So can you give us some more examples of maybe different ways that you'd look at genetics and design a therapy, including drugs, supplements, maybe behaviors?

Yeah, absolutely.

So let's talk about supplements.

You know, a lot of people are like, "What's the best supplement for migraine? What should I take?" And first of all, the answer is biology's not a one-step process.

There is no single supplement that's ever gonna fix an entire biological pathway with 10, 15, 20 different steps in it.

So you really need a multivitamin as a foundation that hits all these biological pathways, but we can talk about that later.

In terms of how your biology defines what supplements your body actually needs, let's think about, um, somebody who has inflammation problems, okay? Versus somebody who has energy production problems.

People who have sleep issues, is there something they can do to get their sleep in line? And how does that affect their migraine habits?

Is it like COMT playing a

role? Yeah, COMT is one of them.

COMT breaks down dopamine and noradrenaline, kind of the kind of your fight or flight reaction that's in your brain.

So that is linked for sure.

It's not one of the strongest links to migraine.

The serotonin genes are a little more strongly linked.

Glutamate, which is I think of it like glue, like glucose, you know, the main upper for your brain.

okay let's move on to the devices there's so much out there these days that can give us information what's good what's like what's worth our while and what's not i kind of talked a little bit about the cgms earlier um you know those are great i think they're great for even people that don't have diabetes or pre-diabetes because they give you so much information about your own metabolism and how your body reacts to food but you know you tell me what you think is good is there one device or a couple devices paired together that you like

So what's different about how you work with someone now?

Well, I don't prescribe anymore.

And what I focus on, I actually, my favorite way to do this is to start with genomics testing.

So I developed a genomics testing panel based on everything we've learned about migraine, the things that are most relevant, in my opinion, of course.

And we check this panel.

We get a good idea of how these biological systems are wired.

And then we bring in a support protocol.

And for the people that aren't ready to just commit to working with you, are there just some practical tips that you have that people can just apply to their everyday lives, their homes, their relationships that will support them in feeling better?

And is there-- Are there things that could help people understand that if they do have bad migraines? Maybe you can tell us a little bit more about how to understand what's happening, you know?

Yeah.

And I think two things really matter.

So number one, the things that make migraine more likely, and number two, why I think the diagnosis does not matter as much as we used to think, and I know I'm gonna ruffle some feathers with that conversation, so I'm saving it for second.

W- what is migraine actually? So migraine headaches tend to be more on one side of the head.

They tend to throb or pulsate like your heartbeat.

They're worse with exertion.

Mm

So I guess the first question is, what is a headache? What causes a headache typically?

Oh my gosh, there are going to be so many different things going on under the surface, which is really why it's hard for people to figure out what's causing it and how to fix it.

And I think that's where a lot of this new science is helping us the most because it's just shining a light on what those underlying factors are.

Is it something to do with brain chemistry? Is it something to do with inflammation? Is it toxins, energy production, blood flow? What really is the issue? And once you have a clear idea what it is for you, of course, then you have the roadmap to figuring it out and finding lasting relief.

So a lot of people are curious about kind of what's the difference between a migraine versus other types of headaches.

And honestly, this may sound crazy coming from a neurologist, but I don't think the definition matters as much as people think.

If you're having headaches that interfere with your life, it's a problem.

What are some of the typical causes for a tension headache?

What about you? I'm curious from your perspective, what is the biggest thing that people miss in migraine, um, therapy?

Well, y- you know, it's that...

It...

The, the biggest thing that people miss with migraines is that they don't look hard enough for fixable causes of migraine.

So for example, super common, migraine is very common in menstruating women.

What are they at risk for? They are at risk for anemia because of their monthly cycle, which is often when the migraines flare.

Many of these people end up having low iron, especially when you look at more detailed types of tests.

Yes, and I'm curious, what advice would you have for people from your perspective in terms of, you know, people that are suffering from migraines?

What is the biggest thing that people miss in migraine, um, therapy?

Well, y- you know, it's that it...

The, the biggest thing that people miss with migraines is that they don't look hard enough for fixable causes of migraine.

So for example, super common, migraine is very common in menstruating women.

What are they at risk for? They are at risk for anemia because of their monthly cycle, which is often when the migraines flare.

Many of these people end up having low iron, especially when you look at more detailed types of tests.

And what I'm talking about here is ferritin.

Yes, and I'm curious, what advice would you have for people from your perspective in terms of, you know, people that are suffering from migraines?

But like what what's actually going on in the brain there?

So so let's talk about two things.

So first, how do you know if it's a migraine? Honestly, just go to your doctor.

Just go get diagnosed.

Please don't diagnose yourself based off a podcast or a video or a social media clip.

Just go get just just go do the thing.

OK, have them take a look at all the factors.

And when does DNA, because you mentioned it already, but when does that start to come more on your radar as as a tool?

What are the contributors behind migraines and headaches? And I want to talk about just, in just a minute, the general brain health, but maybe let's specifically talk about the headaches and the migraine piece, too.

too.You know, I think there are a couple of key factors there.

Number one, nutrients.

I mean, I think most of us who have any kind of health problem, we think we're eating healthy, but the brain is very demanding.

[laughs] And if we are having migraines, we are using up energy at an incredible rate, and we can get nutrient deficiencies.

The brain has subtly different needs than other organs, and we're not always eating exactly what our brain needs or supplementing exactly what we need to reduce headaches.

So I think that is a pretty big piece.

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Are those just compounding our, here we are again, and we're staying in this sand pile?

Yeah, absolutely.

Those are the underlying factors that are now surfacing.

And they may not have been as bad when you were young.

I mean, as you know, we can accumulate toxins in our body that impair our mitochondria's ability to function.

That is acquired over time.

It wasn't there when you were younger.

How is inflammation related to migraine? Yeah.