Niacin B3 is Supportive to Those with Migraine

The hunt for B vitamins that don’t trigger migraine

Earlier last year, in my ongoing hunt for a Folk Medicine solution to easily, safely, and affordably abort migraine headaches, I got distracted by a long and circuitous diversion when I found myself studying B vitamins.  I wanted to understand why some people with migraine who clearly need B vitamins so much can’t tolerate them. I had personally been triggered by methylated B vitamins myself and had heard stories from clients reacting poorly to them.

In the process of discovering which B vitamins may be causing the most havoc for those with migraine, I also discovered that niacin worked beautifully to abort migraine.  But the irony is that it is niacin – aka nicotinic acid or B3 – that I was initially the most skeptical of.  I wrote about my concerns that niacin might be triggering migraine in this blog post:  (“Does Niacin B3 Contribute to Migraine and Histamine Intolerance?”). Please read that blog post for a primer on Niacin.

I was suspicious of niacin as a potential trigger because niacin is a “methyl sponge” – ie, it mops up methyl.  It is generally known that high histamine is associated with undermethylation.  I had tied my own migraines to histamine intolerance and helped many with migraine to eliminate their migraine symptoms through a low histamine diet while rebuilding gut health.

If it is true that those with high histamine are undermethylated already, wouldn’t lowering their methylation with niacin deepen the histamine load and add to migraines? This was my concern. Surely the few anecdotal reports of people I had found online who had had success with niacin to abort migraine were not really suffering from true migraine then – or were they?

While niacin does mop up methyl, it turns out it is actually required for the breakdown of histamine:

“Alcohol Dehydrogenase (ADH) is the final step in histamine breakdown. This is the same enzyme that breaks down alcoholic beverages. This explains why some individuals flush when they drink. It is also a good reason to perhaps skip cocktails, beer, and wine during hay fever season. This enzyme actually has four different cofactors including zinc, vitamin C, thiamine (B1) and nicotinamide adenine dinucleotide (NAD—a niacin-based flavoprotein).” (Source)

Folic acid and folate contribute to glutamate load – and niacin reduces folate

It appears there is more to migraine than histamine or methylation. I’m beginning to wonder if in fact the low histamine diet and gut healing in my approach is successful because it also raises niacin (by way of feeding gut bacteria that produce it), and lowers glutamate.  Maybe glutamate toxicity is playing an even bigger role in migraine outcomes than histamine or methylation status.  Not so incidentally, it seems that folic acid and folate supplementation is the biggest culprit in triggering migraine (even methylated folate) – and niacin reduces folate.

“Folates are comprised of numerous glutamic acids conjugates. The higher the dose of folates, the greater the propensity towards an increase in the pool of free glutamate. Hence, the “excitatory” and neurological types of adverse effects of folate in certain individuals.” (Source)

According to Dr. Albert Mensah, those who are undermethylated have low brain serotonin and also

“. . . have a genetic tendency to be very depressed in calcium, magnesium, methionine, and Vitamin B-6 and may have excessive levels of folic acid in nuclei of brain cells.” (Source)

I make a point to eat a lot of vegetables to get naturally-occuring folate since I choose not to supplement with synthetic  folic acid or folate, for reasons stated above. One concern I had with taking niacin (eventhough I take mine in my own hand-blended B complex with other Bs but without folic acid or folate) was that it might deplete folate, since niacin-derived NAD is a necessary co-factor for the enzymes dihydrofolate reductase in the folate/tetrahydrobiopterin cycles and S-adenosylhomocysteine hydrolase in the methionine cycle (Source).

A recent blood test showed no folate deficiency even while supplementing with 80mg of niacin a day (and sometimes more when I aborted a headache) for three months. It seems my concerns about taking niacin depleting folate and folic acid may be unfounded – perhaps because undermethylators are high in folic acid.

Luckily, the B-complex B-Minus by Seeking Health contains no folic acid or folate (or methyl b12).  It also contains some niacin B3, whereas many other B blends contain niacinamide or non-flushing B3, which does not have the same benefits as niacin as nicotinic acid does.

Why niacin sufficiency is so important for those with migraine

Because migraine is a chronic systemic inflammatory condition affecting the whole body, there are many angles from which to view migraine causality.  One perspective worth recognizing is that migraine is a metabolic disease caused by inefficiencies in enzymatic processes.  Because vitamins, minerals, and amino acids are all needed for enzymes to work, it makes sense to ask to what extent nutritional deficiency is playing a role in migraine.  This is especially important in the case of niacin, which is used in more biochemical reactions than any other vitamin-derived cofactor once it is converted to the enzyme NAD.

 “. .Your body uses NAD (with a hydrogen it is NADH) in over 450 biochemical reactions, most of which are involved in anabolic and catabolic reactions. Most people tend to associate NAD with glycolosis (sugar breakdown) and ATP (energy production). However, NAD is involved in many other reactions as a cofactor, including either the synthesis (anabolism) or the breakdown (catabolism) of just about every molecule our cells make: steroids, prostaglandins, and enzymes. NAD is involved in cell signalling and assists in ongoing repair of your DNA.” (Source: Niacin, the Real Story)

Technically, niacin is the third B vitamin discovered (although because it can be made from tryptophan in the body it actually should be classed as an amino acid). Niacin deficiencies in the general population but also in those with migraine may be more widespread than realized because testing for niacin deficiency is not a common practice.

Niacin B3 is vitally important, especially for those with migraine because it:

• raises blood sugar (good for migraineurs with low blood sugar)
• breaks down glutamates (often the cause of that migraine that starts at 4am)
• it helps synthesizes sex hormones like estrogen and progesterone (low estrogen and progesterone lead to migraine)
• helps heal leaky gut
• helps metabolize excess ammonia (cause of leaky gut and also brain inflammation)
• increases serotonin
• removes heavy metals
• cleans out the lymphatic system
• helps to break down beta-amyloid lesions in the brain (common in migraineurs)
• thins the blood – ie, has an “anti-sludging effect” (migraineurs have sticky blood)
• mops up adrenaline, thus reducing anxiety
• improves sleep

Causes of niacin deficiency and pellagra

Compromised gut flora due to the use of antibiotics, consumption of high-carb diets, estrogen dominance, and stress all contribute to niacin deficiency. A diet high in the amino acid leucine may also contribute because it interferes with the conversion of tryptophan to niacin. Leucine is high in whey and soy protein concentrates and is also known as the food additive  E641 as a flavor enhancer (Source). Niacin deficiency can also be caused by Hartnup’s disease, where there is a block in the tryptophan-nicotinic acid pathway. Consumption of polyunsaturated fats DHA, EPA, and linoleic acid also play a role because they activate the conversion of tryptophan to quinolinic acid, and inhibit the formation of niacin (Source).

Problems caused by niacin deficiency can range from mild to fatal, as in the case of severe pellagra. Mild niacin deficiency is characterized by mental fatigue, irritability, weakness, indigestion, and skin irritations, while mild to advanced pellagra involves headaches, insomnia, loss of strength, light sensitivity, nausea, indigestion, and hypersensitivity to smells (Source). In acute niacin deficiency, an encephalopathy is found which closely resembles Wernicke’s syndrome – a thiamine B1 deficiency disease usually found in alcoholics and discovered post-mortem.

Prior to the discovery that pellagra was caused by niacin deficiency (and subsequent fortification of flour with niacin in 1940), it was thought to be an infectious disease.  Three million pellagra cases and 100,000 deaths resulted from niacin deficiency in the US in the first half of the 20th century – with 30,000 of those deaths occurring in 1930 following the Great Depression (Source: “Niacin, the Real Story”).

Given that migraine headache is experienced by a disproportionate amount of women compared to men, it’s really interesting to make note of the fact that:

“Pellagra occurs about twice as often in women as in men, and this is because estrogen activates an enzyme that alters metabolism of tryptophan, blocking the formation of niacin . . . Progesterone inhibits the activity of that enzyme. Progesterone also . . . decreases the excitatory carcinogens and increases the formation of niacin.” (Source)

Niacin is a known – but obscured – migraine solution

From my research it appears that the benefits of niacin for migraine are known but not widely shared, realized, or emphasized.  A few websites mention niacin as being helpful along with a long slew of other substances, most notably riboflavin (B2), feverfew, butterbur, ginger, magnesium, etc etc.  With niacin mentioned in passing along with this long list of other contenders, it is easily overlooked and does not stand out as a legitimate solution. The majority of the websites I saw didn’t mention that niacin could abort a migraine outright, or how to do it, they just said it was supportive of migraine.

The two sites I did find that said migraine could be aborted with niacin didn’t mention that it could also be used to prevent migraine, or why it worked.  The authors of the book “Niacin, the Real Story” (by Hoffer, Saul, Foster) only had a very small section on the topic sharing a single report from the Scottsdale Mayo Clinic in which a patient had responded to sustained-release niacin.  They also mention that a 2005 review of nine articles investigating niacin therapy for migraine stated:

“Intravenous and oral niacin has been employed in the treatment of acute and chronic migraine and tension-type headaches, but its use has not become part of contemporary medicine, nor have there been randomized controlled trials further assessing this novel treatment . . . Although niacin’s mechanisms of action have not been substantiated from controlled clinical trials, this agent may have beneficial effects upon migraine and tension-type headaches.” (Source)

Clearly, there is benefit in the use of niacin for migraine, but for some reason these benefits have become obscured, forgotten, ignored, buried, unrealized, or just not very rigorously studied. I want to bring niacin back into the limelight.

Going off the protocol to experiment with niacin

A nagging voice of intuition kept asking me why there would be anecdotal reports and some support from studies that niacin helped migraine if it actually exacerbated it. I’m glad I got over my initial caution with niacin so I could discover its benefits.

I love niacin, because it clearly stabilizes my mood, improves my sleep quality, has completely eliminated any brain fog I used to wake up with in the morning (which usually went away after an hour), and has given me more resilience in being able to eat very high histamine foods without even a glimmer of brain fog.  I take it daily, and truly appreciate it’s value for improving my quality of life. I try not to share anything with my migraine clients that I have not personally tried or use regularly myself.

Feedback from clients on niacin

I’ve received feedback from a number of clients who have used niacin for migraine, with mixed results. As with all things, diversity in response, approach, and interest is the name of the game.  That includes people who just don’t like the idea of taking a synthetic supplement, even while they rely on synthetic pharmaceuticals to abort migraine.

A few of my clients have had great success aborting migraine with niacin – these are the people who don’t mind the flush. One client even said that the flush of niacin felt almost identical to the flush she gets from her Imitrex shots. Some people, myself included, enjoy the flush.

Another client was encouraged by the research I shared but chose to do a lot more research herself and after doing so, decided to take time-release niacin before bed.  She no longer wakes up with migraine in the morning like she used to, and she has replaced her nightly triptans with niacin. Personally, I am not in favor of time-release niacin due to its potential challenges it poses for the liver to process it, but my client has done her research and made her own conclusions.

Others can’t tolerate the flush and some even find the experience downright awful (itching, burning, prickling, shivers, nausea).  From the people I’ve worked with taking niacin, I’ve observed that it is generally those who have had migraine for a longer time period, who eat a normal diet including high histamine foods, and who also take medications for migraine that have the most unpleasant reactions.  For these people niacin may not be a viable option for aborting migraine, though they may benefit from getting smaller doses in a B complex taken with food to avoid such reactions.  On the other hand I also had a client who had migraines for a long period and took medications while eating high-histamine food who felt fine with the flush and used niacin to get off her meds.

Some people don’t even get a flush even on very high doses of niacin, and also aren’t able to abort a migraine with niacin without a flush – while other people can abort a migraine with niacin even in the absence of a flush. So responses are all over the board.

Flushing from niacin usually indicates a high level of histamine (since niacin empties the mast cells of histamine), while a lack of flushing from niacin usually indicates a very high threshold for niacin and potentially a very deep deficiency and/or an excess stress manifested as adrenaline in the body.

Most people can abort a migraine with 250mg of niacin on an empty stomach or with only a small amount of food if the migraine is caught early on.  If it is not taken until the migraine is advanced, more may be needed for it to work.  Generally 250-500mg is sufficient to abort a migraine for most people, but individual tolerances for niacin vary widely.

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