[00:00]
What if the exhaustion, brain fog, dizziness and migraines you have been treating as separate
[00:05]
problems are actually giving you one important clue about your iron stores?
[00:13]
Welcome to Migraine Heroes, a podcast for people living with chronic migraines with
[00:17]
years of pain, misunderstanding and lack of answers.
[00:21]
I'm Diane Ducarme, I've helped more than a thousand people reduce the burden of migraines
[00:27]
and feel more in control.
[00:29]
My mission in life?
[00:31]
To help a million people.
[00:33]
Each episode brings you grounded insights into what your body might be asking for and
[00:38]
what can truly help.
[00:40]
Just to keep you fully supported, this podcast is educational.
[00:45]
For diagnosis or medication, always work with your doctor.
[00:50]
Now take a breath and let's dive in.
[00:54]
In this episode, you will learn why low iron can affect much more than your energy, and
[00:59]
how iron participates in oxygen delivery, brain energy and chemical signaling that may
[01:05]
matter when you live with migraine.
[01:07]
Why a normal-looking blood count does not always tell the whole story, what ferritin
[01:12]
represents and how to have a much more useful conversation with your doctor about whether
[01:17]
iron could be one piece of your migraine puzzle, and a simple trick you can use in your kitchen
[01:23]
to add more iron to your food, including one surprisingly clever tool you may have never heard of.
[01:30]
Stay with me till the end, because the next tool you add in your migraine toolkit might
[01:34]
be nothing like you would expect.
[01:37]
When you live with migraine, you can end up with a long list of symptoms that seem completely
[01:44]
You're exhausted, your head hurts, you cannot concentrate.
[01:49]
You stand up and you feel lightheaded, you might even exercise suddenly feels harder.
[01:54]
Your heart may race, you may become cold when everyone else seems comfortable.
[02:00]
And because migraine itself can cause fatigue, brain fog, nausea, sleep disruption and dizziness,
[02:04]
it is incredibly easy for everything to be placed in the same migraine basket, or even
[02:10]
worse to place it all in different baskets and see specialists on all fronts when they
[02:15]
are actually connected.
[02:17]
So let's talk about what iron actually does.
[02:20]
So most people hear the word iron, and they immediately think of blood.
[02:26]
And that is certainly part of the story.
[02:29]
Iron is required for hemoglobin, the protein inside red blood cells that helps carry oxygen
[02:37]
When iron deficiency becomes severe enough to reduce hemoglobin, we call this iron deficiency
[02:45]
But iron has jobs long before anemia appears.
[02:48]
Iron participates in cellular energy production, in mitochondrial function, in brain development
[02:55]
and in the metabolism of several neurotransmitters, the chemical messengers used by your nervous
[03:01]
That means a person can have depleted iron stores without yet meeting the laboratory
[03:06]
definition of anemia.
[03:09]
A 2021 review in clinical medicine emphasized exactly this point.
[03:14]
Iron deficiency without anemia is common and may be overlooked.
[03:17]
And the authors noted that evaluating iron status may require looking not only at hemoglobin,
[03:24]
but also at ferritin and transferrin saturation.
[03:27]
So I want you to think about ferritin as one window into the body's iron storage cupboard.
[03:33]
Hemoglobin tells us something about the red blood cells circulating right now, and ferritin
[03:39]
gives us information about how much stored iron the body has available.
[03:44]
And those two numbers do not always fold at the same time.
[03:47]
So you can imagine your body trying to protect one of its most essential systems.
[03:53]
It may draw from its iron reserves to keep hemoglobin functioning.
[03:57]
The cupboard can be getting emptier while the delivery trucks are still running.
[04:01]
And that does not automatically mean every symptom is caused by iron deficiency.
[04:05]
It means that hemoglobin alone cannot answer every question about iron status.
[04:11]
So what does research say about migraine?
[04:14]
So here we need to be actually careful because the science shows an association, but it does
[04:19]
not yet prove that low iron causes migraine.
[04:24]
And the distinction matters.
[04:26]
So one of the more important recent analysis was published in 2025, and researchers performed
[04:32]
a systematic review and meta-analysis examining iron deficiency anemia and chronic headache
[04:38]
disorders, and they included 13 observational studies.
[04:42]
And their pooled analysis found that chronic headaches occurred frequently among people
[04:47]
with iron deficiency anemia, while iron deficiency anemia was also found relatively often among
[04:53]
people with chronic headache disorders.
[04:55]
So overall, people with anemia had a higher statistical risk of chronic headaches than
[05:01]
people without anemia.
[05:03]
Then the researchers also found substantial variation among the individual studies.
[05:09]
In other words, there is a real signal worth investigating, but not a proof that iron deficiency
[05:15]
explains every migraine.
[05:17]
And I know you know that.
[05:18]
You know it is not as simple as an iron fix.
[05:22]
Migraine is complex and can be influenced by genetics, sensory processing, sleep, stress
[05:27]
physiology, metabolism, inflammation, and many other factors.
[05:30]
So iron may be one contributor for some people rather than the explanation for migraine.
[05:36]
But for some people, it can be really substantial.
[05:39]
Now ferritin may be particularly interesting.
[05:43]
In 2021, there was an analysis in Frontiers in Nutrition, and it examined dietary iron
[05:50]
intake, serum ferritin, and severe headache or migraine among adults in the United States.
[05:57]
And they found associations between iron measures and severe headache or migraine,
[06:03]
although these relationships differed by sex and age group.
[06:06]
And so the authors also discussed several biologically plausible reasons iron could
[06:11]
matter to the migraine brain, including its role in energy metabolism and neurotransmitter
[06:18]
Then in 2024, researchers studied people with both migraine and iron deficiency anemia,
[06:24]
and they did not find increasing severity of anemia consistently predicted migraine
[06:29]
frequency or severity across all groups.
[06:31]
However, lower ferritin was associated with greater headache severity and headache impact.
[06:37]
And menstruation-related migraine showed a relationship with lower hemoglobin.
[06:41]
That is a fascinating finding because it reminds us that iron stores and anemia are related,
[06:47]
but they're not identical concepts.
[06:50]
So if I recap, iron is the mineral your body uses both to make hemoglobin and to support
[06:56]
functions like energy production and brain chemistry.
[06:59]
Hemoglobin tells you whether iron deficiency has progressed enough to affect your blood's
[07:04]
ability to carry oxygen.
[07:06]
If hemoglobin is low, anemia may be present.
[07:10]
And then ferritin tells you more about your stored iron reserves.
[07:13]
So ferritin can fall before hemoglobin does.
[07:16]
So low ferritin may reveal depleted iron stores even when you are not yet anemic.
[07:22]
Now why women may deserve particular attention?
[07:25]
So there's another reason this conversation comes up frequently in migraine care.
[07:29]
Migraine disproportionately affects women and particularly during their reproductive years.
[07:35]
Menstruation is also one of the most common recurring causes of iron loss.
[07:39]
And so put those two facts together and you can see why the overlap deserves attention.
[07:44]
If you experience heavy or prolonged menstrual bleeding, you may be losing iron month after
[07:51]
And here's the tricky part, gradual iron depletion can become your new normal.
[07:56]
Maybe you tell yourself, I'm always tired because I'm busy.
[08:00]
Jade mentioning I'm tired because that's my personality.
[08:02]
I have a tired personality.
[08:04]
There is no such personality.
[08:06]
Now I get dizzy because I have migraine.
[08:08]
My brain fog is just part of my migraine.
[08:11]
I'm breathless because I'm out of shape or my period has always been heavy.
[08:16]
But sometimes normal for me is not the same thing as physiologically ideal.
[08:22]
And so research has repeatedly found signals connecting menstrual factors like iron status
[08:27]
That doesn't mean that menstruation-related migraine is simply an iron problem.
[08:32]
Hormonal changes, particularly changes in estrogen, are well-established drivers of
[08:36]
menstrual migraine.
[08:38]
But iron loss may represent another layer of vulnerability in some people.
[08:43]
So how could low iron actually influence migraine?
[08:46]
So there are several hypotheses about that.
[08:49]
The first one is oxygen delivery.
[08:52]
So when iron deficiency progresses to anemia, your blood has less capacity to carry oxygen
[08:58]
The body compensates by increasing heart rate and blood flow.
[09:01]
That can contribute to fatigue, weakness, exercise intolerance, palpitation, dizziness
[09:07]
So oxygen delivery is only one possibility.
[09:10]
The second one is brain energy.
[09:13]
Your brain is an extraordinarily energy-hungry organ.
[09:16]
Iron participates in enzymes involved in cellular energy production.
[09:20]
And migraine researchers increasingly think about migraine partly as a disorder in which
[09:25]
the brain can become unusually sensitive to changes in energy demand and sensory load.
[09:30]
That does not mean iron deficiency creates migraine.
[09:34]
But in someone whose nervous system already has a lower threshold for migraine activation,
[09:38]
reduced metabolic resilience could theoretically matter.
[09:42]
The third area is neurotransmitter chemistry.
[09:44]
So iron participates in pathways involved in dopamine and other neurotransmitter systems.
[09:50]
Migraine biology also involves changes in neuronal signaling and sensory processing.
[09:55]
Researchers have therefore proposed that disturbances in iron metabolism could influence some of
[10:01]
Now, these mechanisms remain under investigation rather than proven explanations.
[10:06]
And there is an important complication.
[10:08]
Too much iron is not healthy either.
[10:12]
There was a 2024 review titled Iron in the Migraine Brain and it discussed this complexity.
[10:18]
Both insufficient iron and excessive iron may potentially affect neurological function
[10:24]
through different pathways.
[10:25]
So excess iron can promote oxidative stress, which is one reason blindly taking high-dose
[10:31]
iron just in case is not a sensible migraine strategy.
[10:35]
So the goal is not more iron.
[10:37]
The goal is appropriate iron status.
[10:41]
Now what symptoms could be worth noticing?
[10:44]
Low iron does not have one signature symptom.
[10:47]
It often creates sort of a pattern.
[10:50]
You may notice fatigue that feels disproportionate to what you've done or how much you've slept.
[10:54]
You may notice reduced exercise tolerance.
[10:57]
Perhaps walking upstairs suddenly feels surprisingly difficult.
[11:01]
You may experience a dizziness, lightheadedness, weakness or palpitations, shortness of breath,
[11:06]
restless leg, difficulty concentrating, headaches of course, or feeling unusually cold.
[11:12]
And some people notice hair shedding or brittle nails.
[11:16]
And some people develop cravings for non-food substances, particularly ice.
[11:21]
That's a big, big factor.
[11:23]
And that one is very noticeable.
[11:25]
But many of these symptoms overlap with dozens of other conditions.
[11:29]
That's why symptoms can raise a question, but they cannot diagnose iron deficiency.
[11:34]
Now the laboratory conversation therefore matters.
[11:38]
If iron deficiency is suspected, your doctor may consider several blood measurements.
[11:43]
So one is of course going to be the hemoglobin, which helps identify anemia.
[11:48]
And another one is ferritin, which is going to reflect the stored iron and is often the
[11:52]
most useful single marker of iron deficiency.
[11:55]
Other measurements, such as transfer and saturation, can provide additional information about how
[12:00]
much iron is available for use.
[12:03]
Now there's another subtlety here.
[12:05]
Ferritin is also what doctors call an acute phase protein.
[12:09]
Inflammatory conditions can push ferritin upward.
[12:11]
That means that someone can occasionally have iron deficiency while ferritin looks less
[12:17]
The British Society of Gastroenterology Guidelines, published in GUT in 2021, therefore recommended
[12:23]
interpreting ferritin alongside the clinical picture and considering other iron measurements
[12:29]
when a falsely reassuring ferritin result is suspected.
[12:32]
So this is exactly why interpreting iron is different from scrolling through your laboratory's
[12:37]
results and deciding whether a number is in the red or in the green.
[12:41]
Your context matters.
[12:43]
Now if your iron is low, the question is why?
[12:48]
And this may be the most important part of the entire conversation.
[12:52]
Iron deficiency is not just something to replace, it's something to understand.
[12:57]
Possible causes include heavy menstrual bleeding, inadequate dietary intake, pregnancy, blood
[13:06]
donation, gastrointestinal blood loss, or difficulty absorbing iron.
[13:12]
Now I remember a woman who came to see me around 2020, and we spent nearly an hour going
[13:19]
through all the possibilities because I kept thinking something here looks like a depletion,
[13:24]
an iron deficiency.
[13:25]
Like her body is simply isn't keeping up with what it's losing.
[13:28]
But I couldn't find the reason.
[13:29]
And so we spoke for about an hour, just I couldn't find it.
[13:32]
Then right at the end of the conversation, she casually said, oh, I donate blood.
[13:36]
Could that have anything to do with it?
[13:38]
And when we added up together, she was donating close to two liters of blood a year.
[13:44]
And considering an adult only has around four to five liters of blood circulating in
[13:49]
the body at any one time, that was a huge clue and a huge amount.
[13:53]
So that conversation was actually first made me start to look much more closely at blood
[13:58]
donation iron stores in the context of migraine.
[14:02]
Sometimes the explanation is straightforward, and sometimes it deserves further medical
[14:07]
Sometimes it deserves reimagining contraception.
[14:10]
So if low iron is discovered, the conversation with your doctor should not end with which
[14:15]
supplement should I buy?
[14:17]
It should also include why are my iron stores so low?
[14:21]
That question can be much more important.
[14:23]
Now let us change lenses.
[14:26]
Traditional Chinese medicine does not describe ferritin, hemoglobin, or transfer and saturation.
[14:31]
Those are modern biomedical concepts, and it would be misleading to pretend that an
[14:35]
ancient medical system was describing modern laboratory iron deficiency.
[14:40]
But traditional Chinese medicine offers a different language for thinking about these
[14:45]
It's going to talk about depletion, about nourishment, about menstruation, about fatigue,
[14:48]
about dizziness, and about migraines.
[14:51]
And sometimes that language helps us notice relationships that are easy to miss when we
[14:55]
divide the body into separate organs and separate symptoms.
[14:59]
So in traditional Chinese medicine, blood, and I'm going to capitalize the B here because
[15:04]
it's going to describe its traditional functional concept rather than merely the
[15:08]
physical liquid measured in a lab, its beliefs to nourish the muscles, the skin, the eyes,
[15:15]
the brain, and the emotional life.
[15:19]
And so a person described traditionally as having deficient blood might experience symptoms
[15:24]
such as fatigue, dizziness, paleness, pale lips, poor concentration, disturbed sleep,
[15:30]
changes around menstruation, or a sense of being insufficiently nourished.
[15:35]
Does that mean traditional Chinese medicine, blood deficiency equals biomedical iron deficiency?
[15:42]
The two frameworks overlap in some symptoms, but they're not interchangeable diagnoses.
[15:46]
What is interesting is the pattern recognition.
[15:49]
Eastern medicine often asks, not simply, where does it hurt?
[15:54]
But what is the terrain in which the pain is occurring?
[15:57]
Is the person depleted?
[15:58]
Are they losing more than they replenish?
[16:01]
Are they sleeping deeply enough?
[16:03]
Are they eating in a way that supports restoration?
[16:06]
Is menstruation especially heavy?
[16:07]
Are they pushing through exhaustion again and again?
[16:10]
The migraine becomes one part of a much larger landscape.
[16:14]
Now traditional Chinese medicine often describes headache through patterns involving either
[16:19]
too much upward movement or too little nourishment.
[16:24]
Sometimes the picture is one of excess, excess of heat, of tension, of agitation, of rising
[16:30]
And at other times, the language is more about emptiness.
[16:34]
So think of it like a plant.
[16:36]
If its leaves are wilting, you can keep examining the leaf or you can ask what's happening in
[16:43]
Is there enough water?
[16:44]
Is there enough nourishment?
[16:45]
Is there enough soil, enough time to recover?
[16:48]
That is the perspective I found particularly useful here.
[16:51]
If your migraines occur in a body that is also exhausted, depleted, menstruating heavily,
[16:57]
skipping meals, sleeping poorly and running continuously on adrenaline, traditional Chinese
[17:02]
medicine would rarely consider the head completely separate from the rest of the system.
[17:07]
It would ask whether the whole person is sufficiently nourished.
[17:11]
So classical Chinese medical thinking pays enormous attention to menstruation because
[17:16]
menstrual patterns were viewed as a window into the body's broader state of nourishment,
[17:21]
circulation and hormonal rhythm.
[17:23]
We oftentimes call it the fifth vital sign, although historical practitioners did not
[17:28]
use modern hormonal terminology.
[17:31]
If someone loses substantial blood every month and does not adequately rebuild it afterward,
[17:37]
the traditional image would be one of gradual depletion.
[17:42]
And this is where Eastern and Western thinking can unexpectedly stand beside each other.
[17:48]
Western medicine might say heavy menstrual bleeding can deplete iron stores, and traditional
[17:53]
Chinese medicine might say repeated loss without sufficient restoration can weaken the body's
[17:58]
They're not saying precisely the same thing, but they may point your attention toward the
[18:02]
same practical question, are you replacing what your body is losing?
[18:07]
Ayurvedic medicine offers another traditional concept that fits beautifully here, the importance
[18:13]
of building versus depleting.
[18:15]
So when the body is repeatedly taxed by inefficient food, poor sleep, chronic stress, blood loss,
[18:22]
So where I think Eastern medicine has something important to contribute to magnetic care is
[18:27]
in its philosophy.
[18:29]
Even when the lab science remains firmly Western, it encourages us to stop treating the body
[18:35]
like a badly behaved machine.
[18:37]
A symptom is not always an enemy, sometimes it is information.
[18:42]
Fatigue may be information, a change in your period may be information, feeling breathless
[18:47]
during ordinary activity may be information, a migraine appearing at the same time vulnerable
[18:52]
point in your menstrual cycle may be information.
[18:55]
And none of this means you should romanticize symptoms or avoid medical treatment.
[18:59]
It means instead of asking, how do I stop this migraine?
[19:03]
You might occasionally ask, what conditions make my nervous system less resilient right
[19:10]
And that question can open a much bigger door.
[19:13]
Then this topic is also deeply personal to me.
[19:15]
When I was 17 or 18, I had a serious skiing accident and lost an enormous amount of blood.
[19:22]
My hemoglobin dropped to around 70 grams per liter for a normal level that should be closer
[19:29]
And at the time there were major concerns around contaminated blood, so I was not transfused.
[19:35]
And recovery was long, especially because I had already struggled with anemia as a child.
[19:40]
So my whole system felt turned completely upside down, my energy, my cycle, my hormones,
[19:47]
And years later, 12 years later, discovering traditional Chinese medicine became an important
[19:53]
part of how I learned how to think about rebuilding and nourishing the body after depletion.
[19:58]
I'd never say that one system of medicine explains everything, but for me, this experience
[20:02]
made the connection between blood nourishment, resilience, and later, for others, migraine
[20:08]
And it's one of the reasons this subject is really close to my heart.
[20:12]
I have really deep empathy for people who are, in traditional Chinese medicine, qualified
[20:17]
as blood deficient.
[20:19]
Now here's an advice you can use at home.
[20:22]
So one simple way to increase iron in food is to cook with cast iron pans.
[20:27]
But another option is with the Lucky Iron Fish, which I will link in the show notes
[20:33]
So it's a small iron ingot that you cook with your food or with your water.
[20:38]
So some iron is released into the meal or into the water, and it was developed in Cambodia
[20:44]
as a practical way to help reduce iron deficiency and anemia.
[20:48]
And the concept has since evolved into different shapes and versions.
[20:52]
Now I have no affiliation with the company.
[20:54]
I just think it's a clever and it's a very useful idea.
[20:57]
Some people tend to have anemia chronically, and this is a really easy and sort of, in
[21:02]
many ways, inexpensive way to introduce more iron in your life in a way that can easily
[21:10]
That's all for today.
[21:11]
I hope this episode added another piece to your migraine puzzle.
[21:14]
If you'd like to apply what we've discussed to your own life, you can find us by searching
[21:19]
Migraine Heroes in the App Store or Google Play.
[21:23]
Look for the green icon with the love heart in the brain.
[21:27]
Migraine is complex, but it's not random, and every step forward brings us closer to
[21:33]
Your body has a story to tell.
[21:35]
Let's keep listening.
[21:36]
I will be back with you soon.
