Migraines, Metabolism & Functional Medicine: A Holistic Roadmap to Healing
Migraines, Metabolism, and Functional Medicine: A Holistic Roadmap to Healing
Dr John Sciales, Director CardioCore Metabolic Wellness Center
Introduction
Migraines are among the most common neurological disorders worldwide, affecting nearly 15% of the population. (1) They are not simply “bad headaches.” A migraine is a full-body neurological storm that can leave a person incapacitated for hours or even days. Symptoms may include throbbing pain, nausea, dizziness, vision changes, sensitivity to light or sound, and sometimes balance or speech difficulties.(2)
Migraines are disabling. Many sufferers retreat into dark, quiet rooms, unable to work, care for family, or enjoy daily life. Even after the pain ends, many experience a “migraine hangover,” a 24– 48 hour period of fatigue, brain fog, and irritability.
For decades, medicine explained migraines in two ways:
1. A blood vessel problem — where brain arteries constrict, then rebound and dilate, triggering pain.(2)
2. A neurotransmitter problem — involving serotonin and other brain chemicals.(16)
Treatments have followed these models, using drugs to either control pain or reduce the frequency of attacks. Common options include:
Triptans – (sumatriptan Imitrex, rizatriptan Maxalt, zolmitriptan Zomig) – narrow blood vessels and block pain pathways.(9)
Beta-blockers – (propranolol Inderal, metoprolol Lopressor, atenolol Tenormin) – often used to prevent migraines, but long-term use can worsen insulin resistance, contribute to weight gain, and mask early signs of low blood sugar.(10)
Anticonvulsants – (topiramate Topamax, valproic acid Depakote) – repurposed from seizure treatment. Topiramate can sometimes aid weight loss, but valproic acid is strongly linked to weight gain, insulin resistance, and fatty liver.(10)
CGRP inhibitors – (erenumab Aimovig, fremanezumab Ajovy, galcanezumab Emgality) – new biologic drugs that block a pain-signaling molecule.(9)
These medications can reduce symptoms or frequency, but they rarely address the root cause of migraines. Worse, some — especially beta-blockers and valproic acid — can worsen the very metabolic dysfunctions that appear to drive migraines in the first place.(10)
That brings us to a new way of understanding migraines: as a metabolic brain disorder.(7,11) This perspective is part of the growing field of Metabolic Psychiatry, which studies how the body’s energy systems influence brain and mental health. (20) Depression, anxiety, ADHD, bipolar disorder, and Alzheimer’s all share metabolic roots. Migraines may be one of the clearest examples.
Part I: The Brain’s Unique Energy Needs
The Brain as an Energy Hog
The human brain is a remarkable organ. Although it accounts for only about 2% of total body weight, it consumes nearly 20% of the body’s daily energy supply. (2) This disproportionate demand reflects the constant activity within the brain, as billions of neurons — the specialized nerve cells that transmit electrical messages — are firing around the clock. Neurons function much like electrical wires, sending rapid signals that allow us to think, feel, move, and interact with the world.
To do this, they rely on a steady supply of ATP (adenosine triphosphate), the cell’s “energy currency.” ATP powers the pumps that move ions across neuronal membranes, creating the electrical impulses that form the basis of thought and action. But unlike a battery that can be charged and left to run for a while, ATP must be regenerated second by second. If energy production slows even briefly, neurons falter, and brain function becomes unstable.
The Brain: a High Performance Sports Car with No Gas Tank
One of the most striking features of the brain is its lack of an energy storage tank. While muscles and the liver can stockpile glycogen as a reserve fuel, neurons themselves hold virtually no meaningful stores of glucose or fat. Even the brain’s support cells, called astrocytes, contain only a tiny glycogen reserve — enough to sustain activity for perhaps one or two minutes. (2) Beyond that, the brain must depend on a continuous, uninterrupted stream of fuel delivered through the blood.
If that supply is interrupted, the consequences are immediate and severe: after about 10 seconds of deprivation, a person will lose consciousness. Within 2 to 3 minutes, seizures or flat brain waves appear, signaling electrical failure. By 4 to 5 minutes, permanent injury sets in, and neurons begin to die.(2) This is why cardiopulmonary resuscitation (CPR) emphasizes the “golden four minutes”. Beyond that, permanent neurological dysfunction sets in, even if the other organs can still recover.
In this way, the brain can be compared to a high-performance sports car with no gas tank — it must be constantly refueled while running at top speed. This fragile dependence on steady energy supply makes the brain uniquely vulnerable to metabolic disruptions.(7,12) Any disturbance in how the body processes, delivers, or utilizes energy — such as insulin resistance, mitochondrial dysfunction, or impaired blood flow — threatens the brain first. Migraines, with their sudden onset and disabling symptoms, may be one of the clearest examples of what happens when this delicate energy balance breaks down.
Part II: Pathogenesis of Migraines
Nerve Hyper-excitability and Energy Crisis
Migraines are not random events. They emerge from a chain reaction — a cascade of metabolic, vascular, and inflammatory changes(16) that destabilize the brain’s delicate balance. When these systems falter, the result is the disabling storm we recognize as a migraine.
The process often begins with neuronal hyperexcitability. (13,16) Many people with migraines have brains that are “wired hot,” meaning their neurons — the cells that transmit electrical signals — fire too easily and too often. This hair-trigger wiring can be influenced by genetics, low magnesium levels, mitochondrial weakness, or an unstable energy supply. Hyperexcitable neurons create a brain environment that is prone to sudden electrical disturbances.
The second step is an energy crisis. Neurons are highly dependent on ATP, the fuel that powers all their activity. When ATP production drops — due to insulin resistance, fluctuations in blood sugar, or inefficient mitochondria — neurons lose their stability. A starving neuron is like a flickering light bulb: unpredictable, unstable, and prone to sudden surges of activity.(13,16)
This instability can set off cortical spreading depression (CSD), a hallmark event in migraine biology. CSD is a slow-moving wave of abnormal electrical activity that sweeps across the brain’s surface. It begins with a burst of neuronal firing, followed by prolonged suppression. This phenomenon explains why many migraine sufferers experience an aura before the pain begins — flashes of light, zigzag patterns, blind spots, or tingling sensations are the visible footprints of CSD moving through the brain.(16)
As CSD unfolds, it disrupts neurovascular coupling — the tight coordination between neurons and their blood supply. In a healthy brain, blood flow increases in areas that need more fuel. But during a migraine, especially in the setting of insulin resistance, this relationship breaks down. Neurons are starved of glucose, yet blood vessels, still sensitive to insulin, dilate excessively. The brain becomes paradoxically flooded with blood but deprived of usable energy. This mismatch creates the throbbing pain, vision changes, balance problems, and sensory overload that define migraine attacks.(7,17)
The Brain on Fire
The next step is neuroinflammation. As CSD and vascular changes ripple through the brain, immune cells known as glia become activated. They release cytokines — inflammatory messengers that amplify pain signals, sensitize neurons, and extend the attack. (17) In parallel, molecules such as serotonin and CGRP (calcitonin gene-related peptide) interact with blood vessels and nerve pathways, further escalating pain sensitivity and duration. (9,16) This inflammation is why migraines often leave sufferers feeling drained long after the pain subsides.
Finally, hormonal and metabolic triggers often determine when a migraine actually strikes. Drops in estrogen lower serotonin and increase inflammation, which is why many women experience migraines around menstruation. (15) Surges in cortisol — the stress hormone — raise blood sugar and destabilize neuronal energy balance. (6) High-carbohydrate meals spike insulin, shut down ketone production, and inflame vessels, making the brain more vulnerable to an attack. (20,21)
The Perfect Storm: when Two Worlds Collide
Taken together, these processes explain why migraines are so disabling and complex. They are the result of a perfect storm: a brain that is energy-starved, neurons that are hyperexcitable, vessels that are mismanaged, and immune pathways that are inflamed.
“Migraines are not random — they are the visible symptom of deeper metabolic dysfunction in the brain.”
Part III: Insulin Resistance and Migraines
One of the most important — and overlooked — links in migraine biology is insulin resistance. Insulin is a hormone made by the pancreas that acts like a key, unlocking cells so that glucose can enter and be used as fuel. (6) In a healthy brain, insulin helps neurons take in glucose efficiently, fueling their high demands. But in insulin resistance, the key no longer fits the lock. Neurons stop responding well to insulin, and as a result, they become energy-starved even when blood sugar levels look normal. (7,8) At the same time, blood vessels in the brain often remain insulinsensitive. This means that while neurons are struggling for fuel, the blood vessels still respond strongly to insulin by producing nitric oxide, a chemical that dilates them. The paradox is striking: starving neurons paired with vessels that are flooded open, a mismatch that destabilizes the brain and can help trigger migraines.
Unfortunately, this problem is invisible on the standard tests most doctors rely on. Physicians often measure fasting glucose or hemoglobin A1c to screen for diabetes. But these are snapshots, not movies. In the early stages of insulin resistance, fasting glucose may remain normal because the pancreas is working overtime, pumping out two or three times more insulin to keep blood sugar in range. This hidden struggle can persist silently for 10 to 20 years before blood sugar finally begins to rise. During this time, damage is already taking place: fatty liver is forming, inflammation is smoldering, cardiovascular risk is climbing — and the groundwork for migraines is being laid.(7,8)
The way to unmask this dysfunction is with a dynamic test: the oral glucose tolerance test (OGTT). (8) In this test, a person drinks a concentrated glucose solution, and both glucose and insulin are measured over the next two hours. In migraine patients, the results are often striking — insulin spikes much higher than normal and remains elevated longer, revealing the hidden resistance that a fasting glucose alone would have missed.
Pregnancy provides a natural example of why dynamic testing matters. During pregnancy, the body becomes more insulin resistant on purpose — ensuring that extra glucose remains in the blood to nourish the growing baby. OB/GYN doctors rely on the OGTT in pregnant women because a single fasting glucose would miss this physiologic change. (6) The lesson for migraines is the same: it isn’t just the sugar level that matters — it’s how your body processes the sugar. For many patients, especially those with migraines, the hidden dysfunction of insulin resistance explains why symptoms persist despite “normal” labs.
Part IV: Ketones, Metabolic Flexibility, and the “Bear Diet”
If insulin resistance represents the problem, ketones and metabolic flexibility represent the solution. Under conditions of low carbohydrate intake, the liver shifts gears and begins breaking down fat into small molecules called ketones. Unlike glucose, ketones do not require insulin to enter neurons. They cross directly into the brain and provide a cleaner, more efficient source of energy. In fact, ketones generate more ATP per unit of oxygen consumed than glucose and produce fewer reactive oxygen species (ROS), the damaging byproducts of energy metabolism. (20,21) For a brain that struggles with glucose delivery, ketones are not just an alternative — they are a preferred fuel.
The problem in the modern diet is that carbohydrates block ketones. When a person eats carbs, insulin rises, and the liver immediately shuts down ketone production. Instead of burning fat, the body stores it.(20) For someone with insulin resistance, this means the brain is trapped in glucose-dependence at the very time it cannot efficiently use glucose. The result is unstable energy, greater inflammation, and increased vulnerability to migraines.
This is where the concept of metabolic flexibility comes in. A healthy metabolism can smoothly switch between burning glucose when it’s available and burning fat (and producing ketones) when it’s not. But insulin resistance locks the body into sugar-burning mode. The person feels hungry sooner, fatigued faster, and more vulnerable to energy crashes. These same crashes destabilize neurons and contribute to migraine attacks.(20)
By shifting toward a diet centered on protein and fat — especially with controlled carbohydrate intake — insulin levels are suppressed, fat-burning is restored, and ketone production resumes. This stabilizes brain fuel, suppresses appetite, lowers inflammation, and supports natural weight control. Migraines often improve dramatically when the brain is consistently supplied with ketones.(20,21)
The Bear Diet
A vivid way to understand this is through the “Bear Diet” analogy. In late summer, bears gorge on berries and other carb-heavy foods. The surge of insulin drives fat storage and slows metabolism, preparing the bear for hibernation. Humans on high-carb diets do the same: burn sugar, store fat, slow metabolism — like the bear preparing for winter. But unlike bears, we don’t hibernate. We stay awake, eating more, while our metabolism stalls.
Carbs alone: burn sugar, store fat, slow metabolism — the “bear state.”
Protein and fat: burn fat, produce ketones, speed metabolism, suppress appetite, reduce inflammation.
Carbs + fat together (the Western diet): carbs win, insulin spikes, fat is stored rather than burned, ketones are shut off, inflammation rises — the worst of both worlds.(20,22)
In other words: “Carbs win, you lose.”
Finally, it’s important to reassure patients that eating fat is not what clogs arteries. The fat seen in blood vessels comes primarily from carbohydrates being converted into fat by the liver, not directly from dietary fat. Studies show that low-carbohydrate, higher-fat diets consistently lower triglycerides, raise protective HDL cholesterol, reduce systemic inflammation, and normalize body weight. Far from harming the body, dietary fat — when combined with reduced carbohydrates — restores the very metabolic flexibility the brain needs to prevent migraines.
Part V: Mitochondria and Energy
At the heart of every cell are the mitochondria, often called the “power plants” of the body. Their job is to take nutrients — glucose, fats, or ketones — and convert them into ATP, the molecule that fuels nearly all cellular processes. The brain, which demands a constant and massive supply of energy, is especially dependent on efficient mitochondrial function.(12)
In people with migraines, research consistently shows signs of mitochondrial impairment. These brains produce less ATP than they should, leaving neurons vulnerable to energy shortages. At the same time, weakened mitochondria produce more reactive oxygen species (ROS) — unstable oxygen fragments that damage proteins, membranes, and DNA. This combination of low energy and high oxidative stress contributes directly to the energy crises that destabilize neurons and help trigger cortical spreading depression, the electrical wave that underlies migraine aura and pain.
Fortunately, several nutrients can help support mitochondrial health:
-Magnesium is critical for ATP production and nerve stability. (13)
-Riboflavin (vitamin B2) is a cofactor in mitochondrial enzymes, and high-dose riboflavin has been shown in studies to reduce migraine frequency. (13)
-Coenzyme Q10 (CoQ10) is essential for the mitochondrial electron transport chain, helping shuttle electrons to generate ATP; supplementation often improves both energy and resilience(12)
-Alpha-lipoic acid is a potent antioxidant that neutralizes ROS while supporting mitochondrial function. (12)
-Carnitine plays a key role in transporting fatty acids into mitochondria, enabling them to be burned as fuel.(12)
Ketones themselves are another powerful ally. When available, ketones not only bypass insulin resistance but also increase ATP production efficiency and lower ROS generation compared to glucose. (20,21) By providing more energy with fewer damaging byproducts, ketones can protect fragile mitochondria and stabilize the energy demands of neurons. For many migraine patients, this shift in fuel source is transformative.
Creatine supplementation may help boost ATP levels in the brain, potentially alleviating migraine symptoms by supporting energy metabolism and reducing oxidative stress at the mitochondrial level. Research suggests that creatine may reduce migraine frequency and severity, while also improving cognitive function and supporting brain health. Creatine is produced naturally in the body but additional supplementation may be beneficial.
Part VI: Gut–Brain Axis
Modern science has revealed that the gut and the brain are in constant communication, linked by nerves, immune signals, and metabolic pathways. This relationship — known as the gut–brain axis — means that the health of our gut microbiome has a profound impact on neurological function, including the development of migraines.
The gut microbiome is made up of trillions of bacteria, fungi, and other microbes that normally live in harmony with us. These microbes perform essential jobs: they produce vitamins such as folate (B9), B12, and vitamin K(23) ; they ferment dietary fiber into short-chain fatty acids (SCFAs) like butyrate(23), which feed the cells lining the gut, regulate immune activity, and even influence gene expression; and they help regulate the production of neurotransmitters such as serotonin and dopamine, both of which affect mood, pain perception, and sleep(23,24).
A Delicate Balance
When this balance is disturbed, a state called dysbiosis occurs. Dysbiosis can involve an overgrowth of harmful bacteria or fungi, such as Candida(24), or a loss of beneficial species. Dysbiosis often leads to increased intestinal permeability (“leaky gut”), in which gaps in the intestinal lining allow bacterial fragments and toxins to escape into the bloodstream. This triggers the immune system, leading to the release of cytokines, inflammatory messengers that travel throughout the body — and into the brain. Once in the brain, cytokines activate glial cells and contribute to neuroinflammation, lowering the threshold for migraine attacks(24).
Testing for dysbiosis is available through tools like the CSAPx-2 stool analysis, which identifies microbial imbalances, pathogenic overgrowth, and markers of gut permeability. Correcting dysbiosis with diet, probiotics, prebiotics, antifungals (if needed), and nutrients that support gut integrity often reduces both systemic inflammation and migraine frequency. This is a clear example of how healing the gut can help heal the brain.
Part VII: Hormones
The role of hormones in migraines cannot be overstated. Migraines occur about three times more often in women than in men, a disparity that highlights the central influence of hormonal fluctuations(15).
The most important hormone in this context is estrogen(15). Estrogen has protective effects on the brain: it enhances serotonin levels, supports blood vessel stability, and reduces inflammation. When estrogen levels fall — such as just before menstruation, during perimenopause, or after childbirth — these protective effects diminish. The drop in estrogen can lower serotonin, widen pain pathways, increase inflammation, and destabilize blood vessels, all of which increase the risk of a migraine attack. This “estrogen withdrawal hypothesis” explains why so many women experience menstrual migraines.
Another key hormone is cortisol, the stress hormone produced by the adrenal glands(6). Cortisol is meant to provide short-term bursts of energy in response to stress, but chronic stress keeps cortisol levels elevated. High cortisol spikes blood sugar, worsens insulin resistance, and destabilizes brain fuel supply, all of which increase migraine susceptibility. Many patients notice their migraines flare during times of high stress — a pattern directly tied to cortisol’s metabolic effects.
Melatonin, the hormone that regulates sleep–wake cycles, is also closely linked to migraine biology(15). Low melatonin levels are associated with poor sleep quality and increased migraine frequency. Because melatonin also has antioxidant and anti-inflammatory effects in the brain, low levels may remove another layer of protection. This is why migraines are often triggered by disrupted sleep schedules, jet lag, or insomnia. Blue light from electronic devices, chronic stress, and nutritional deficiencies including Vitamin B6, magnesium and tryptophan can all negatively impact your melatonin production. Sleep is vital in reducing neurological inflammation and promoting repair. Conversely, migraines can disrupt sleep patterns, leading to sleep deprivation, which in turn can trigger more migraines.
Testing Identifies Deficiencies
Testing can help clarify these hormonal contributions. The DUTCH hormone panel (Dried Urine Test for Comprehensive Hormones) provides a detailed view of sex hormones (estrogen, progesterone, testosterone), adrenal hormones (cortisol, DHEA), and melatonin(15). This test not only measures hormone levels but also reveals how hormones are being metabolized, giving a deeper picture of hormonal balance or imbalance. With this information, targeted nutritional, lifestyle, and in some cases botanical or bioidentical hormone support can help restore balance and reduce migraine burden.
Part VIII: Genetics
While lifestyle and environment play major roles in migraine development, genetics set the stage(18). Certain genes can make a person more vulnerable to migraines by influencing how their body processes nutrients, manages inflammation, detoxifies chemicals, or regulates neurotransmitters. Importantly, though, genes are not destiny. They represent tendencies, not inevitabilities — and when we understand these genetic tendencies, we can design personalized interventions that shift the outcome(18).
This is where modern genetic testing becomes invaluable. For example, the DNA Health Panel examines key variants in genes related to nutrient metabolism, detoxification, and inflammation. Some people may carry variations that reduce their ability to activate folate (B9), recycle glutathione (the body’s master antioxidant), or break down inflammatory molecules. These small differences can add up, raising migraine risk — but they can be counterbalanced with targeted nutrition, supplementation, and lifestyle strategies.
The DNA Diet Panel adds another layer of personalization. This test looks at how an individual’s genetics influence their ability to metabolize carbohydrates, fats, and proteins. It can also uncover genetic predispositions to food sensitivities or variations in how appetite and satiety hormones are regulated. For someone with migraines, this information is particularly valuable because diet is such a powerful trigger — and a personalized diet plan based on genetics can prevent many attacks before they start.
Finally, the DNA Mind Panel focuses on genes that influence neurotransmitter production and breakdown, mood regulation, and stress response. Variants in serotonin, dopamine, or GABA pathways can affect pain sensitivity, sleep patterns, and vulnerability to anxiety or depression, all of which are tightly linked to migraine frequency. By identifying these variants, clinicians can better understand why a patient responds the way they do and provide targeted support — whether through specific nutrients, lifestyle practices, or even mindfulness approaches.
Together, these panels provide a blueprint of individuality. Instead of guessing, we can see which pathways may need extra support. This allows functional medicine to move beyond onesize-fits-all treatment and toward truly personalized, precision care for migraines.
“It is possible to effect the expression of the Genetic information, each one of us has, through the complex interaction with Nutrition, Exercise, Stress Management & Socialization including such factors as Sleep Hygiene”
Part IX: Functional Medicine Roadmap
Migraines are complex, but functional medicine offers a structured, step-by-step approach that gets to the root of the problem. At the heart of this approach is the principle of addressing the whole person, not just the pain.
Step 1: Assessment
The journey begins with a comprehensive assessment. Patients complete the Multi-System Questionnaire (MSQ), which scores the severity and distribution of symptoms across different body systems. This creates a snapshot of overall symptom burden. Next, we map the Matrix and Timeline — tools that identify connections between life events, hormonal cycles, seasonal changes, stress patterns, or environmental exposures and the onset of symptoms. This often reveals hidden triggers, such as migraines that flare during high-stress seasons, after antibiotic use, or around hormonal shifts.
Functional testing deepens this picture. The CSAPx-2 stool test identifies gut dysbiosis and leaky gut. Metabolomix testing reveals nutrient imbalances, oxidative stress, and mitochondrial dysfunction. The DUTCH hormone panel maps sex hormones, adrenal output, and melatonin rhythms. And the DNA panels (Health, Diet, Mind) personalize the plan by showing genetic tendencies. Together, these tools provide the foundation for a precise, individualized treatment strategy.
Step 2: The 16-Week Foundational Program
Once assessment is complete, patients enter a structured 16-week program designed to restore balance step by step.
Weeks 1-4: Nutrition & Elimination
The first step is to remove common dietary triggers and inflammatory foods. Gluten, dairy, soy, corn, sugar, and processed foods are eliminated. This allows the immune system to calm and gives the gut a chance to heal. In many cases, a low-carbohydrate or ketogenic diet is introduced, both to reduce insulin resistance and to supply the brain with steady ketone fuel. Patients often notice fewer migraines even within the first month.
Weeks 5–8: Gut Restoration
With triggers removed, we focus on rebuilding the gut. The HCl challenge assesses stomach acid levels, since low stomach acid can impair digestion and nutrient absorption. Support for zonulin regulation (using nutrients like glutamine and zinc carnosine) helps strengthen the intestinal barrier and reduce leaky gut. Probiotics and prebiotics are introduced to restore microbial balance and boost production of SCFAs, which reduce inflammation and support the gut–brain axis.
Weeks 9–12: Metabolism & Hormones
Next, we address systemic metabolism and hormonal balance. Methylation support with B vitamins (especially B12, B6, and folate) ensures proper neurotransmitter function and detoxification. Mitochondrial nutrients such as CoQ10, magnesium, and riboflavin are added to stabilize neuronal energy. The patient’s DUTCH hormone results guide interventions for sex hormones, cortisol balance, and melatonin rhythms. For women with menstrual migraines, this step is often transformative.
Weeks 13–16: Lifestyle & Environment
Finally, we tackle the broader environment in which the patient lives. Stress reduction techniques — including mindfulness, yoga, or heart-rate variability (HRV) training — lower cortisol and stabilize blood sugar. Sleep optimization is emphasized through both behavioral practices and melatonin support when needed. Exercise is introduced in a balanced way, combining aerobic activity to enhance mitochondrial function and resistance training to improve insulin sensitivity. Environmental toxins are identified and reduced — from plastics and heavy metals to mold exposure. Even EMF exposure (Electromagnetic frequency) and water quality are addressed, since subtle environmental factors can accumulate and contribute to migraine burden.(23,25)
By the end of 16 weeks, patients not only experience fewer and less severe migraines but also notice improvements in energy, mood, sleep, and overall resilience. The roadmap provides a structured way to peel back the layers of dysfunction, restoring balance one step at a time. Beyond the foundational program, patients transition into a personalized maintenance plan to sustain progress and prevent relapse.
Part X: Migraines in Metabolic Psychiatry
Migraines are not isolated neurological accidents. They are not random electrical storms of the brain or simply unlucky genetic inheritances. Instead, migraines should be seen as metabolic distress signals — early warnings that the brain’s core energy systems are struggling.
This perspective is central to a new and growing field called Metabolic Psychiatry. Traditionally, psychiatry has focused on brain chemistry alone, using medications to adjust neurotransmitters like serotonin, dopamine, or norepinephrine. While these approaches can provide temporary symptom relief, they rarely address the underlying “why.” Why is the brain unstable in the first place? Why do the same patients who have migraines often struggle with depression, anxiety, ADHD, or even early memory loss?
The answer lies in metabolism
The same biological disruptions that underlie migraines — insulin resistance, mitochondrial dysfunction, oxidative stress, and chronic inflammation — are also present in many other brain-related disorders. Research increasingly shows that:
Depression is associated with insulin resistance, inflammatory cytokines, and impaired mitochondrial energy production. The relationship between migraines and depression is bidirectional, with each condition potentially increasing the risk of developing the other due to shared underlying factors such as neurotransmitter imbalances, stress, and inflammation(18,20,22).
Anxiety disorders are worsened by blood sugar instability and excessive cortisol, both downstream effects of metabolic dysfunction. Just like depression,Anxiety and migraines have a bidirectional relationship, with anxiety potentially triggering migraines and the experience of migraines contributing to increased anxiety.(18,20,22)
ADHD has been linked to impaired dopamine regulation, which in turn depends on stable energy supply and methylation pathways tied to metabolism. Migraines and ADHD may be related due to shared underlying factors such as neurotransmitter imbalances and cortical excitability, and individuals with migraines often experience cognitive symptoms like brain fog.(18,20,22)
Alzheimer’s disease is sometimes called “type 3 diabetes” because of its strong association with insulin resistance and reduced glucose utilization in the brain. A history of migraines may increase the risk of developing dementia, including Alzheimer's disease and vascular dementia, with potential underlying mechanisms including vascular effects, shared genetic factors, neuroinflammation, and oxidative stress.(18,20,22)
In this context, migraines become part of a larger pattern: the brain signaling its distress when its energy needs are not being met. Migraines may be one of the earliest and most visible signs of this process — a red flag that metabolic dysfunction is at work long before more severe disorders manifest.
The implication is profound:
By healing metabolism, we do not just reduce migraines — we protect the brain for the long term. (29,22,23)
Improving insulin sensitivity, restoring mitochondrial function, calming inflammation, and supporting the gut–brain axis all create resilience against not just migraines but also against depression, anxiety, ADHD, and cognitive decline. This integrated view is where neurology and psychiatry meet metabolism, and where functional medicine provides solutions that conventional approaches too often overlook.
Conclusion
Migraines are not accidents. They are clear signals from the brain that metabolism is broken. (20,21,22) Because the brain has no fuel tank, it relies entirely on a steady supply of energy delivered in real time. When carbohydrates dominate the diet and insulin resistance develops, that supply becomes unstable. Neurons are starved of energy, blood vessels are overstimulated, and inflammation spreads. The end result is pain, nausea, sensory overload — the all-too-familiar experience of a migraine.
But there is another path. By shifting metabolism away from sugar-dependence and toward fat burning and ketone production, the brain can regain stability.
Ketones provide the steady, efficient energy the brain prefers, producing more ATP and less oxidative stress.
This metabolic flexibility restores balance, reduces inflammation, and lowers the threshold for migraine attacks.
Functional medicine offers a roadmap to achieve this. Through careful assessment, personalized nutrition, targeted supplements, hormone and gut balancing, and lifestyle interventions, we can move beyond temporary symptom relief to true root-cause healing. The framework is simple yet powerful: test, restore, personalize, maintain.
As a Cardiometabolic expert, a Medical doctor, and an expert in Functional medicine, I see how this seemingly unrelated disorder — migraine — actually takes center stage in the story of human metabolism. Migraines are not just about neurology; they are about the body’s core energy systems. Unfortunately, many of these metabolic insights remain outside the traditional neurologist’s expertise, which is why treatment often focuses on suppressing symptoms rather than correcting the underlying dysfunction.
At the CardioCore Metabolic Wellness Center, we take a different approach. Our philosophy is: “Getting to the Core… the Path to Wellness — where being Healthy is Not an Accident.”
Western medicine often falls short because it chases sparks — pain, nausea, or blood vessel changes — without ever extinguishing the fire itself. At CardioCore, we don’t chase sparks. We put out the fire.
By identifying and correcting the underlying metabolic dysfunction, we do not simply mask migraines. We restore balance, resilience, and long-term health.
If migraines have controlled your life — and traditional approaches have failed to give lasting relief — it’s time to look deeper.
It’s time to get to the core.
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