Hormonal Migraines and the Menstrual Cycle (Episode 507)

Full Transcript: Episode 507

Lisa Hendrickson-Jack: This is the Fertility Friday Podcast, episode number 507. Today I’m sharing a brand new episode. I’m sharing my episode with Diane Ducarme and we’re talking all about migraines. And if this is a topic that interests you, I’m going to also make a point of including in the show notes page a number of episodes that we’ve previously released on the topic of migraines and also on the topic of boosting low progesterone. When migraines, especially when they’re cyclical — when you’re charting your cycles and you identify a connection between migraines and the menstrual cycle, there’s often a connection to hormone imbalances as well. And so the general theme here is that by supporting optimal hormone health and balancing hormones, many women also notice a shift and improvement in their overall experience of migraines. And I suppose another important point and takeaway from these migraine-themed episodes is that it’s not this life sentence that you may have been told. It’s actually possible to restore a normal life with either no migraines or a very limited experience of migraines over time once you implement these principles.

So before we jump into today’s episode, I’ll share a little bit about Diane. Diane Ducarme is the founder and CEO of Nectar Health, a company that advocates for and adds years to the lives of those suffering from migraine disease. Diane has an MBA from Harvard Business School, she is a Fulbright scholar and an Edmund Hillary fellow. She has a master’s in science, engineering, technology, and mathematics from Europe, and studied traditional Chinese medicine in China. She’s now with the Academy of Healing Nutrition. And fun fact, Diane speaks seven languages, one of which is Mandarin. So without further ado, let’s go ahead and jump into today’s episode.

And I’m excited to be here with Diane Ducarme. Welcome to the show.

Diane Ducarme: Thank you so much, Lisa, for having me.

Lisa: You’re welcome. I just have kind of like a fun fact before we get into everything. Because in your bio, you speak seven languages, one of which is Mandarin, and I would love — I often like wish that I could speak those — I don’t know if you want to share a little bit about that or a little bit about your background, because I find that to be fascinating.

Diane: Yeah, well, actually, I think when I was a kid, I was talking with my sister and we would have pretend languages. They didn’t mean anything. I’m born in Brussels, I’m Belgian of origin, my mother tongue’s French, but in Brussels you have so many different cultures. We were always exposed to Dutch, but also English, German, Spanish, Italian with the European Commission. And I think it just grows your brain with curiosity. And then I went on learning English and I moved to London. When I moved to London, I was a teenager, before I wanted to become a doctor. And when I moved to London, I thought, oh my God, the world’s so much bigger, I want to learn languages and I want to travel. And then I learned Mandarin. And I think my eighth language is actually migraines.

Lisa: Interesting. Love that. It’s a language of the brain.

Diane: I really mean it. I know you asked this question by coincidence and I’ve never had the opportunity to see that on a podcast. Migraine is a language.

Lisa: Well, that’s such an interesting segue. I love that. And so let us know a little bit about your background then — your professional background — and what has inspired you or motivated you to really deepen into this area of migraines in women.

Diane: Yeah, so when I was a kid, I had a very weak health. I was the type that has the bronchitis, the infection. I had a lot of empathy for people with bodily issues because my body would just always say no. I had the purple lips in the pool. You’re always tired, always need to go to bed early. And then I went to London and I thought, wow, the world’s so much bigger. If I’m a doctor, I’m just going to know Belgium. So I studied business and I became a businesswoman traveling around the globe. I worked all over Europe, in South Africa, the Middle East, the US, and in China. Prior to that, I had a skiing accident where I lost half of my blood, I shrunk a kidney, and I broke my femur. I was 17. My face was full of blood for about two months and I gained about 12 kilos. My body was completely out of work.

After that I really was struggling. I was napping from 2 p.m. to 8 a.m. No one would really know, but I was like struggling massively. And when I did my MBA, which you’d think would be the sharpest time of my life, I was just completely unsharp and unwell. It’s when I went to China that I had on my to-do list: try traditional Chinese medicine. I went to see a doctor when I was actually pregnant with my first daughter. The gynecologist told me I was borderline on my blood sugar level, borderline gestational diabetes. And I cried because I said, I’m doing my best but I’m exhausted. And coincidentally, I went to see that doctor and she said, oh, you still don’t have enough blood volume — you’re struggling in your pregnancy to recuperate that blood volume. And she fixed me in three weeks just with food. I was pregnant but I was back to the energy I had when I was 17. And especially after my pregnancy, my menstruation was for the first time regular. So I thought, wow, what did she do? And my colleagues told me it’s placebo. And I thought, come on, I can’t decide not to have sugar cravings and I can’t decide that I’m going to have a regular cycle. And from there I started a love for food as medicine and the body, and that’s how things got started on the migraines.

Lisa: That is really fascinating. I always find it just so interesting how people get into the work that they’re doing because it’s often a personal story. And you said in three weeks you were fixed with food and your friends told you it was placebo. I feel like this just summarizes the problems of our medical system right there.

Diane: Yeah. My colleagues — I adored my work, I was working at McKinsey and Company — and a lot of my colleagues are men. I think it’s really hard to relate to what happens in someone else’s body. Don’t gaslight me, don’t tell me I don’t feel what I feel. And then what happened is my sister — my godfather had died of a glioblastoma, which is a very violent form of cancer. And my sister approached me and she said, look, I haven’t told mom, but I have these massive migraines for the last three to four years. I’ve done a couple of MRIs and they haven’t found anything yet. It’s very serious. I have three children and I don’t know what it is. No one has an answer for me. And that day I really heard her and took it seriously. She was the first one I helped out with migraine specifically. And she had no more migraines after three or four months. She had deficiencies at the kidney system level, the liver system level, and we just fixed those.

I tell her what to eat, really simple things, and then three to four months later she has normal migraines. And I’m like, well, hold on — her dad is a neurologist. Why did he not tell her? So I discovered 18% of women have migraines. I discovered that it’s genetic. I discovered that they’re extremely debilitating. And then I looked into the medication because I thought, I must have given her something that resembles a medication compound. Not at all. She was given painkillers and I thought, oh gosh, they’re targeting the pain, but the pain is just a message. It’s just a language to say, I have a problem — but it’s not the problem itself. That doesn’t make sense. It’s a bit like if your daughter jams her finger in the door and you go to the doctor and she cries and he gives you earplugs.

Lisa: That is just so fascinating. Let’s dial it back a little bit. I think the stats on migraines are really interesting — they’re really high — and they also show a very clear relationship to hormones for a lot of women. The onset is typically coinciding with puberty. And cyclically the migraines are often happening at certain times of the cycle — before menstruation, during menstruation, maybe around ovulation. It’s often cyclical for women when they start paying attention. So share with us — what are migraines? What’s the difference between a migraine and a headache?

Diane: I think it depends on the pathway. For some people, they start with headaches and then those become more and more intense with life and with time. For some, they have this super abrupt first migraine when they go to the emergency room — they lost their eyesight and were put on morphine immediately. In both cases, over time, doctors will diagnose migraines by exclusion. They’re going to say: because your MRI shows nothing, because your blood test comes back normal, because there is nothing in your body, therefore you must have migraines. And then they go a little bit into the family history. Which can be very frustrating because it’s a very invisible disease. So it’s almost just in your head — which is very confrontational and very hard and not really accepted in society, with lots of stereotypes, which makes it very isolating.

Most GPs — even professionals around migraines — will not completely understand or acknowledge the hormonal connection. When you look at a pure scientific paper, it’s going to say it’s only a really small fraction of migraines that are purely hormone-related, but there’s so much more going on in the body. The knowledge that is received — the continuing education — well, it’s pharmaceutical companies explaining new forms of medication. Those are pain suppressors. The explanations that revolve around this are more around CGRP and mechanisms of pain along the vagus nerve. And with that you might also be told there’s a massive correlation with depression, and so another way to solve for it is with depression medication or antiepileptic drugs. Do you see what I mean?

Lisa: Yeah. Part of my frustration is that our medical system is not designed to look for root causes. It’s a pill for every ill. And as long as we understand that, it helps us understand why things are the way they are. You researched the medications they used only to determine that they were treating the pain but not the cause. You can generalize that to a whole lot of medical interventions. I’m out here holding my flag up about the menstrual cycle for all these years because that’s exactly how they treat the cycle.

Diane: I started to just word of mouth see — hey, can I try to fix this using systems, using rules, if-then statements — to help women know what to take for their migraines. I thought I’d find three to four root causes of migraines and it would be quickly done. Turns out it was super complicated. There’s a myriad of types of migraines — some of it at ovulation, some before menstruation, some during, some after, some random, some triggered by certain foods, some by stress. All of these things, little by little, just by talking with women and using the best of Western science and the best of Traditional Chinese Medicine, and working with these women hand in hand, I started to form that system until I was really able with really high predictability to help women in a way that would completely transform their lives.

Lisa: Share with us then a bit of the connection between migraines and the menstrual cycle and the hormonal piece of it. Women suffer from migraines disproportionately compared to men. What’s going on?

Diane: I would make the following statement: as long as you have a genetic predisposition to migraines and you have migraines, your cycle and your fertility is not impeccable yet. And it’s when you manage to really get that to zero or down that your fertility massively increases. When I work with women — because they do not come to me to have children, they come to me for migraines — I always warn them a few weeks in: careful, moving forward your fertility is going to increase. Some people say, oh, don’t worry, I never protect myself. And I’m like, whoa, whoa, whoa — you might get pregnant.

When you track your menstruation, you can track your migraines in parallel and you can learn a few things along the way. There are a number of different migraine patterns that occur at different times of the cycle. At ovulation — this is really a moment women can experience migraine. In Traditional Chinese Medicine, it’s the time of the kidney system. And in Chinese, the word for kidney actually means kidney and bladder and adrenals and behind the head and resilience to stress and ovulation and immunity against big disease. So what decides to go for pregnancy — and what decides fight or flight or detects a big problem — is the same function. Are we at war, or can we get a baby? And so that system is going to be depleted.

If you have it more around PMS, then it’s usually that your liver system is overloaded. In Traditional Chinese Medicine, at the time of hormone fluctuation, it’s when your liver is loaded with toxins — it’s at its highest peak. Your menstruation serves a purpose to empty garbage as well. All of the toxicity from pollution, cosmetics, medication, food — it’s all charged there and it’s ready to go. And when that toxicity is excessive, you might experience migraines. Those migraines will typically be more in the temple, on the top of the head, across the eyebrows — different parts of your liver system, which in Traditional Chinese Medicine governs all of your female hormones and is the most linked to the brain.

When the menstruation allows for all of that toxicity to come out, then the migraines might go. But for some women, migraines are going to stay during menstruation or kick in during menstruation. This is yet another kind. When that happens, usually there are a few blood clots stuck in the uterus. Your body is grumpy. It’s feeling under threat. And so the body is going to cramp. This is where the pill will make no sense — because if you take a continuous pill, you prevent your body from doing that very job. Then you can have migraines after your menstruation — when you’ve depleted some of your blood, you’ve also depleted your yin, your noble liquids. So these are some of the cycles we experience.

However, this is where women will feel confused. The pattern is not always impeccable. Even though you might feel intuitively, my migraines are completely related to my cycle — I tracked, and sometimes yes, sometimes no. Why? Because your body is going to prioritize constantly. There’s a threshold of tolerance or threshold of toxicity. If you’re at your PMS and you have that extra glass of wine, you’re going to tip over. But if you don’t, you won’t. And this is where when you bring your data to a GP, they’re going to say, well, you say it’s related to your cycle, well, clearly not really — so you need to get on medication. And this is where women will lose a lot of their self-confidence.

Lisa: That’s so important and interesting. You touch on a really important point — if you are charting your cycles and they are often related to the migraines, you can start to see: okay, I tend to get migraines in this phase of my cycle. But people will think it’s because the cycle is causing the migraine. And I think that’s the key piece — it’s not your cycle causing the migraines. There are issues happening in the body and it’s manifesting at this time for these reasons. It goes back to the concept of the fifth vital sign: yes, you can see these connections and that’s what’s alerting you that there’s something wrong. But there’s a whole lot of women that don’t get migraines at this time of their cycle, so it obviously can’t be the cycle that’s causing your migraine. Let’s dig deeper. The interesting thing too — look at what helps, right? Because what helps isn’t to stop menstruating.

Diane: No, no, no, no. And again, it’s going to depend. I’ll even push the envelope further. I find that sometimes you can have a woman who has bled a lot — really heavy menstruation — and the heavy menstruation can create blood loss to the extent that migraines are going to kick in because of that blood loss. It’s the brain saying, hey, mayday, mayday, we don’t have enough blood, we don’t have enough oxygen. We’re sharing it with the digestive system. If we’ve eaten, all of the blood is going to go in the liver and it’s going to process the digestion, and the brain says, whoa, whoa, whoa, I have nothing left. Then we take a triptan. The triptan is going to contract the blood vessel and send the blood back. So we’re going to feel, with a bit of intoxicated blood, a little bit normal.

So let’s imagine that woman who does this — she’s going to go on a Mirena IUD. And indeed she’s going to stop losing blood. So for a while she might feel, ah, this was like the solution for me. She’s less fatigued. Rightfully so. She’s building her blood reserve again. If you just do the math of how many liters of menstruation a woman loses in her lifetime — it’s like 23 to 28 liters for the average woman. She has to refabricate the material. The problem is, over time she’s going to accumulate these toxins and she’s not going to have a menstruation to expel them. So over time she may start to have migraines induced by the Mirena IUD because she can no longer expel through that door. This is where it can be very confusing and very dynamic. So you need to really look at migraines like a fire alarm. When the alarm goes on, let’s try to find the smoke and the fire as fast as possible. And once we’ve found it, then we extinguish it. If we let it go for too many years, there’s a juxtaposition — lots of different migraines on top of each other and it becomes really hard to read.

Lisa: You said something interesting about the connection between migraines and fertility — that when you start working on the migraines and improving that, you might notice a change in fertility. Share with us a little bit about what you’ve found there.

Diane: So it’s a bit like the migraine acting like a genetic fire alarm. Once the alarm goes off, it means we’re ready to go. I have these beautiful stories. For example, there was a woman in Mexico — she was going better, better, better, almost no migraines. And then suddenly she contacts me and says, I don’t know, I have to go for some test analysis, I have so many weird things happening in my body and I’m going to have to stop the program. I was so sad. What’s going on? And then she comes back 24 hours later and says: I’m pregnant. After her, I put a signal in my system to say — also check if she’s looking forward to getting pregnant. Because then I had one recently in Europe, and her cycle was delayed. She’s like, oh, it’s bizarre, my cycle’s delayed. I’m like, you’re not just pregnant. And she was.

So it’s when the fire alarm goes off, the body is just happy. As long as it’s on, it means there’s still a problem. Your job is to chase what is the root cause? What is my body trying to say? Trying to speak your body language.

Lisa: The way I often look at the menstrual cycle is that as a grown woman of reproductive age, having a normal cycle — even extending to the general experience — is it normal to have crippling migraines such that you can’t get out of bed? No, it’s not. And when you correct those things — in order to truly correct them without just taking pain medication, which you should if you’re in pain, but obviously that’s a temporary solution — when we actually address those underlying root causes and we are able to see lasting improvements and changes, then it makes complete sense that you would see an improvement in fertility.

And you mentioned something really interesting — the only time I’ve really experienced migraines was when I was on the pill. I didn’t even make that connection until much, much later. I experienced full-on migraines, the aura, the whole thing. But what happens during pregnancy? Because you were sharing in our pre-chat some of the challenges where if you are experiencing migraines and having to medicate for them, what happens when you are pregnant?

Diane: When women get pregnant, it can happen one of two ways. Either she stops having migraines — and this is going to be the most beautiful time of her life. I meet women who say, I’ve had migraines for the last 30 years and my pregnancies were the only time where I was like, oh, heaven. The other type of woman can have migraines accentuate and become worse or vary throughout trimesters. And at that stage, when you’re in pain, you have to medicate. You just can’t medicate chronically, but you have to do what you need to do to function. When you’re pregnant, it might be an exception.

There’s a number of research papers that point out that even Tylenol, which has been treated as something quite benign to take during pregnancy, may be associated with more ADHD in children. There are classes of medications that have been shown to damage the liver of the fetus — all of the acetaminophen, all of the NSAIDs such as ibuprofen, which are highly used for migraines, and all of the antiepileptic medications. All of those are going to place burden on the liver of the fetus. The liver as a system is highly correlated to the brain. So it’s really important to be mindful. If we can’t have alcohol when pregnant, or recreational drugs — well, you need to be really mindful of the damage being caused. That said, you have to sit with your pain and it can be absolutely awful. It’s a short-term sacrifice I would strongly encourage you to do if you can.

Lisa: You mentioned situations where you were able to support women to overcome their migraines so they were no longer getting them on a regular basis or at all. Are any of those solutions available when women are pregnant?

Diane: Yes. When a woman is pregnant she needs to go from let’s say four to five liters of blood to about eight. When that can’t happen or can’t happen well, she might experience migraines. Some of the medication will contract the blood vessels again to irrigate the body faster, but it doesn’t replace more blood. So just trying to have more blood from food can completely help in that situation. This is one type of migraine that you can completely address during pregnancy. And it will help carry a good pregnancy.

That’s why sometimes I meet women who have migraines and they tell me, I’m going to go for IVF. And I’m like, oh — can you postpone it by one or two months? Can we make — it’s a bit like, let’s imagine your earth is like the desert and you’re going to take that little tree that you planted in the lab and you’re going to put it in your desert. It may grow — but can we make the earth a bit more fertile before we do? Can we water it? Can we fertilize it? And then chances are much bigger that things will take off. And maybe they’ll take off naturally before.

Lisa: So as we start wrapping up, for someone who is listening specifically because the word migraine is in the title of today’s episode and they’ve been a sufferer — what, if anything, would you want them to take away from our conversation today?

Diane: I would like to flip the finding and say that the more you’re going to medicate for migraines, the more you’re going to have migraines. That’s a phenomenon called rebound migraines, or medication overuse headaches. And women will feel that. But I want to push the envelope further today because we’re on the Fertility Friday Podcast. Those medications will impact your liver system, which will impact your hormones. And so if you are in a situation where you need to medicate very often and you are of reproductive age, just take a moment of pause. Wonder why your body cannot function like this. And what sort of collateral harm are you doing? There’s something really to be said about taking more medications and impacting your natural hormonal cycle.

Lisa: I always strive to find this balance between encouraging women to look deeper and really getting into the root cause, so that you can get to the place where either you have far less painful periods or — for some women — they’re able to have pain-free periods. But simultaneously not discouraging women from using pain medications when they’re still in that phase where they’re experiencing the pain — hoping that we can eventually wean them off, not because we’re trying to make them suffer, but because they’re actually getting better.

Diane: Absolutely. When I work, I only add foods — that’s number one. But I also tell women: if you’re in pain, you medicate yourself, you don’t change your plan. Your job is to manage your pain. My job is you have no more pain. It’s like Lisa’s job is to make you fertile. Your job is to be functional along the way. But once Lisa has fixed your menstruation, you’ve also solved for that. And you no longer need that medication. I think chronically medicating does harm your liver system and therefore your hormonal system.

Lisa: And the phenomenon of consistent over-medicating leading to a worsening of symptoms — that doesn’t seem like such a stretch, especially if you’re also not addressing the underlying root cause. Look, if you put yourself in the shoe of a doctor — you have this patient in massive pain and you have a medication that you know is going to give them rebound migraines. Do you tell them? If your patient is a little girl, you’re going to tell the mom: I’m going to give you this medication, you have to be careful, because the more you medicate her, the more she’s going to have migraines. But if the patient is the person herself, how do you navigate that fine line?

Diane: Usually women will come back and say, I really feel I have to upgrade my medication, I feel I’m in more pain. And ultimately the doctor will say, oh yeah, well, there’s a rebound migraine effect I’d like to share with you now that you mention it. But it’s hard. It’s equally hard for them.

Lisa: Well, Diane, this has been so informative and so important. Let us know where we can go to find more information about you and what you do.

Diane: I have a website called My Nectar Health — nectar, like the flower. You can get on there, take a test, and we can meet and talk about your migraines extensively. And I started a podcast called Migraine Heroes where I’m actually interviewing women about their life with migraines. It’s incredible — the level of suffering, the level of gaslighting, the level of nonsense that many of them go through. The impact on their personal life has been very, very humbling to listen to.

Lisa: Well, that is such an amazing resource for women who have suffered migraines. We’ll be sure to link those places in the show notes page. I just want to thank you again for being on the show. This was great.

Diane: And I really want to acknowledge your work and acknowledge how in capable hands women are with you. Being a mom — it’s so important. In traditional medicine, people say the strength of the child is as strong as the strength of the parents at conception. And so when you do things very naturally and you follow your cycle and you listen to your fifth vital sign, then it leads to a really long-term family happiness. I really want to encourage the audience to go in that direction.

Lisa: Thank you so much, Diane. It’s been a pleasure.

Diane: Thank you, Lisa.