I wanted to share some discoveries I’ve been making about iron status and menstrual migraine. I’m a little embarrassed it’s taken me this long to think deeply about the role of iron in migraine, because in retrospect what I will reveal here all seems so obvious once you start to consider that when women bleed, they lose iron. Therefore, when women get migraine when they bleed, it could very well have something to do with low iron.
Why would low iron contribute to migraine? I’ll explore that in this article, but it comes down to lowered oxygen, serotonin, and dopamine levels (not to mention, iron is needed for thyroid function as well, which is intimately linked to migraine).
So why hasn’t this rather obvious relationship between iron status and menstrual migraine been more thoroughly elucidated? After all, if you look into the literature, there is not a lot of research or discussion on migraine being caused by iron lost through menstruation, or low iron as a possible root cause of menstrual migraine, much less the role that iron plays in neurotransmitters or hormones. In this post, I’ll share with you what I’ve been able to piece together.
One reason I’ve overlooked this obvious connection between low iron and menstrual migraine is that while it is clear that many women with migraine are anemic, anemia is often caused as much by low copper (which is needed to get iron into cells in hemoglobin) than it is by low iron. For this reason, my focus in dealing with anemia has often been to support a woman’s copper status. This is because taking iron alone without copper can do a lot of harm – bio-unavailable iron lowers zinc and copper, is highly acidifying, and for that reason is implicated in many serious health conditions. Anemia and iron deficiency can also be caused by heavy metal toxicities, especially mercury toxicity (when mercury is removed, iron levels normalize).
In my training in Hair Tissue Mineral Analysis, I was warned about the dangers of iron supplementation and so, I have somewhat vilified this mineral. I have had many women friends (not all of whom have migraine) complain that taking iron supplements for anemia doesn’t work. They still feel fatigued. This is because iron requires vitamin A, vitamin C, and copper to become bioavailable. When not bioavailable, iron in oxidized form is basically rust in your body, which is no bueno.
Up until this point, my focus in helping women’s hormonal balance has been to support zinc and copper status. You can learn more about the role these two minerals play in hormonal health and menstrual migraine here. Now I realize it is very important to know not just what your zinc/copper ratio is, but also what your iron levels are, and your copper levels. In other words, your Fe/Cu ratio is an important indicator for how to solve unravel your very own unique mineral imbalances and migraine mystery.
Most discussions on menstrual migraine focus on shifts in hormones as the root cause.
It is well established that most menstrual migraines in women occur when there is a sudden drop in estrogen right after ovulation, two days before menstruation, or on day three of menstruation. Of course there are variations on this theme for individual women, but presumably most menstrual migraines, whenever they occur, happen when women’s estrogen levels drop suddenly.
During menstruation, progesterone levels are also very low. This is because most progesterone comes from the corpus luteum after the egg has been released. Indeed, dissolution of the corpus luteum and the absence of progesterone is the hormonal signal that tells the uterus to release its lining and to bleed. So therefore, menstrual migraine is triggered not only by drops in estrogen, but also by lack of progesterone.
Actually, the deeper issue is drops in progesterone, not estrogen – because estrogen is made from progesterone (which in turn is made from pregnenelone, which in turn is made from cholesterol). All steroid hormones (estrogen, testosterone, cortisol, and aldosterone) are made from progesterone (source).
The adrenal glands also produce some progesterone, but much less so. It is likely true, therefore, that women who have weak adrenal glands will have more headache or migraine symptoms during the transition to menstruation, and will have even less progesterone available during menstruation, than a woman who has healthy adrenal glands (and likely doesn’t get headaches often).
This matters a lot because aldosterone, another hormone made by progesterone and secreted from the adrenal glands, is a mineralcorticoid – meaning that it regulates the electrolytes sodium and potassium in the body. So, a woman with weakened adrenal glands and low progesterone will also have a dysregulated electrolyte balance (especially for sodium and potassium), which in turn will affect the voltage in her body. Naturally, if aldosterone is made from progesterone, and progesterone is low during menstruation, electrolyte levels will suffer during menstruation more than at any other time of the moonth.
When women are pregnant, the placenta produces much larger amounts of all the steroid hormones, which is one reason why women prone to migraine will stop having migraines during much of their pregnancy – for some women the migraines stop right around when the placenta starts growing while for others who are more chronic they don’t get relief until the third trimester when the placenta is much larger.
But back to iron.
Why iron status is so important for healing migraine
Since iron is used in hemoglobin to bring oxygen into cells, low iron = low oxygen. If you are familiar with my other writing, you’ll know that this has broad reaching implications, because hypoxic states are also low voltage states, and low voltage = pain (read more about that here).
Researchers confirm this connection between low iron and hypoxia as a cause of migraine:
Dietary iron intake was inversely associated with severe headaches or migraines in women 20-50. Experts believe that reduced oxygen can cause migraine. Low iron levels can lead to the brain receiving less oxygen than it needs to function optimally. This can lead to the onset of migraine-related headaches.
Iron deficiency can worsen your migraine headaches, which may have something to do with the oxygen levels your brain receives. However, addressing your iron deficiency can eventually lead your body to produce healthier red blood cells that will bring improved oxygen levels all over the body, including the brain. (source)
Iron also has impacts on serotonin and dopamine levels. Low levels of serotonin (5-HT) are known to be linked to migraine. So it makes sense that if you need iron to make serotonin, and you lose a lot of iron at one time of the month in blood, you will not be able to make as much serotonin.
Medical management of iron deficiency (ID) requires to consider its consequences in biochemical and physiological plural functions, beyond heme/hemoglobin disrupted synthesis . . . . Neuro-bioavailability and brain capture of blood iron are necessary for an appropriate synthesis of neurotransmitters (serotonin, dopamine, noradrenaline). These neurotransmitters, involved in emotional behaviors, depend on neuron aromatic hydoxylases functioning with iron as essential cofactor. (source)
Here’s another source that confirms this:
Iron, a common mineral (and, paradoxically, a common mineral deficiency in humans) is . . . a key cofactor in the making of neurotransmitters, chemicals in the brain that affect neuron signaling, including serotonin, norepinephrine, and especially dopamine. Iron is also necessary for the enzyme monoamine oxidase to break down these neurotransmitters. The numbers of dopamine receptors in areas of the brain will change depending on the iron levels in the brain. (source)
That’s interesting, because monoamine oxidase (MAO) is also an enzyme that breaks down histamine, and migraineurs are known to have high histamine levels.
From here, it’s also valuable to consider that progesterone, which is low during menstruation, is necessary for serotonin receptor sites. AND, to top it off, estrogen (also low during menstruation), is necessary for progesterone receptor sites.
So we can see why and how hormones and neutrotransmitters being low is a real problem during migraine. If you combine low levels of these hormones with a state of high histamine and hypoxia (lack of oxygen to the cells), which leads to low voltage in the body, you’ve got the perfect recipe for disaster.
There are many minerals and vitamins needed to support all of these hormones and neurotransmitters and to make iron bioavailable to carry oxygen into the cell, and iron is one of those key minerals.
In part 2, I share more research notes and insights into iron status and menstrual migraine. This additional information is available in the Repattern Migraine Masterclass.
