Chronic headaches are a complaint that I see quite often in my practice. This type of pain can be absolutely disabling and, as a naturopathic doctor and functional medicine practitioner, I am always looking to address the underlying causes of a symptom or condition. Because there are so many variables involved in headaches, I wanted to put together a guide that will help you think through the different contributing factors that may be responsible for your symptoms. Let’s take a detailed look at the various factors involved in headaches and migraines: 1. Dehydration causes your blood volume to drop which, in turn, lowers the flow of blood and oxygen to the brain. What You Can Do: It is estimated that we need approximately half our body weight in ounces of water each day. For example, a 150-lb. person should aim for 75 oz. of water. You may need to increase this amount with increased activity and sweating. High water content foods such as watermelon and cucumber also count toward your daily total. 2. Food sensitivities are a very important factor in chronic headache and migraine. Fermented and aged foods such as alcohol, cheese, vinegar, sauerkraut and kombucha are high in tyramine and histamine which can be problematic in some people. Additionally, seeds, nuts and beans contain tyramines and vaso-active amines which can enlarge blood vessels and irritate nerves. Sensitive individuals will also need to be conscientious of foods cooked or fried in seed and nut oils. The food additive monosodium glutamate (MSG) can have an “excitotoxin” effect and cause multiple neurological symptoms including severe headache. Other food additives such dyes and preservatives or sweeteners such as aspartame and stevia may also be linked with headache. Cured meats such as hot dogs, salami and bacon contain nitrites which can dilate blood vessels and lead to headache in susceptible individuals. Interestingly, both caffeine consumption and caffeine withdrawal can be a headache trigger due to its effect on blood vessels. Gluten, a protein found in grains such as wheat, rye and barley has also been reported as a common headache trigger. Some people are even sensitive to citrus fruits due to a stimulating compound called synephrine. What You Can Do: Many times, food triggers are dose-dependent and vary by person. The best way to identify problematic foods is to do an elimination diet and carefully track food reintroduction with a food and headache journal. Supersensitive individuals may find a 4-day rotation diet helpful. The National Headache Foundation has several helpful resources including food lists and a headache diary. There is also some evidence to suggest that IgG food sensitivity testing can be helpful in identifying problematic foods in migraine sufferers. 3. Chronic infections such as Candida overgrowth, Lyme disease and Babesia release inflammatory compounds that can lead to headache. What You Can Do: It is important to work with your healthcare provider to correctly identify and treat these infections. 4. Hormone fluctuations and imbalances can also lead to headaches. For women, a balance between estrogen and progesterone is important. Many women are “estrogen dominant” due to a combination of stress, high-estrogen foods and chemicals in our environment that mimic estrogen. The sudden drop in estrogen just before a woman’s menstrual period is also a common headache trigger. What You Can Do: There are several diet and lifestyle interventions for hormone health: regular activity and exercise, avoidance of harmful chemicals, nutrient-rich diet including dark, leafy greens and brassica vegetables. Additional nutrients such as B6 are important for supporting estrogen metabolism. When appropriate, botanical medicine can also be used to support hormone balance. Working with your healthcare provider to assess for hormone imbalance, nutrient deficiency and other lifestyle factors is important for a personalized wellness plan. 5. Low blood sugar, or hypoglycemia, can lead to symptoms that may include headache, blurry vision, nervousness, fatigue, sweating or rapid heart-rate. While low blood sugar can happen to anyone, especially if you’ve skipped a meal or done an intense workout without refueling, it may also be a symptom of diabetes, prediabetes or insulin resistance. What You Can Do: Avoiding high-sugar foods and refined carbohydrates (think pasta, chips, bread, crackers, baked goods and sweet drinks) while eating regular meals that contain adequate protein and healthy fat is very helpful for balancing blood sugar. If you have diabetes, low blood sugar can be very dangerous; careful monitoring of your blood sugar and good medication management is important. 6. Medications and supplements can also be associated with chronic head pain. Any hormone therapy, including birth control pills, can be a headache trigger. Over-the-counter pain medications such as aspirin and ibuprofen (NSAIDs) may initially be helpful for headache but can lead to a “rebound” effect and a worsening of pain. Even a supplement such as ginkgo, which is generally considered safe, can lead to headache due to its effect on blood vessels. What You Can Do: It is important to discuss all supplements and over-the-counter medications with your healthcare provider. If you are taking any prescription medication and suspect a connection with your chronic headache, talk with your doctor. 7. Nutrient deficiencies can also play a role in chronic headache. Our cells need a variety of vitamins, minerals and other nutrients for healthy function. A standard American diet is largely deficient in many vital nutrients. There are also a number of gastrointestinal conditions including IBS (irritable bowel syndrome), IBD (Crohn’s and ulcerative colitis) and SIBO (small intestinal bacterial overgrowth) that can decrease a person’s ability to adequately absorb nutrients from the diet. What You Can Do: There are several studies indicating benefit from improved diet and supplementation in the reduction of headache. Some of the nutrients studied include folate from green, leafy vegetables, B vitamins, especially Riboflavin (400 mg daily), magnesium (200-600 mg daily), CoQ10 (100-400 mg daily), and vitamin D (2,000-5,000 IU daily). While these vitamins are generally safe at the recommended doses, it is always a good idea to work with your healthcare provider to make sure you are not over-supplementing or causing any interactions with other supplements, herbs or medications. If you are struggling with a gastrointestinal condition, its important to work with your doctor to address the underlying cause. 8. Poor posture can put strain on the muscles of the head and neck, resulting in nerve irritation and tension headache. Many of us spend several hours a day hunched over a computer or looking down at our phones. What You Can Do: Simple changes such as setting your phone or computer at eye-level can be very helpful for decreasing neck tension and strain. I have this VARIDESK and I love it! Targeted strength training, physical therapy, massage, chiropractic care and acupuncture can also be helpful to correct muscle imbalances and posture. 9. Stress is one of the most commonly recognized headache triggers. When we are stressed, physiological changes such as inflammation, tense muscles and improper breathing can all contribute to head pain. What You Can Do: We are all exposed to stressors daily, but it’s important to know that we have the power to change our response to the stressors. There are several tools that can help us shift to a healthier response. Practices like deep breathing, biofeedback, HeartMath, meditation, yoga, tai chi, chi gong and mindfulness can be life-changing. 10. Eye strain is another common headache trigger. Many of us are staring at a computer screen or electronic device several hours each day. LCD monitors and fluorescent or flickering lights can be especially problematic for migraine sufferers. What You Can Do: It’s important to have proper lighting and take breaks. LED lights are a better option since they meet energy requirements and do not flicker. My optometrist also recommends the “20-20-20 rule.” Every 20 minutes, take a 20-second break and focus your eyes on something at least 20 feet away. If you’re struggling with chronic headaches, it’s also essential to have your vision checked regularly for eye muscle imbalance or vision problems. 11. Allergies can cause sinus pressure that results in headaches. What You Can Do: It’s important to identify and avoid the allergen when possible. If you’ve been outdoors and allergens such as pollen are an issue, you can minimize exposure by taking your shoes off at the door, changing your clothes and washing your hair before bed. Mold can be especially problematic for some individuals. The American College of Allergy, Asthma and Immunology (ACAAI) recommends keeping the humidity in your home between 30 and 50 percent to limit mold. Cleaning bathrooms, kitchens and basements regularly while utilizing a dehumidifier for damp areas also helps decrease mold. Using a HEPA vacuum and air filter can also be helpful for trapping particles like pollen, pet dander, dust mites, mold spores and some bacteria and viruses. Natural treatments to decrease an allergic response include vitamin C, quercetin, stinging nettle and ginger to name a few. Consuming an anti-inflammatory diet is one of the best ways to combat allergies. For example, fruits and vegetables contain vitamin C, quercetin and other anti-inflammatory compounds. Healing your gut lining by drinking collagen-rich bone broth or taking a high-quality collagen powder will also reduce allergic responses. –> Download our FREE Look Good, Feel Good guide for more gut-healing strategies. It’s important to note that some herbs and foods can cross-react with certain types of pollen. For example, those with an allergy to grass may also notice symptoms when eating melon, orange, peanuts or tomatoes. Using a neti pot or saline spray to flush the sinuses can also be helpful for allergy sufferers. 12. Genetic susceptibility is another consideration in chronic headache. Dozens of genetic variants have been associated chronic headache and migraine. With the availability of affordable genetic testing through companies like 23andMe, obtaining our own genetic information has become quite easy. Single nucleotide polymorphisms (SNPs) are common genetic variants that can influence a variety of traits such as appearance, disease susceptibility or response to drugs. The study of these SNPs and how they affect our health is a relatively new area of research. Genetic SNP information can provide some helpful information, but we still have a lot to learn. The genetic variant for methylenetetrahydrofolate reductase (MTHFR) has been getting a lot of press lately. The MTHFR enzyme plays a very important role in the utilization of folate. Having one or more “bad copies” of this gene can contribute to multiple health-related issues including headache, migraine, trouble with detoxification, difficulty breaking down histamine, neurotransmitter (dopamine, serotonin, norepinephrine) imbalance, elevated homocysteine and cardiovascular issues. While MTHFR SNPs and folate get a lot of attention, it’s important to know that they are only one piece of the puzzle. There are several other genetic SNPs, nutrients and lifestyle factors involved in these biochemical processes. Our bodies are very dynamic and have many checks and balances in place to overcome health challenges. It’s also important to know that our genes are not our destiny. There are several factors that affect how our genes are expressed such as nutritional status, infections, toxin exposure, gut health, exercise and stress management. What You Can Do: If you suspect a genetic connection with your chronic headache or migraine, it’s best to work with a healthcare provider that is knowledgeable on the subject. 13. Constipation and headache can occur together for several reasons. First, we reabsorb toxins and hormones meant for elimination when we’re constipated. There are also common underlying causes for both headache and constipation such as magnesium deficiency and dehydration. Food sensitivities, especially to gluten, have been linked with constipation and headache. Conditions that affect our nerves such as Multiple Sclerosis and Parkinson’s are also linked with both headache and constipation. The stress, discomfort and straining associated with constipation can also contribute to headache. Finally, there is a link with serotonin. Serotonin is a neurotransmitter (chemical) that is made in the body and passes messages between nerve cells. Roughly 90% of the body’s serotonin is found in the GI tract, where it acts on the intestinal nerve cells. People with constipation tend to have low amounts of serotonin in the gut, and low brain levels of serotonin have been linked with migraines for decades. I’ve also worked with patients who report headache relief within 5 minutes after having a bowel movement. What You Can Do: Much like chronic headaches, constipation is multi-factorial. It’s always important to start with lifestyle basics such as drinking enough water, addressing nutrient deficiencies and eating a fiber-rich diet with healthy fats. Exercise and activity are also important for encouraging healthy bowel movements. Finally, treating any underlying disorders that slow gastrointestinal motility such as SIBO-C, hypothyroidism and neurological disorders is very important. 14. Toxic exposure is another trigger for headache and migraine sufferers. Each day, we are exposed to multiple chemicals and scents found in perfumes, personal care products, cleaners, air fresheners, candles, building materials, paint, fabrics, furniture, carpeting, clothing, food additives, preservatives, pesticides and more. Per the Chemical Industry Archives, a project of the Environmental Working Group, more than 7 million recognized chemicals are in existence. It’s estimated that the EPA reviews between 2,000 and 2,500 applications for new chemicals each year (that’s 40 – 50 new chemical applications each week!). Very little information is required for these submissions and 80% are approved in 3 weeks with or without any safety data! Even if each chemical were to be thoroughly tested, we still have no idea what happens when these chemicals interact with each other. What You Can Do: With the large number of daily chemical exposures, it can be difficult to know where to start. In our Body Bliss program, we’ll take you through a deep-dive about toxic exposures so you can learn how to protect yourself and avoid migraine triggers. Tips For Quick Relief As you work to address the underlying causes of your headaches, I’d like to provide some options for symptomatic relief so that you can get through your day! One of my absolute favorite ways to stop a headache or migraine in its tracks is to consume a 1-inch piece of fresh ginger root (chopped or juiced) or ½-1 teaspoon of dried ginger or ginger capsules. One study found ginger to be as effective as the powerful migraine drug Sumatriptan! It’s important to take the ginger as soon as you first notice symptoms, because it won’t be nearly as effective if you wait until you have a full-blown headache. While ginger is generally very safe, it may cause a slight increased risk of bleeding. Talk with your doctor if you are pregnant or taking blood-thinning medications such as Warfarin or Coumadin. Some people are also helped by using a cold washcloth or ice pack on the back of the neck or forehead while simultaneously submerging their feet in very warm water. This can provide symptomatic relief by drawing blood-flow away from the head and down toward the feet. Final Points Important: A “first or worst headache” that is unusually severe or lasts more than a couple of days should be checked by a doctor. Always seek emergency medical care for any headache that is accompanied by chest pain, fever, stiff neck, paralysis, or confusion! In my clinical experience, chronic headaches and migraines are usually the result of multiple factors. With so many potential headache triggers, it can be difficult to know where to start. That’s why we developed our Body Bliss program, which takes you step-by-step to uncover your personal root causes of headaches and other health challenges. Body Bliss gives you the same proven system that we’ve used in our clinic to help hundreds of people like you successfully stop their headaches and migraines – without drugs. What natural remedies have you tried for headaches? Is there anything else you’d like to know about treating headaches naturally? I want to hear from you! Be Well 🙂 Dr. E. The naturopathic doctors (NDs) at Attune Functional Medicine proudly serve the Denver metro area including Broomfield, Boulder, Arvada, Louisville, Thornton, Lafayette, Westminster, and Erie. Telehealth is also available for long-distance care.This blog post contains affiliate links, which means that we may receive compensation if you make a purchase through clicking the links in this post. Please know that we only link to products that we personally use, love and recommend!