FAQ Episode 91: Iron levels and migraines: Too little, too much or both?

Frequently Asked Questions about Natural Migraine Relief

Jun 12, 2025

I was re-reminded of how variable iron stores can affect your health when I reviewed a recent survey of over 300,000 premenopausal women which revealed that 45% had low hemoglobin, which is the iron stored in red blood cells.1 I’ve previously addressed this common condition and it’s migraine connection in an extensive post about iron deficiency, anemia and migraine: FAQ Episode 23 What is the relationship between anemia and migraine?. While too little iron can promote migraines, usually in women who are still menstruating, in this episode I’d like to address the flip side of this story and review how excessive iron stores can promote headaches and brain pathology.

While excess iron probably in not a primary root cause of migraines, it has been associated with longer disease duration, higher attack frequency, and greater migraine-related disability for those already with a history of migraine headaches. Also, the accumulation of too much iron as one approaches and passes the menopausal phase of life could also accelerate brain aging disorders in future decades.

Because anemia is the more common problem, the alternative problem of accumulating too much iron over time is easily overlooked. Years ago, a popular ad for an iron supplement cautioned “Do you have iron poor blood!?!” (oh no, not that!) and counseled a daily iron supplement. Also, anyone with a pregnancy was prescribed multi’s with iron and were conditioned to continue the same “iron in your multi” formula for years to come. We have been programmed to fear iron deficiency, while under-recognizing the potential perils of excess iron as we approach mid-life.

Iron overload promotes inflammation, a prime driver of recurrent migraines

Before menopause, you are donating away some iron every month, which explains the tendancy for anemia at this time in life. After menopause, the accumulation of excess iron can contribute to oxidative stress and inflammation, which are root cause factors for many with migraines. Studies2 have found that those with ongoing migraines can have focused brain iron deposits in the nucleus accumbens (NAC), a brain center which:

plays a crucial role in motivation, reward processing, and reinforcement learning
acts as a key interface between the limbic system and the motor system
allows emotional responses to be translated into action, and
plays a role in pain modulation. Its activity can influence how pain signals are processed.

Functional activity in this area of the brain is linked to both migraine and chronic pain, which could make iron deposition there a biomarker for those with difficult to treat migraines.

If you are in your forties or beyond, the evaluation for a change in or increase in headaches should include a look at your iron stores.

Another inheritable migraine connection

We know that some migraine patterns are inheritable. More than half of people who experience migraines have at least one family member who also experiences them. If a person has a parent with migraine, they have a 50% chance of developing migraines themselves. This chance increases to 75% if both parents experience migraines. Most, but not all of these genetic patterns are still poorly defined.

A recognizable disorder that could contribute to a familial migraine pattern is a less common condition known as hereditary hemochromatosis. This is a genetic disorder that causes the body to absorb and store too much iron. While it affects both men and women, the disease is often diagnosed later in women due to the iron loss associated with menstruation and pregnancy. Hereditary hemochromatosis is estimated to affect 1 in 300 people in the United States. Not common, unless its you, but if true for you, it could be a factor in your migraines, as well as promoting blood vessel plaquing and brain aging. It occurs most commonly in Caucasians of Northern European descent and is diagnosed with blood tests measuring iron levels (including serum ferritin and transferrin saturation.) If these are elevated, one can do genetic testing to identify the specific mutation— C282Y— that is associated with the disease. I’ve had patients with hereditary hemochromatosis, both male and female, experience significant migraine improvement when excessive iron levels were corrected.

If the following apply to you, see the recommendations in the ‘Action’ section below:

you are a women who has been told “you’re certainly not anemic” (maybe borderline high red cell count) in the past
you have a family member, usually a male, who has been told they have excess iron stores.
your migraines are getting worse in your 40s-50s.

Additional health risks of excess iron

For migraine patients, this is probably #1: Your mitochondria, the engines and powerplants of your cell may take the greatest hit. When in excess, iron becomes dangerous as it interacts with hydrogen peroxide to produce hydroxyl radicals, which are among the most aggressive and destructive types of free radicals. They damage the inner mitochondrial membrane, where energy is made. Over time your tissues begin to break down under the stress of this progressive oxidative damage as the production of cellular energy is eroded. As migraine is for many patients a “bioenergetic drain” problem, this can be a core provocative factor.
Excess iron raises your risk for several diseases of midlife: excess levels of iron stores have been directly linked to cancer and Type II diabetes. High ferritin has been directly linked to higher rates of cancer.3 Oxidative stress from elevated levels of stored iron cause the DNA damage that results in mutation and tumor growth. Studies also connect excess iron to increased rates of Type 2 diabetes.4
Iron overload weakens your bones — If you think of calcium as the builder of bones, think of excess iron as the wrecking ball. Research shows that high iron levels damage bone microarchitecture — the structure that gives your bones their strength. This damage makes bones more brittle and likely to break, especially after minor falls or routine stress. On the outside of the bone, excess iron contributes to the risk for osteoarthritis.5

Action considerations:

If you experience frequent or severe migraines, discuss the possibility of iron deficiency (or excess) with your doctor.
Consider getting blood work for three values:

-a CBC to look at your red blood cell iron stores (hemoglobin level)

-a ferritin level to assess active iron stores. “Normal” levels for women are in the 12-150 range, with “ideal” ferritin around 60 to 75 ng/mL. Hemochromatosis levels for ferritin are more often in the 300+ range. If this elevated finding is true for you, consider getting additional genetic testing, both for yourself and, if positive, for other first degree relatives. If your ferritin level is on the high side consider donating blood two to three times a year, although I would keep your hemoglobin level at or above a 13 (for women, and more than 14 for men.) I love the concept of donating blood, and I do myself, but I find that the blood bank may be willing to draw your blood down lower than the ideal. If the hemoglobin level they check before donating is less than 13, I’d postpone the next donation for another 6 weeks.

-one of the most useful indicators of iron stores is your serum transferrin saturation. This test measures the amount of iron bound to the protein transferrin that carries iron in the blood. Transferrin saturation values greater than 45% are considered too high

If these tests show that iron levels are high normal or excessive, consider:
-talking with your doctor to see if genetic testing for hemochromatosis is right for your situation
-cutting back on Vitamin C supplements, especially if more than 250 mg/day. Vitamin C increases absorption of iron in the gastrointestinal tract (which is good if you need more iron, but not when its in excess.)

-taking a look at your dietary red meat content. You may need to pare it back some in favor of non-meat protein sources.

- taking a look at your multi-vitamin, and unless you have a specific need for it, consider leaving Iron OFF the list of ingredients.

-discuss with your physician if donating blood would be a safe and reasonable measure to reduce excess iron stores.

Having the right amount of iron is something most of us take for granted, but any women with migraine headaches should consider having it assessed. It only requires a few simple blood tests to check off this box and make sure that either insufficient or excessive stores are not an undiagnosed contributor to your headaches, as well as adding to the erosion of non-migraine quality of life and future general brain aging.

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