050 The Case of the Headache-free Migraines w/ Dr. Rudrani Banik

The Case: 

• Mary 38 and has been dealing with vertigo, light sensitivity and low energy.
• She was also experiencing gastro-intestinal issues
• She saw a neurologist who provided no answers and a gastroenterologist who prescribed Proton Pump Inhibitor medications

The Investigation

I often meet people with a bunch of symptoms that seem unrelated. That was the case with Mary. In our conversation she also mentioned that she often felt like something was crawling under her skin. When I probed her more she also recalled that she would get headaches here and there. My sense was that it had to do with how her nervous system was responding to something, which is where I started my investigation.

My first suspicion was migraine syndrome. It’s estimated that over 33 million Americans suffer with some form of migraines. About 11% of the world’s population has migraines. What most people don’t know is that migraine syndrome isn’t just about bad headaches. There are a lot more symptoms to consider. 

To help me unravel Mary’s mysterious symptoms, I asked Dr. Rudrani Banik.  Dr. Banik is a board-certified and fellowship-trained Neuro-Ophthalmologist with over 20 years of medical experience. She is the Founder of Envision Health NYC in New York City. She shares my root-cause approach to solving problems and specializes in integrative eye and brain health so I knew she was the right expert to discuss Mary’s case with. 

What is Migraine Syndrome

Migraine Syndrome is a neurologic disease that can manifest in several aspects of bodily function. There are very specific criteria that the International Headache Society have proposed for making a diagnosis. Firstly, there have to be at least five attacks of symptoms which may or may not include a headache. Headaches, when they do occur, last from 4 - 72 hours (longer than a typical headache) and usually also have a pulsating quality.  Additional symptoms include nausea, vomiting, light sensitivity and sound sensitivity. Additionally, some experience dizziness, vertigo, gastrointestinal issues which can include cramps, bloating, and diarrhea. Frequent urination and sweating may also be present. Dr. Banik says that she sees patients with a variety of different symptoms. 

Who is at Risk of Having Migraine Syndrome

Migraine Syndrome is very common. According to Dr. Banik,  one in ten people have migraines and women are 3 times more likely to suffer from it.  If someone in your family has Migraine Syndrome, you are more likely to be affected. Children of migraine sufferers are 50% more likely to also suffer from migraines. Keep in mind that Migraine Syndrome often goes undiagnosed so you may be predisposed to it and not know it because family members are unaware that their symptoms are related to migraines. 

The Migraine Gut Connection

A lot of people don’t realize the connection between gastrointestinal issues and migraines - in fact many doctors are unaware of it too. There are many connections between the brain and the gut. The primary connection is through a nerve called the vagus nerve which carries parasympathetic information from the brain to the gut. It helps control digestion and other GI functions.  Plus, there's actually a nervous system in the gut called the interior nervous system. So, the gut releases neurotransmitters that send signals back to the brain. These two systems represent a dual neural-pathway between the brain and the gut. 

Common Migraine Triggers

Migraine triggers are unique to the individual but there are some more common triggers to be aware of. Food sensitivities can trigger migraines. These foods may be foods you love (like red wine, beer, chocolate, and cheese) that do not trigger any other symptoms. Fermented foods or foods that are high in histamines or sulfites are common culprits. Caffeine can cause migraines, but it can also help some people. In order to track down what foods may trigger a migraine for you, Dr. Banik suggests keeping a food diary or using a free app like MigraineBuddy. This app will also help you track stress as this is a very common trigger. 

Additional triggers include toxins (especially inhaled toxins) as well as certain mold.

Determining the Root Cause of Migraine Syndrome

Because of the close connection between the gut and the brain, Dr. Banik usually starts by testing for the root cause of migraines in the gut. She will help heal the gut by bringing the gut microbiome back into balance and see if that alleviates the migraines. It’s also important to test for deficiencies because these can play a role in migraines, especially magnesium. Genetic testing that can identify the MTHFR gene which is common in migraine cases. In this case, a methylated vitamin B may be helpful. 

There are some tests that can help identify possible causes include an MRI, a food sensitivity panel (the IgG Panel), or a stool sample. 

Conventional Treatment of Migraines

Conventional doctors are most likely to treat migraine syndrome with a prescription and not bother looking for the cause of the migraines. They're relatively safe, but they can have side effects. Many migraine treatments are in the class of either blood pressure medication. Some of them are anti-seizure medications, some of them are antidepressants. There are some newer classes of treatments called CGRP (Calcitonin gene-related peptide) which is thought to play a major role in migraine. These are biologic agents that need to be injected.  

Treating Migraines Naturally

In addition to treating any root cause (like a deficiency or the MTHFR gene), Dr. Banik always focuses on the diet first. She starts with an elimination diet to help determine triggers and will sometimes recommend the mitochondria diet. She also encourages patients to avoid night shades (potatoes, tomatoes, peppers and eggplants) because they tend to release histamine and can be pro-inflammatory, especially in patients with an autoimmune predisposition. As for supplements, Dr. Banik often suggests melatonin because it helps stabilize sleep patterns which can be interrupted by migraines and also cause migraines. 

And finally, stress-management is key to treating migraines. This can be accomplished by reducing stressful situations, meditation, doing something you enjoy, using relaxing essential oils (such as peppermint, lavender, and frankincense)  as well as getting exercise. Another technique to try is EFT (emotional freedom technique - also known as tapping). The key is to prioritize self-care to ensure stress does not trigger migraines. 

Mystery Solved

For Mary,  we started by running a food sensitivity test (the Alcat test because it can test for as many as 200 foods). We discovered that Mary had a bunch of food sensitivities. She removed them all out of her diet. Additionally, we cut out some of the very high histamine foods like kombucha and spinach. 

We also ran a stool test and found she had some bacterial and fungal overgrowth (not picked up on the doctor’s stool test when they tested her for parasites). We used rotated Allicillin, Oil of Oregano and Tricycline (a synergistic antimicrob...