Angela Stanton is the perfect person to have authored the book, Fighting the Migraine Epidemic: How to Treat and Prevent Migraines Without Medicine. A migraine and nutrition scientist and long-term migraine sufferer herself, she was fed up with the lack of understanding and treatments for migraines within the medical community. So she focused her research on the root cause of migraines as well as their prevention and treatment. Stanton’s research helped her identify a “migraine code,” or collection of circumstances that likely cause migraines, which is explained in her book and helps migraine sufferers better manage their symptoms.
You researched the root cause of migraines. What did you learn and what do you believe are the root causes?
A migraine is the symptom of a biochemical imbalance in electrolyte mineral-density, which is the result of genetic variants in many of the ionic channels that are important for neurons to communicate.
Migraineurs, what I call people who suffer from migraines, have hypersensitive sensory organs, meaning they are more sensitive to scents, light, sounds, touch, and often taste, too, because they have more sensory-neuronal connections than the average person (this is also genetic).
Because of the ability to sense with their sensory organs, their sensory neurons are easily overstimulated. The cascade of events that follows the excess stimulus depletes sodium. Sodium is a key mineral for neuronal voltage generation and communication. As a result, some brain regions (hubs) become unable to function properly and lack “action potential,” which I’ll explain here:
The Role of Sodium
Migraineurs use more energy for voltage generation because of their hyper-sensitive sensory organs, which are more active than in the brain of a non-migraineur.
A study also showed that migraineurs pass 50 percent more sodium in their urine than other people eating the same food. This extra sodium is significant; a brain in need of higher sodium concentration is not a sick brain; it merely needs a different nutritional regimen with higher sodium for the necessary electrolyte density.
“Voltage” is generated by voltage-dependent ionic pumps. These are found in neuronal membranes and they facilitate ionic exchanges between the intracellular and extracellular space – the sodium/potassium pump.
To initiate an action potential (voltage), these pumps must be able to open to let sodium in and let potassium out, after which, the same pumps reverse and must allow potassium to rush in and sodium to move out of the cell.
Without enough sodium, these pumps cannot work. Substances that reduce the availability of sodium here are detrimental, because the inability of the ionic channels to respond to electrolyte imbalances is genetic for a migraineur.
The inability of the ionic channels to function properly is referred to as ionic channelopathy. Thus a migraine is caused by an undersupply of sodium, which channelopathy prevents from being able to autocorrect “on the go” without help.
In sum: a migraine is an electrolyte imbalance that is not possible for the brain to autocorrect because of channelopathy.
Exactly where changes occur in the brain as a result of temporary sodium shortage, determines the type of symptoms migraineurs experience. While channelopathy is permanent, the reduction of sodium is not. So, to manage migraines, the focus should be on ensuring migraineurs get enough sodium.
What reduces sodium in the body? There are several factors potentially involved that are associated with the renal (kidneys) handling of sodium. There are people and also certain nutritional methods that cause the body to waste salt. There is even a genetic condition of salt wasting.
Cerebral salt-wasting is one of these conditions, in which sodium is not retained properly in the extracellular space of cells, causing hyponatremia, or low sodium in the blood. While serum sodium levels, for most migraineurs, most of the time, is normal, it’s not always the case. Furthermore, sodium can be removed from the extracellular space by common substances to which some people are more sensitive to than others. Carbohydrates are one of those.
The Role of Carbohydrates in Migraines
Carbohydrates convert to glucose in our body via metabolic processes. As glucose enters cells, it removes water and sodium from the cell (this often-forgotten fact can be found in the Harrison medical manual on page 4 (18th edition), causing electrolyte disruption. Since migraineurs have genetically reduced ability to reset their sodium storage, the consumption of exogenous glucose generates an exaggerated response, and it seriously disrupts electrolyte sodium density.
So, while carbohydrates are not the cause of migraines, they initiate migraines because they remove sodium from the cells. The actual cause of migraines is the lack of enough sodium for the use of cells.
You call yourself a “neuroeconomist,” can you explain what this means?
Neuroeconomics is a field of science. When I received my doctorate, this field, under this name, was not yet offered as a degree; it was a new term at that time. One could achieve this degree by a mixed field of economics and neuroscience.
My dissertation is completely neuroscience, but my doctorate is officially in economics, because of the lack of neuroeconomics as a degree at that time. It is not quite a double Ph.D., but it’s similar in that both fields had to be defended at once. There were many economists disgruntled about neuroeconomics, so while there are several labs continuing work in neuroeconomics, the degree of “Neuroeconomics,” I think didn’t last long.
Neuroeconomics approaches human behavior from the perspective of “feeling human,” which is to say not just an automaton with such rationality that will grab every penny at the expense of the other, which is the classical economic theory of how humans make decisions. Economics doesn’t see the “agent” as a human, only as a machine-driven agent. Since that is clearly wrong and the work of neuroeconomists proved that wrong, the theories of economics were questioned, and that was not well tolerated by economists.
For example, according to economic theories, since economics doesn’t understand feelings, an agent will always take an offer that is a penny more than another offer, regardless of any “emotional costs.” I thought this was wrong, hence my studies. Some hormones are responsible for a person being generous (for example, anonymous charitable donations) or trusting. Economics cannot explain these behaviors with its models. Experiments showed that the hormone oxytocin is responsible for many things, such as trust and generosity, as well as other functions, such as bonding, nursing, etc. One of my clinical trial experiments showed that subjects who received a nasal-spray dose of oxytocin were much more generous than those who received placebo (saline nasal spray) in money-exchange games, proving that humans are not rational automatons, but make financial decisions based on feelings and hormones.
The importance of this to my current research on migraines and nutrition is the recognition of differences among people based on hormones we don’t normally think of as being important in an everyday setting. We are familiar with hormones like steroids or insulin and some others, but do we understand the changes the hormone vasopressin can cause? Vasopressin is given to millions of women for urinary incontinence and also given for diabetes insipidus. I showed in my studies that vasopressin, sprayed into the nose, made subjects more aggressive and less likely to cooperate with others than those on placebo. Vasopressin may also affect metabolic status, not to mention migraines.
So while neuroeconomics remains an exotic field, it was extremely useful in my understanding hormones and their importance. The fact that it was connected to economics—and that my doctorate is Ph.D. in Economics—allowed me to see through research papers and see statistical tricks employed that invalidate an academic paper.
My undergraduate degree is in mathematics, and I have two master’s degrees, one in MBA and another in management science and engineering. The combination of these very analytical forms of training I have received allows me to see migraines differently from those whose field is only in the biological sciences.
How many different types of migraines are there?
This is a tricky question akin to asking: “How many types of colds are there?” There is only one kind of cold, though there may be many symptomatic manifestations of it.
All migraines are caused by the same exact physiological and anatomical differences and electrolyte disturbance because a migraine is a genetic condition that is dependent upon genetic variants that must be expressed. So, there is only one kind of migraine; however, the symptoms of migraines vary considerably. Some people may have episodic migraines (less than 15 migraine days a month) and others chronic (over 15 migraine days a month). Are they all the same types of migraine? Sure. Do they manifest differently? Absolutely. Some people may have an aura, others don’t.
The difference is in the location of the “hub” in the brain that is unable to start an action potential. So migraineurs with aura and those without have the exact same migraine cause, but they have different brain regions affected. Thus the migraine will have different symptoms. The most severe symptoms of migraines may include half-body paralysis (hemiplegic migraines). Others may have symptoms of a stroke, such as slurred speech or inability to think; some may not be able to see with one eye for some time, experience dizziness, and so forth. Just as some colds may come with a cough and others with just a runny nose, migraines are all the same with different symptoms.
Who is susceptible to migraines? Are there other traits commonly shared by migraineurs?
Since migraines are genetic, one must have a particular genetic variant setup to be able to experience migraines. While many people consider that they have migraines because of the strong headache they sometimes get, headaches may not even be present in migraines—it is not a requirement that a migraine hurt at all! This misconception is all based on a lot of misunderstandings and misdiagnoses. So one cannot be susceptible to migraines; however, those who were not born with a migraine brain may later end up with one, since epigenetic (environmental) factors also matter. For example, injuries and surgeries may lead to a brain that is capable of migraines; meaning the brain can change over time and start a migraine brain later in life.
Common traits by migraineurs are many—in some ways, we seem to all be related. For example, one of the most common early symptoms of migraines is that we all end up with one eye smaller than the other. This rarely known phenomenon is present in probably all migraineurs. It’s funny because there are posts in the group by migraineurs about movie stars or reporters, or other public figures with question marks about that individual having a migraine. When we get a migraineur to join us, I often look at their FB page and I frequently discover a child with migraine eye! And there is a good chance that it was missed by the mother; it’s hard to discover something different in something you see every day.
Most migraineurs in my groups are also very friendly and open-minded, follow science as much as they can, post new discoveries all the time, and are physically very active. It’s amazing how many of them are athletes. We can only see that, of course, when they stop having migraines.
Why do you think the medical community is so far behind on understanding and treating migraines?
Great question, and that question is one to which the medical community will not like my answer. In medicine, the cure is not the solution for the industries seeking solutions. Imagine if all conditions were permanently cured. Where would that leave the healthcare industry? So finding a cure is not the goal; symptom management is.
Symptom treatment is very lucrative. Migraines have many symptoms; each can be treated separately, and many migraine sufferers join my migraine group on Facebook with a substantial list of such medicines. Some may work a little bit, usually temporarily, often for a very short time, and provide minimal relief.
In a group discussion, we found that the average migraineur spends over $20,000 a year on medicines alone plus emergency room treatments. And, if they are like me, I used to end up in the emergency room two to three times a month because my migraines spiraled out of control. Of course, insurance covers most of the costs, but the healthcare industry as a whole benefits. With the deductible and copays, the out-of-pocket costs to the migraineurs are substantial, depending on the benefits they can afford.
There is also a misunderstanding about migraines. I don’t want to get too technical, but here they are in as simple terms as possible: there are certain brain phenomena that researchers have identified that are associated with what happens in the brain before a migraine starts. Interestingly, the only thing researchers are trying to do is stop this phenomenon rather than understanding why this occurs. Perhaps this phenomenon is the body’s prevention mechanism, as I have come to understand that it is. So rather than stopping it, I found that supporting what it signals is the key to preventing migraines.
You created a protocol for treating and preventing migraines without medication. Can you describe your protocol and the role that a low-carb, high-fat (keto) diet plays in this protocol?
My protocol is set up to very specifically act upon the little signs our brain sends through when the “phenomenon” I mentioned above is happening. The brain sends a lot of early symptoms or signs to us to recognize. We have the task of deciphering what sign means what and act accordingly.
Since, based on my research, migraineurs are carb-intolerant, glucose-sensitive, and need a lot more sodium than other people do, the protocol is simple: reduce or eliminate carbs and increase salt. I also amended the protocol to include increased fats because the white matter of the brain, the myelin, which is an insulating matter that helps brain communication via voltage pass faster and with less effort, is made of cholesterol and fat. The human brain is over 60 percent fat and cholesterol. Research shows that both glucose and insulin cause damage to the myelin. So it makes sense to increase the consumption of fats and cholesterol, in addition to reducing carbs and increasing salt.
I created more than one protocol, though only the original Stanton Migraine Protocol® is usually referred to by all as “the Protocol.” The original Protocol is a low-carb, high-fat diet with special restrictions and allowances. For example, dairy is not recommended in just about any reduced-carbohydrate diets. However, milk is an electrolyte (literally) and is to the benefit of migraineurs. I also found, based on an in-group survey several years ago, that while the general population is mostly lactose intolerant, migraineurs are mostly lactose tolerant and dairy lovers. Few migraineurs cannot drink milk!
I developed several carnivore and ketogenic approaches to fit migraineurs. There are huge metabolic differences between people and so slight differences are applicable in the diet as well.
In addition, I restricted a few food items that other such programs allow. Because MCT oils either mislead our measurements (such as MCT modifies beta-hydroxybutyrate readings) and since testing for us is mandatory for both blood glucose and blood ketones, MCT oil is not permitted. This is just one of many changes.
Does your protocol apply to all types of migraines or are there different causes/treatments depending on the type of migraine?
Since there is only one migraine, as noted above, there is only one type of treatment. In my experience of over five years just on Facebook alone with a forever changing group membership (because migraineurs in full control of their migraines often return to work and leave the group), all migraine manifestations have responded to the same treatment of reduced or eliminated carbohydrates and increased sodium.
You mention that frequent glucose and ketone testing is imperative for individuals following your protocol. Why is that?
Since migraineurs are carbohydrate intolerant and they all come into the group from eating a diet high in carbohydrates, it’s essential that each and every new member start testing both their blood glucose and beta-hydroxybutyrate (BHB), which is blood ketones. In fact, I created a Kraft in-situ mimicking test. Dr. Kraft applied a five-hour blood glucose and insulin test to all his patients to evaluate if they had insulin resistance; he found that most people do. I cannot ask my members to measure insulin. I can barely ever get their doctors to prescribe a fasting insulin test once! So I ask them to do at-home five-hour blood glucose and BHB test, measuring both every 30 minutes after having fasted a minimum 10 to 12 hours.
They start by measuring fasting, then pre-meal, then they eat and measure for five hours. I recommend people use the Keto-Mojo blood-testing meter for all testing because of its accuracy. Many migraineurs using kits other than Keto-Mojo get very inconsistent results and check each sample by repeating it two to three times, which is a waste of testing strips. Keto-Mojo also tests both blood glucose and BHB so it is perfect for our use.
This test, using BHB as a proxy for insulin, which, short of a Kraft in-situ test, is possibly an even better predictor of what insulin is doing than an actual insulin test, is a perfect way to identify metabolic issues. So far, the odds are in favor of all migraineurs having metabolic syndrome. In the past couple of years since we incorporated this five-hour test to measure blood glucose and BHB, I have not found a single migraineur joining us without some level of insulin resistance.
Given how important a healthy metabolic status is to a migraineur, we focus on reversing insulin resistance to prevent blood glucose variability, and in the process, we also are able to prevent migraines. While migraines are predominantly driven by carbohydrate consumption, endogenous-glucose release by the liver in the form of glycogen can cause significant metabolic chaos and migraines as well.
We continue to measure our blood glucose and BHB regularly even after we reversed our metabolic disease to prevent disturbances, such as a sugar crash or runaway ketones (too high ketones). While for the general population greater variances may be acceptable, in the migraine population greater variances lead to a migraine. So our normal blood glucose and BHB ranges differ from non-migraineurs. We prefer significantly less variance in blood glucose (80 to 99mg/dl) and in BHB (0.5 to 2.5 maximum) with migraineurs in order to prevent migraines.
Are there certain foods migraineurs should completely avoid?
Migraineurs should quit all grains. Grains are responsible for many autoimmune diseases that can place additional insult on a migraineur. I find that quitting grains is the number-one most important factor in helping migraine prevention. We had plenty of cases where the migraineur had been in complete control for several months and then took a few bites out of a muffin or pasta or pizza and a week of migraine torture follows that is impossible to reduce or stop or prevent. Migraineurs should absolutely avoid all sweeteners—including zero-calories sweeteners, be it naturals or substitutes. Not only are they major irritants, but they can also initiate or increase insulin resistance.
As noted earlier, all ketone supplements, be it MCT oil, ketone salts, or esters, cause problems as well. And finally, migraineurs should quit all their supplements, get properly tested for what they need, and then switch to bioavailable supplements only. Some of the genetic variants need to be confirmed by blood tests and then attended to. For example, while most migraineurs know about the possibility of their MTHFR (the rate-limiting enzyme methylenetetrahydrofolate reductase) variants and pile on B vitamins, they rarely if ever test for their homocysteine (amino acid), which can be very dangerously high for them. Taking B vitamins without any “discovery” first can cause harm.
How long does it typically take for your clients to find symptom relief on your protocol?
Some of the migraineurs find instant relief. They are usually young and have not taken any or too many medicines. I work with many very young children, through their parents, of course. Their recovery is often instantaneous. On the other extreme, some migraineurs who have had migraines for a very long time (I had mine for over 40 years) and are on many medicines, may take up to a couple of years to recover. And, most surprisingly, vegans are the hardest to help. If a vegan migraineur switches off veganism, there is a good chance that in a few months they start to recover and can completely prevent migraines in several months. If they remain vegan, it is impossible, because they eat only carbs all day and are also nutritionally deficient.
What are the top three pieces of advice you have for migraineurs who have not found relief in the medical community?
One: Find the cause of the problem instead of settling for medicines. No one ever got sick from insufficient medicines in their body. So stop adding new medicines on the list of migraine prevention; they don’t work. Instead, join us and we can help you change your lifestyle.
Two: Be open to unconventional solutions. We so often bump into migraineurs with a completely closed mind toward anything other than medicines. Be open. Something new may help you better.
Three: Measure blood glucose often and blood ketones too if you are on a reduced-carbohydrate diet. Blood glucose and ketones can tell a lot about your body and metabolic status and maybe even why you are having a migraine.
For information on Angela Stanton’s book, Fighting the Migraine Epidemic: How to Treat and Prevent Migraines Without Medicine, go here.