
Use of Acid-Suppression Therapy and Odds of Migraine and Severe Headache in the National Health and Nutrition Examination Survey Margaret Slavin, PhD et.al. June 2024 issue 14 (3) https://www.neurology.org/doi/10.1212/CPJ.0000000000200302
Proton pump inhibitors
Prilosec: omeprazole
Nexium: esomeprazole
Prevacid: lansoprazole
Dexilant: dexlansoprazole
Protonix: pantoprazole
Aciphex : rabeprazole
H2 blockers:
Zantac: ranitidine
Pepcid: famotidine
Axid: nizatidine
Tagamet: cimetidine