FAQ Episode 58: What About Men With Migraines?

Frequently Asked Questions about Natural Migraine Relief for Humans

I first wrote my “Natural Migraine Relief for Women” course and started this blog to answer “Frequently Asked Questions about Natural Migraine Relief for Women” out of my clinical experience with..yes you guessed it…women with migraines. The majority of those suffering migraines are women, but what about the roughly 30% who are male? Obviously, the levels and ratios of the female dominant hormones found after puberty are not driving their headaches. But men do share the other potential root causes that underlie migraine headaches for all humans. These include:

• inflammation from multiple sources, 10 of which I discuss specifically in the Natural Migraine Relief course, with two of those being less a factor for men than women, and at least one of them often present to a greater degree in men.

• deficits in key nutrients.

• cellular energy deficit factors.

• reproductive hormones consistent with gender.

• thyroid, parathyroid, pineal and adrenal factors.

• brain chemistry and autonomic nervous system factors.

• lifestyle and structural root cause factors.

Three migraine root cause factors for men to consider

All of the above listed agents can contribute to migraines in males. Just as is true for women, some of them will not be gender specific in their relative and ranked risk vs benefit of treatment for any one person. But for the purpose of this post, let’s look at three migraine promoting factors that can be more male specific and worth assessing and addressing:

• male reproductive hormone levels

• adrenal building blocks

• inflammation related to iron stores.

Reproductive hormones in men

Low testosterone levels have been associated with migraines in men.¹ In some cases this may be related to the hypothalamic and pituitary pathways that support and stimulate testicular activity, as well as to a diminished level of testosterone itself.

In a related concern, a rise in the estradiol/testosterone (E/P) ratio is also associated with migraine incidence.² As I’ve discussed in the course and multiple FAQs in this blog, estrogen dominance is a separate promoting factor for migraines in both men (related to testosterone) and women (related to progesterone levels.) If you are a man with migraines and have a low Total or Free Testosterone level, you may also want to get a check on the estradiol and LH (leutenizing hormone) levels. Low Free T along with low LH points to a pituitary singaling insufficiency, and may respond better front line to a medication like clomiphene (an LH agonist) to augment your natural testicular output. This often helps the E/P ratio enough to correct that part of the equation. Check with your primary care physician, or you can get direct-to-consumer (DTC) testing of these levels to find out if this might apply to you. You could start with a test profile such as Life Extension’s Basic Male Profile to find out if this is potentially an issue for you. This Basic Male Profile also has the DHEA-sulfate level that we will discuss in the next segment. It also has the best priced DTC lab prices I’ve seen out there. If the Free T is low, you should go on to test for the pituitary hormones LH and FSH to see if they are complicit in the situation. Men who used anabolic steroids in their teens or twenties, or who had head impacts (everything from “got my bell rung” to a full on concussion can later have a premature reduction of the key LH (leutenizing hormone) signal that asks the testes to step up and produce testosterone. If this is the case it can entirely change the approach to hormone support. If so, you will need a prescribing physician to assist you.

I should add that I have no professional or proprietary relationship with Life Extension or any other direct to consumer lab entities.

Adrenal building blocks

Your adrenal hormones are critical to handling inflammation and stress, which are major players in migraine headaches. Recurring migraines are both the result and then in turn the cause of a cycle of inflammatory stress. The resulting adrenal stress can reduce the output of two key adrenal hormones, pregnenolone and DHEA. Adrenal stress can lead to adrenal fatigue, and then on to low grade adrenal insufficiency, where key hormones are still made, but in insufficient amounts. This can be an even greater contributing problem for men, as DHEA is the key building block for making testosterone. Sometimes the first step in assessing low testosterone for men under 50 is to ask if its precursor, DHEA, is too low.

The ‘normal values’ for DHEA and pregnenolone cover a vast range, and many of those with migraine can be in the so called ‘normal range’ and at the same time have suffered a 50-70% drop from previous optimal levels. It would be like having the guidance counselor tell you your child was “doing just fine” in their classes while being a hair breadth’s distance from flunking out.

I aim for what is optimally healthy at 38-42 years as a reference point for healthy function. For example, for men, adrenal related lab references levels for ‘typical’ vs ‘optimal might be:

Typical DHEA-sulphate level = 280-640

Optimal DHEA-sulphate level = 500-640

Typical Pregnenolone level = 10-200

Optimal Pregnenelone level = 180-200

Both DHEA and pregnenolone are available without a prescription, and low doses of either DHEA (25-50 mg for men) or pregnenolone (50-100 mg for men) are typically safe to start with. But these hormones do have several downstream products that can have side effects, especially the androgens (testosterone-as in too little, if you’re low on adrenal building blocks, and dihydrotestosterone-if adrenal building blocks are excessive.) To find the right dosing regimen for your situation, I would advise that you see a qualified practitioner to review your initial results and follow up lab tests to make sure that you are getting both adequate and safe individualized doses.

If you are still in your 30s to early 50s, you may also find that herbal adaptogens can augment your own endogenous adrenal function. A trial of herbs like Rhodiola, Eleuthero, Schisandra and Ashwaganda can be useful to augment the production of adrenal building blocks. The adaptogen combo in Adrenasense by Natural Factors as an useful brand for this purpose at one cap/day. Depending on your results, you may also need to take direct DHEA and pregnenolone supplementation as well to achieve optimal levels.

Inflammation related to iron stores.

Men have a higher risk of carrying excess iron and with it the potential inflammation producted by its oxidation (think “rusting”.) Unlike most women, men don’t donate blood every month for most of their teens to 40s. As a group, we are most often meat eaters, with a good amount of iron ingested over the years. The resulting oxidative ‘rusting’ caused by iron excess can be a contributing root cause factor for endothelial inflammation and secondarily, migraine headaches.

Men, especially those 30-35 years plus having migraines, should consider checking basic lab for this to include: 1) serum ferritin. Optimally, it should be less than 100 ng/ml. 2) serum iron level. Optimally less than 100-150 mcg/dl and 3) Gamma-glutamyl transferase (GGT), a liver enzyme that is highly sensitive to the oxidative stress due to excess iron. Ideally it should be <20 U/L.

If these tests reveal excess iron or iron related inflammation, consider the following:

• checking your complete blood count (CBC) to see if your blood count also reflects a high iron load. Check in the Hemoglobin (Hb) section of this panel, which measures red cell content as grams of hemoglobin per every 10 cc of blood. A level of 15-15.5 grams/dl is around the optimal oxygen carrying level for males. For every whole number above this, you have roughly an extra pint of blood on board. So in terms of blood donation, a unit of blood donated drops a “16 gram/dl” to a “15 gram/dl” level. If you are running a Hb of 16+, consider donating at least one unit of blood at your nearest blood bank. Some situations might require a physician’s form for a “therapeutic phlebotomy” where the blood is removed, but not used for donation.

• consider cutting back the animal meat content in the diet. This might be especially applicable if a recent trial of a keto or carnivore diet worsened your migraines. Using alcoholic beverages can exaggerate iron load related inflammation, so moderation there can help minimize this interaction.

• consider limiting daily Vitamin C to 500 mg, especially if you were in the habit of taking larger amounts. Vitamin C can potentially double your dietary iron absorption.

• consider genetic testing for heriditary hemochromatosis (HH), which occurs in roughly one in 300 individuals, seen most often in those of Northern European origin. These individuals will typically run a serum ferritin >250 and/or a serum iron >300. If you have both genetic variants you will need ongoing monitoring of your iron stores. I have had several male patients where optimal management of their HH significantly reduced their migraines.

While these factors are more male than female specific, the majority of root cause factors for migraine are very similar in both men and women. If you would like to learn about how these apply to your headache story, consider becoming a paid subscriber at $7/month and get full access to the Natural Migraine Relief Course with the individualized Migraine Action Plan.

1. “Testosterone levels in men with chronic migraine.” Neurol Int Lisa BE Shields 2019 Jun 19;11(2):8079. doi: 10.4081/ni.2019.8079 https://pubmed.ncbi.nlm.nih.gov/31281602/

2. “Female sex hormones in men with migraine” Willebrordus P.J. July 24, 2018 91 (4) e374-e381 https://www.neurology.org/doi/10.1212/WNL.0000000000005855