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Welcome to The Dr. Kumar Discovery, a health and wellness podcast hosted by Dr. Ravi Kumar, a board-certified neurosurgeon. This is the medical podcast for anyone who wants honest, evidence-based answers to the health questions that matter most. No corporate influence. Just a physician who reads the research, questions the dogma, and breaks it down in plain language so you can make better decisions about your own health.
Dr. Kumar is a practicing neurosurgeon who brings a surgeon's precision to topics most doctor podcasts only scratch the surface of. Each episode dives deep into the science behind metabolic health, cardiovascular disease, heart disease, hormones, nutrition, brain health, mental health, pain, inflammation, weight loss, aging, blood pressure, sleep, and longevity. Whether it's the truth about seed oils, the real data on GLP-1 drugs and weight loss, the science of cold water therapy, how light can heal the body, or why your testosterone is declining, Dr. Kumar goes straight to the peer-reviewed literature and tells you what the evidence actually shows, not what the headlines say. This is evidence-based medicine in plain English.
The show features three formats. Solo deep dives explore a single health topic from the ground up, covering everything from the biology to the practical takeaways you can use today. Expert interviews bring on leading researchers, clinicians, and forward-thinking voices in health and medicine for in-depth conversations you won't hear anywhere else. The Tribulations series tells the true stories behind medicine's greatest breakthroughs, from the discovery of penicillin to the invention of vaccines to a father's fight to save his son's life. These are the stories of the doctors, scientists, and patients who changed the course of medicine.
Topics covered on the show include testosterone and hormone optimization, sleep science, photobiomodulation and red light therapy, exercise with oxygen therapy, creatine, uric acid and gout prevention, gut health and probiotics, cardiovascular risk and Lp(a), cholesterol, PANDAS in children, PTSD and trauma, acetaminophen safety, glyphosate, foot health, and much more.
If you're tired of generic health advice and want to hear from a neurosurgeon who actually reads the studies, The Dr. Kumar Discovery is your podcast. New episodes drop regularly. Subscribe and join the discovery.
For show notes, references, and more, visit drkumardiscovery.com/podcast
Welcome back to the Dr Kumar Discovery. My name's Doctor. Ravi Kumar, and today I'm joined by Doctor. Amelia Barrett. Doctor.
Ravi Kumar MD:Barrett is a board certified neurologist who trained at Stanford and spent twenty five years in private practice. She got frustrated with how little medications could do for her patients, so she went looking for answers in their genetics and in the places that medicine wasn't looking. Today, she runs a program called the Migraine Relief Code that helps patients get control of their migraines. She's also built a genomics panel designed specifically for people with migraines, and she's the author of a new book, The Code Your Migraine. In today's episode, we're gonna talk about why the trigger you blame for your migraines is only the last drop in the bucket that causes the whole thing to tip over.
Ravi Kumar MD:We talk about the four biological systems that fill that bucket in the first place. We talk about why trial and error with medications when you don't understand the root cause of your migraines can actually backfire. And we talk about practical interventions that can make real differences when you're trying to control your migraines. So one thing before we dive in is a quick disclaimer. I'm a doctor, and so is doctor Barrett, but we're not your doctors.
Ravi Kumar MD:This show is for informational purposes only. Everything you hear in this conversation is meant to empower you. So take this knowledge, ask better questions, and work with your own doctor to build a healthier life. And just to be clear, this show is separate from my role as assistant professor at UNC. Also, a quick favor.
Ravi Kumar MD:This show currently reaches about 150,000 people every single month, and I want that number to grow so that more people who have problems like migraines can understand it better and find solutions. So if you're getting value from this episode or this show in general, leave a comment, leave a review, and share this episode with someone you know who suffers with migraines or some other health problem. Okay. And the last thing is something I'm super excited about. I designed an app that exercises the different domains of your brain and your thinking.
Ravi Kumar MD:It's called Brain Gamer, and you can find it at braingamer.app, braingamer.app. I designed each game in this app with strict intention to work the different parts of your thinking. It's something I use every morning when I get up, and it's literally like going to the gym but for your brain. I would love for you to take a look. You can play three games per day for free, and if you want unlimited plays, there's a small monthly subscription fee.
Ravi Kumar MD:Let me know what you think. Just check it out at braingamer.app. Alright. Let's get into it. My name is doctor Ravi Kumar.
Ravi Kumar MD:I'm a neurosurgeon in search of the causes of human illness and the solutions that help us heal and thrive. I want you to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal. Let us question everything and discover our true potentials. Welcome to the Dr Kumar Discovery.
Ravi Kumar MD:Doctor Barrett, welcome to the show.
Dr. Amelia Barrett:Thank you. Appreciate you having me.
Ravi Kumar MD:You're an expert in migraines, and I have tons of friends and family members that have problems with migraines, and that's not uncommon, right, because it's a very common problem. And you have a very unique take on how to address migraines, what causes them. And it's not the standard take you're going to get if you go to your primary care doctor or your local neurologist. And so I think this is gonna be a really valuable episode for a lot of people. And maybe you could just start off with telling us what a migraine actually is.
Dr. Amelia Barrett:Yeah. Absolutely. That's a a great starting point. So a migraine is really just a description of a certain type of pain that's tied to certain changes that happen in the brain. That pain is usually on one side of the head, although it can be both.
Dr. Amelia Barrett:It's usually more of a throbbing quality, kind of like your heartbeat. It is usually worse with exertion, and that can be something simple like leaning over to pick up the toy your kid dropped. Right? It doesn't have to be, you know, you get a headache after running a marathon. It doesn't have to be that.
Dr. Amelia Barrett:They can be more associated with nausea, sometimes vomiting. And this can also be subtle. It can be, you know, yeah, I just don't really feel like eating lunch today. It can be as subtle as that. People get sensitivity to light, sensitivity to sound.
Dr. Amelia Barrett:The brain is basically just telling you to shut down, go to a dark room, lie down, and let it fix whatever problems are going on. So those are the characteristics of migraine. Not everybody has all of them. Migraine is massively underdiagnosed according to the American Migraine Foundation. They present data on their website that only about five percent of people who actually really do have migraine have been to a doctor, gotten diagnosed, and received migraine specific medications.
Dr. Amelia Barrett:So a lot of people have migraines, and they are calling them something else. Tension headaches, sinus headaches, menstrual headache, like whatever words they use. So I think it's really important for people to not get too hung up on the diagnostic criteria, but just to think about this. Do the headaches interfere with your life in any way? Do they make you take a medication?
Dr. Amelia Barrett:Do they make you miss things? If so, then it's time to think about it. It's time to do something about it, figure out what's going on, and make them stop happening.
Ravi Kumar MD:Yeah. Exactly. So people with diagnosed migraines are just the tip of the iceberg. There's this massive pool of people who are suffering with migraines who are not diagnosed and probably not addressing or treating it properly.
Dr. Amelia Barrett:Yeah. And you know what else is shocking? Even with that, twenty eight million American women have migraine. That's a lot. Yeah.
Dr. Amelia Barrett:So I think that this problem... Yes. I know. Yeah. It's like, I think this problem affects a lot more people than we realize.
Dr. Amelia Barrett:We just tend to think, oh, it's just a headache. Dismiss it. Not realizing that it's not so much about the pain. It's about what's going on in your brain and the problem's there. That's what the issue is.
Ravi Kumar MD:Yeah. So why do we have this problem? I mean, what is happening and why is it happening in the brain biochemically?
Dr. Amelia Barrett:So fundamentally, the brain is over firing. That can happen for a variety of different reasons. When it overfires, it runs out of energy and has to shut down. So the overfiring phase has its advantages. As you can imagine, if you were the person who had to keep watch over the tribe at night, it would be a good thing if your brain was in high gear.
Dr. Amelia Barrett:Right? The trouble is that certain people have other issues going on as well, and their brain just can't handle those extra demands. That's when you start to get migraine. That's when the brain shuts down and says, no. No.
Dr. Amelia Barrett:Too much. We're gonna make you stop. And, you know, that's kind of the the downside of it. So it's sort of a plus minus feature.
Ravi Kumar MD:Yeah. I feel like we see that a lot with different biological traits, that there's some advantage to it. Some advantage like hypervigilance, but it doesn't always work out to an advantage. It can become a disadvantage, which is chronic migraines or, you know, migraines in general. But people with this trait, they don't live with migraines every day.
Ravi Kumar MD:Most people don't, I I assume. What is actually pushing them over this threshold of this hyperactivation and then this migrainous type phenomenon?
Dr. Amelia Barrett:So this is where migraine gets really, really interesting because we've known for a long time that things like sleep deprivation or certain foods can, you know, trigger a migraine. You know, you can identify what it was that happened right before you got the migraine, try to avoid it, and hope to never have a migraine again. But it turns out that what's actually going on under the surface is that you have chronic dysfunction of one of four different biological systems in the brain. And you can think of that dysfunction as being something that kind of fills up your bucket. Like, when my kids were little, I used to take them to this water park that had these tipping buckets.
Dr. Amelia Barrett:They're, you know, up high, and the water fills up very slowly. And then, you know, when it fills up, it tips over, and all the kids, you know, get... Because freezing cold water splashed on them, and they're all screaming like crazy. And then, you know, I was watching this one day, and I was like, that's just like migraine. There are all these biological factors filling up your bucket, and it tips over into migraines.
Dr. Amelia Barrett:So the important thing is what's filling up the bucket. It's not just that last drip of water, the trigger, the thing you can identify that made the bucket tip over right before. It's the fact that your bucket got full. So that's that's really the key insight from what new research is showing us. A new research is showing us.
Dr. Amelia Barrett:It's it's shining a light on what's filling up the bucket. What is that biology? So that, I think, is really the key shift that is happening as we come to understand migraine better.
Ravi Kumar MD:Okay. And so what what is filling up the bucket then?
Dr. Amelia Barrett:So DNA research has identified nearly 200 different genes that are linked with migraine. They roughly fall into four different biological systems in the body. Of course, our genes regulate our biological systems. If you look at, you know, 10 or 15 different genes together, you can get a good idea of how a system in your body works. So those systems are brain chemistry, and that includes, you know, things like neurotransmitters, serotonin.
Dr. Amelia Barrett:Many people have heard that serotonin is linked to migraine and other neurotransmitters. But there are other brain chemicals like BDNF, which is responsible for neuroplasticity that are helpful as well. Those are also linked to migraine. Inflammation is another big biological system that is related to migraine. People with migraine tend to have abnormalities that are related to gut health.
Dr. Amelia Barrett:And also, they tend to have abnormalities that make their inflammatory system go into higher gear than other people's do. They have a stronger inflammatory response to things than other people do. The third system that's involved is energy production. This happens inside the mitochondria. And I like to think of people with migraines as having sort of a Ferrari brain, but it's, you know, very high performance but also high maintenance.
Dr. Amelia Barrett:And so there are several genes related to energy production that help keep mitochondria functioning well, help keep them... Keeping them in the Ferrari mode, not like, you know, like my 15 year old Subaru mode. Like, we don't wanna be there. We wanna be in Ferrari mode. So there are a lot of genes that tip people over kind of into Subaru mode.
Dr. Amelia Barrett:These are antioxidant genes, detox genes, that kind of thing. And then the final system is issues related to the vasculature. And this is where things like low blood sugar come into play, insulin resistance, methylation. Of course, problems there cause high levels of monocysteine that can, you know, increase the risk of heart attack and stroke. We've known for a long time that those things are linked with migraine.
Dr. Amelia Barrett:So those are the four main biological systems that are at play, that are filling up that bucket under the surface for people with migraines. And that's really a lot of what I talk about in my new book, Decode Your Migraine, just to help people wrap their heads around this new data. I mean, this is only a couple years old that Yeah. We've even done this. And how do we integrate that into our current understanding of migraine, but also move forward so that we can help people in better ways than we've been able to do before.
Ravi Kumar MD:Yeah. Very interesting. So if we were to... First off, let me ask you, are the... All those 200 genes identified and and measurable?
Dr. Amelia Barrett:Oh, yeah. So Okay. Many of these come from genome wide association studies. This is absolutely fascinating. They ran DNA on a 100,000 people with migraine, compared it to about seven hundred thousand people who don't have migraine, and they said, okay.
Dr. Amelia Barrett:What do these migraine people have in common that's different from these people who don't have migraine? So they're looking at, you know, four to 5,000,000 different SNPs per person Wow. On all those people and comparing that to the people who don't have migraine. Because, of course, we don't know yet Mhmm. Exactly which SNPs are the most useful.
Dr. Amelia Barrett:Right? So they just looked at all of them. Right. You know, a SNP is really like a snapshot of a house. You know, if your gene is a house, a SNP is a snapshot.
Dr. Amelia Barrett:You know? And and you can you can use different snapshots. Like, you have your house on Zillow, you know, you you know, you decide which snap shots you wanna put up there. It's all the same house. You're just looking at it different ways.
Dr. Amelia Barrett:Snips are kinda like that. So, you know, we have very, very detailed information about this from genome wide association studies. This is all quite recent. As you can imagine, that takes an extraordinary amount of computing power and and power, and those computers did not exist until recently. So this is on top of two decades of candidate gene research of saying, seems like sleep deprivation is a trigger for migraine.
Dr. Amelia Barrett:Alright. What sleep genes are there that we know of? And do we see abnormalities of those genes happening more often in people with migraine? So kind of two different phases of the the DNA research. But at this point, you know, that's how we have this list of nearly 200 different genes that are linked.
Ravi Kumar MD:Okay. And when you're working someone up for migraines, trying to figure out how to modify their their life so that migraines hurt them less, do you look at their genes, or is that something just to know esoterically?
Dr. Amelia Barrett:No. Absolutely. I actually think it's the place to start. So for a long time, you know, I was in private practice for twenty five years. I did the usual mainstream medicine thing.
Dr. Amelia Barrett:I trained at Stanford. I learned those skills very well. I became very frustrated with the limitations of medications, became interested in other solutions. I used functional medicine for a long time, and I think that provides great tools. But at this point, I literally start with the genomics.
Dr. Amelia Barrett:And here's why. Because it tells me how that person is wired. And once I know how they're wired, I know where to look and how to support their biology. So I designed a proprietary functional genomics panel specifically for people with migraine and other chronic headaches that is based on these two decades of genetics research. That's the panel I run.
Dr. Amelia Barrett:And then, you know, we look at those, you know, the many different genes related to each biological system, focusing, of course, on what's actionable. We can't change our genes. This is not a CRISPR type of problem. Migraine isn't. It's polygenic.
Dr. Amelia Barrett:It's not monogenic. So we have to look at how those biological systems are working, and how do we best support this person? What medications are gonna work for them? What supplements do they actually need? What foods can they actually process and not process?
Dr. Amelia Barrett:What lifestyle changes are actually gonna change their life? And then we put all of that together and create a recovery protocol to get them to the maximal place of wellness that is possible given the current state of technology for them.
Ravi Kumar MD:Wow. Very, very cool. I don't know of anyone else who's doing that. That's... So that's very...
Ravi Kumar MD:That's precision medicine. Correct? Mean,
Dr. Amelia Barrett:you are That's precision medicine.
Ravi Kumar MD:Yeah. Which is the future of medicine, really. And that's where AI is gonna take us for sure. Let me ask you this then. So you've got someone's genomic analysis done.
Ravi Kumar MD:So you know which snips associated with migraine they have. Now you're take each of those, and then there's four pools within that... Those genetics, right, that lead to these four influential factors that fill your migraine bucket. Am I on the right track so far? Yep.
Ravi Kumar MD:Absolutely. Okay. So can you then talk about how you might modify a hypothetical patient in each one of these four areas based on potential genetic susceptibility?
Dr. Amelia Barrett:Oh, I would love to. Okay. Let's dive in. From this data, we know that migraine is not just one disease. Okay?
Dr. Amelia Barrett:I see people who have brain chemistry vascular issues as their primary driver. My primary driver for my migraines is energy production. Some people have inflammation. So it really can be all over the place, and they are dramatically different solutions. So just...
Dr. Amelia Barrett:Let's just take one very simple example of choosing a preventive medication. Okay? So let's say somebody has that vascular type. Okay? That's their main thing.
Dr. Amelia Barrett:They've got abnormalities of several of those genes at points there. Let's say they have an abnormality of ACE, angiotensin converting enzyme. This has been linked with migraine for a long time. We've known that this was a candidate gene early on. We've always known migraine is a neurovascular disorder.
Dr. Amelia Barrett:People have been looking that for... At that for decades. That person is gonna benefit from an ACE inhibitor. Right? If they have an over functioning of that gene, blocking that down is gonna help them.
Dr. Amelia Barrett:If they can't take that, it might be an angiotensin receptor blocker a little farther down the cascade. Now if you... If those genes are completely normal and that person doesn't have the vascular type, they instead have a brain chemistry type, maybe they have abnormalities in their serotonin system. Maybe they need something that's a little more serotonin focused. They might do better on something like a serotonin norepinephrine reuptake inhibitor, an SNRI, something like Cymbalta, that type of medication.
Dr. Amelia Barrett:Maybe even, you know, to go old school, a tricyclic. So that's something like amitriptyline. So that fundamentally influences that very first decision that you're making in the office with that person. And that's why I say I really think genomics is the place to start. Because if you don't get it right in these people and they continue to get worse and worse, you're doing your trial and error.
Dr. Amelia Barrett:Let's try this medication next, that medication next. They're slowly getting worse. What's happening? Maladaptive neuroplasticity is what's happening. The brain is learning a very bad habit.
Dr. Amelia Barrett:You know, the brain learns whatever it does. It gets better and better at it. And if it's doing a thing you don't want it to do, like create a bunch of headaches and migraines, you don't want it to learn that bad habit. So you are really wasting time going through all these trials, allowing people to come more deeply into this place of chronification. That's that's what we neurologists call it, you know, where the brain's in this stuck in a bad habit place.
Dr. Amelia Barrett:You know, you're allowing that process to happen and that person to get worse and worse while you're just, you know, throwing darts at the dart board, you know, trying to hope something sticks. So that's why I
Ravi Kumar MD:think it's so helpful. Sense, honestly. Mhmm. It makes so much sense. Right?
Ravi Kumar MD:Why Yes. You know, someone's given... They have a migraine, they're given a triptan, which is a vasoconstrictor, and their problem is actually energy production in the brain. And so now you're you're reducing blood flow to the brain, blood flow for energy production, and you're chasing your tail. So now you're...
Ravi Kumar MD:What... Like you said, your brain becomes maladapted. It's trying to get around this chemical block you've put in place that's actually not even addressing the problem that it has. 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?
Dr. Amelia Barrett: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?
Dr. Amelia Barrett:And first of all, the answer is biology is not a one step process. There is no single supplement that's ever gonna fix an entire biological pathway with ten, fifteen, 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 somebody who has inflammation problems, okay, versus somebody who has energy production problems. So what reduces inflammation?
Dr. Amelia Barrett:Well, it's fish oil. Right? Or curcumin, turmeric. Right? So it turns out that those actually work on different aspects of the inflammatory response that your body mounts.
Dr. Amelia Barrett:There can be a couple of different things. There can be interleukins. We have lots of different interleukins in the body or TNF, tumor necrosis factor. Turns out that the curcumin turmeric, you know, works on the TNF pathway. The interleukins are more impacted by fish oil, DHA, EPA.
Dr. Amelia Barrett:So even to that level of detail, you can determine which supplement is gonna work best for you. Now if all of those pathways are normal, are you going to get any benefit from that? Probably not. Your body's already handling it for you. You don't need to support your biology there because your body's got that.
Dr. Amelia Barrett:Let's say maybe instead of those inflammatory focused supplements, you need to be focused on energy production type of supplements. So we know that co q ten and b two are involved in the Ferrari type of energy production inside your cells, the... What we call oxidative phosphorylation. You know, B2 and CoQ10 are needed for that pathway. If you don't have enough, your body kinda defaults down to the Subaru pathway, which is not where you wanna be.
Dr. Amelia Barrett:Your brain needs that really, really amazing Ferrari function to keep up with, you know, the demands of everything your brain is trying to do. So even a simple decision like that is influenced by your biology. But, like, do you wanna be on curcumin and fish oil if you don't need it? No. Do you wanna be on co q ten and b two if you don't need it?
Dr. Amelia Barrett:No. Co q ten's expensive anyway. So so I think that, you know, if you're gonna commit to something, you can't just use the outcome. Does this one thing make my migraines all better? Because it is never going to be one thing.
Dr. Amelia Barrett:It won't. Always say, oh, I tried such and such for my migraines. It didn't work for me. Yeah. You probably need more than one thing.
Dr. Amelia Barrett:You don't just need the fish oil. You, you know, you need a combination of five different things. And what are chances you're ever gonna figure that out through trial and error? Zero. Right.
Dr. Amelia Barrett:You are not gonna hit on the right combination without data. You need the data. So that's another example of how this information can change what you do every single day, what you're spending your time on, you know, ordering your supplements, what you're spending your money on. You know, having that data just allows you to have that peace of mind of knowing, well, you know what? I don't love it that I have to take this handful of supplements every day, but I have the data proving that my body needs me to do this.
Dr. Amelia Barrett:So I'm gonna do it.
Ravi Kumar MD:Yeah. No. That's great. I mean, because half the time you take a supplement, you have no idea if it's working with you. Exactly.
Ravi Kumar MD:I mean, there's occasionally a supplement you'll take, and you'll notice a difference right away. Right? Those are very often. Pretty Not very often. That's pretty rare.
Ravi Kumar MD:Yeah. So, yeah, I mean, having data, having basically your genetic makeup and how you process each of these systems, and then seeing the downstream effect, which is hopefully if you've hit it right, less migraines, I think that could that could be very satisfying as a neurologist.
Dr. Amelia Barrett:Oh, absolutely. Absolutely. It's it's an incredibly powerful tool to be able to give people. And I'm telling you, it has made my life as a doctor a million times more satisfying to be able to get people to a place of sustained lasting improvement. I have people tell me things like this is the my...
Dr. Amelia Barrett:Best of my migraines have been in fifty years. Or, you know, I am able to go do things with my family again. I couldn't do that for the last ten years. I mean, that just that just practically makes you wanna cry. Right?
Dr. Amelia Barrett:I mean, that's that's why we went into these healing professions. Right? To try to have a positive impact on people's health and their quality of life.
Ravi Kumar MD:So that... Yeah. That's exactly what we went into it for. And sometimes it's... That's...
Ravi Kumar MD:That kind of result or that kind of practice is hard to find, honestly, in traditional medicine. Oh, yeah. Why is it that women get migraines more often? Am I right on that, first off? Fact check me if I'm not.
Ravi Kumar MD:And then
Dr. Amelia Barrett:Hundred percent.
Ravi Kumar MD:So why do they... Why does that happen?
Dr. Amelia Barrett:Yeah. So women outnumber men with migraine about three to one. So a lot of my... You you know, the information that I put out there does speak more to women. Not that I'm excluding men whatsoever.
Dr. Amelia Barrett:They're a 100%, you know, welcome to use all these tools too, but, you know, we have a lot more estrogen than men do. So that that is one of the main reasons that it's so much more of a problem. So what happens is that anytime estrogen drops off, that is a very potent migraine trigger. It sets in motion a series of events in the vein that... In the brain that result in this pain experience that we call migraine.
Dr. Amelia Barrett:And so, of course, when women are young, that happens every month for us right before our cycle. When we go through menopause, it's happening completely randomly for years at a time. So, you know, that's why the migraines can get worse then and be so unpredictable. Like, why are they randomly worse now in my forties? Well, it's that there's hormonal changes, you know, percolating under the surface as well as a couple other things that might be going on.
Dr. Amelia Barrett:So there's the biology. I also have the personal opinion, and this is really just me. And, you know, this is a generalization that could be... That obviously does not apply to everybody. But I feel like a lot of women put everybody else ahead of themselves.
Dr. Amelia Barrett:And if they can pop a pill and still get the kids to soccer and dinner on the table and get the work report done, that's what they're gonna choose every time. And what that does is it makes them think everything's okay. They don't stop to say, wait, wait, Why am I getting these migraines one, two, three, four days a week? They just say, it's okay. I can take the pill and everything's fine.
Dr. Amelia Barrett:My MRI was fine. I don't have anything to worry about. I just have to suck it up and deal, pop a pill, and power through. And I think that we get so wrapped up in meeting the demands of our lives. It's really hard sometimes to put our own health on the front burner.
Dr. Amelia Barrett:Like, if our kid had bad migraines, we'd be all over it. Right? We'd be taking them to every doctor, trying every supplement, every everything. But when it's us, we have a little bit harder time doing that. Again, generalization, my personal opinion, but I think that sometimes those social roles and expectations feed into this as well.
Ravi Kumar MD:Yeah. I mean, I look at my wife. She's a servant to four children. Like every minute of her life, it's usually paid back with, you know, disrespect and, like, junky attitude sometimes. And every once in while, come up and give you a hug and a kiss, you're like, oh, worth it.
Ravi Kumar MD:But when I get a headache, I'm like, I'm out, guys. You do your own thing. And so, that makes sense. Women do take the brunt of the responsibility for raising a family traditionally in The United States. But I also think women are generally tougher.
Ravi Kumar MD:That's my personal opinion. I I do a lot of spine surgery, which is very painful. And I'll get, you know, an 80 year old woman who I do a big spine surgery on, and she takes Tylenol. That's all she takes. Oh, man.
Ravi Kumar MD:Then I'll I'll get some big guy. I'll do a small discectomy with an incision like that big, and, you know, he's on oxycodone for two weeks, crying like a baby. But I don't tell him that. I just say, you know, listen. Everyone has different pain tolerances.
Dr. Amelia Barrett:So Yeah.
Ravi Kumar MD:I do think women do have better mechanisms for coping with pain, and oftentimes that's that's masking, hiding it. Yes. So... Yeah. Let me ask you about this.
Ravi Kumar MD:There is a... And you may or may not test for this. There is a... An enzyme called catecholomethyltransferase or COMT that breaks down dopamine hormones like estrogen. And in some people, that works very slowly due to certain genetic abnormalities.
Ravi Kumar MD:Does that ever come up on your test as being, connected with migraines?
Dr. Amelia Barrett:Yes. Absolutely. Great question. Yeah. COMT was a candidate gene study early course, because of its role in neurotransmitter breakdown.
Dr. Amelia Barrett:Right? And we know that migraine affects the brain. Neurotransmitters are messed up somehow. So we've looked at this for a long time. As you know, COMT can either go fast or slow.
Dr. Amelia Barrett:Slow is actually better in general. The... If you wanted to make broad sweeping generalizations about what's wrong in the migraine brain across multiple different neurotransmitter systems, it tends to be that the brain is too up and not enough down. And so for things like serotonin, which is a calming chemical on the brain. Okay.
Dr. Amelia Barrett:If you break that down slowly because that's your your metabolism, not necessarily comp. There's, you know, there's a lot of overlap in this stuff. But let's just say if you break that down slowly, then that means you have more calming going on, and that's a good thing. So breaking down neurotransmitters fast through COMT and Mayo A, Mayo B tends to be more of an issue because you want more of the neurotransmitters. Now this is a broad sweeping generalization.
Dr. Amelia Barrett:Like, when it comes to something like glutamates, which is the main excitatory neurotransmitter in the brain, you don't really want more of that. So breaking that down slowly would be a problem. So it's complicated, neurotransmitter system dependent, and it also depends on the other abnormalities you have of those processing systems. So back to serotonin. I like to think of neurotransmission as basically playing ball with your kid.
Dr. Amelia Barrett:Okay? You throw the ball to your kid. That's... Let's just say you and your kid are both neurons. Okay?
Dr. Amelia Barrett:The ball is the neurotransmitter. So you can have abnormalities of how many balls you have, how fast you throw it. That's neurotransmitter synthesis. You can have problems there genetically. You can have problems of how your kid receives it.
Dr. Amelia Barrett:You know? Does your... Is your kid able to catch the ball or not? That's your receptor. Right?
Dr. Amelia Barrett:You can have abnormalities of the receptors for neurotransmitters. You can have abnormalities of recycling, which I think of as, you know, you throw the ball, your kid misses, you go pick up the ball, you're kinda recycling it. Right? You're reusing it. You can have abnormalities of neurotransmitter recycling.
Dr. Amelia Barrett:And then you can also have abnormalities of neurotransmitter breakdown, which you're kind of getting at, which is game's over. We're gonna go inside for dinner, clean up, everything's gone. So, you know, you've gotta look at not just COMT, but all the other pieces of that pathway as well, and a lot of these genes are linked to migraine, which makes I mean, it is a brain problem.
Ravi Kumar MD:Can we talk a little bit about sleep? Because this is a, I think, really one that actually gets ignored quite a bit. I mean, and sleep is essential to our whole health. I mean, metabolic health, our brain health, our cardiovascular health. And I think it plays a big role in migraines because when we sleep, that's when we clear a lot of these stimulating neurotransmitters like glutamine that you just talked about.
Ravi Kumar MD: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?
Dr. Amelia Barrett:Yeah. Absolutely. And that's absolutely foundational. So, you know, one super common thing, make sure you go to a doctor, get checked for sleep apnea, fixable, common problem. So I think that that is foundational.
Dr. Amelia Barrett:Make sure you don't have some kind of an actual sleep disorder impacting your sleep. But for most people with migraine, that's not the issue. The issue is their brain is too up. Right? So there are a number of different ways to get around that.
Dr. Amelia Barrett:The ideal way, of course, is to know your genetics and support the exact neurotransmitters that are a little a little off. But I think one foundational thing that everybody can do is to use two things. Number one, melatonin. There are great studies showing that melatonin works just as well as amitriptyline for migraine prevention. Now it only reduces migraines by about 2.7 days a month.
Dr. Amelia Barrett:Okay. So it's not earth shattering, but it does have an effect on migraine reduction independent of helping you sleep. And you have to remember that most people with migraine are low in serotonin. Serotonin gets turned into melatonin. So if you're low on serotonin, maybe you're not getting quite enough melatonin anyway.
Dr. Amelia Barrett:And to top it off, we all have a drop off in our melatonin production as we get older. So I think there are good reasons to take just a touch of melatonin. I like a three milligram extended release tablet to just layer that in. Don't expect it to take all your migraines away or make you sleep like you're under anesthesia all night long. It won't.
Dr. Amelia Barrett:But there are many reasons to layer it in as part of your overall sleep recovery plan. The second thing I like that's a little bit more migraine specific is magnesium glycinate. Because both the magnesium and the glycine independently help the brain calm down and sleep. The magnesium does it by blocking the glutamate receptor. We call it an NMDA receptor, and it is so smart the way it does this.
Dr. Amelia Barrett:When the brain is over firing, the magnesium will come in and block. And when that glutamate stops over firing, the magnesium unbinds, and your brain can go back to doing what it was doing. I just love it that, you know, the the way that system was designed naturally is so smart. It's so intelligent. So I think magnesium is, you know, one of my second recommendations for people with migraine who are having trouble sleeping.
Ravi Kumar MD:Okay. And what dose do you recommend for magnesium glycinate?
Dr. Amelia Barrett:I like four to five hundred milligrams with dinner, so it's a hefty dose. Yeah. And and people can't always start that right away. You know? They may have to start with more like a hundred with dinner because you gotta remember, a lot of these people have abnormal gut function.
Dr. Amelia Barrett:And if they take that magnesium and get loose stools or diarrhea, that's a sign that their gut health is not quite where it needs to be for optimal health. But a lot of people are struggling with those gut and inflammation issues as well, so they've gotta go slow. Work up very, very gradually.
Ravi Kumar MD:Yeah. It's very interesting. Yeah. Magnesium glycinates, what I recommend in my sleep protocol exactly for that reason. It kind of acts the doorstop for that NMDA receptor, and it also allosterically promotes the GABA receptor, which is a calming neurotransmitter in the brain.
Ravi Kumar MD:Yeah.
Dr. Amelia Barrett:I did not know that. That is super cool. Okay.
Ravi Kumar MD:It's got many hands and many different things that it does. The melatonin, you know, I I generally only recommend that to people who are dealing with sleep issues if they have some circadian dysrhythmia. And I didn't know about its effects on migraines, and that's really actually interesting. So three milligrams sustained release, do you take it about an hour or a half hour before bed?
Dr. Amelia Barrett:Mhmm. Yep.
Ravi Kumar MD:Okay. You know, melatonin's very interesting. I mean, it has anticancer effects. It has these anti migraine effects. It basically kind of...
Ravi Kumar MD:It's a timing molecule that tells you when it's time to go to sleep. Do you ever talk to people about their waking habits afterwards? Because, you know, if you go out and get sunlight in your eyes, it stimulates your hypothalamus and then kind of resets that clock for when melatonin should get released at at the right time later in the evening. And then contra to that is blue light in your eyeballs in the evening from a screen can actually block that melatonin release. Do you see any correlation with that in migraines?
Dr. Amelia Barrett:Absolutely. I'm so glad you brought that up. And, yes, especially for people with serotonin dysregulation, which is, you know, a good chunk of people with migraine. Yeah. You want that morning sunlight to shut off melatonin, shift back into serotonin for your day, and that blue light is gonna make you have a harder time unwinding at night.
Dr. Amelia Barrett:You know? What's our typical unwind in America? You know, it's Netflix and wine or whatever, and, like, neither of those is gonna help you sleep. Right? So it's, you know, it's...
Dr. Amelia Barrett:But it's it's hard to fight people's habits or cultural norms. You know? It's hard for people to let go of those habits. I I get that. But I think I think you're...
Dr. Amelia Barrett:You know, we're we're both on the same page that that's absolutely your goal. You've gotta change those lifestyle factors in order to get to a place of optimal health.
Ravi Kumar MD:Absolutely. So you mentioned alcohol. Where where do you stand on alcohol? I mean, I'll tell you right now. I generally think that there's no healthy amount of alcohol, but please tell me your opinion on this.
Dr. Amelia Barrett:No. Totally agree. You know, acknowledging that we live in a culture where alcohol is everywhere. But I think that the main impact for people with migraine is the effect it has on sleep. You know, I use an Oura Ring to track my sleep.
Dr. Amelia Barrett:When I first started using it many, many years ago, I would still occasionally have a glass of wine. And the the effect on my deep sleep and heart rate variability and pulse on the nights when I had one or maybe two glasses of wine compared to the nights when I didn't have any, absolutely stunning. Once you see that over and over, you're just done. Like, it's not worth it.
Ravi Kumar MD:And that's all been basically recapitulated in the scientific literature. Alcohol is very deleterious for sleep, and sleep is essential to not just normal health, but your brain health and and migraine prevention. So... Yeah. Okay.
Ravi Kumar MD:What do you tell people who are dealing with chronic stress? You know, from what I understand, stress in the acute time period doesn't cause a migraine. It's when you get let down from the stress that you get this migraine. They get a horrible migraine and it, like, doubles their downtime, essentially.
Dr. Amelia Barrett:Mhmm. Yeah. That'll happen until they get worse. And then once they get worse, they're just having migraines all the time. But in that stage of that cortisol let down, you know, cortisol is a steroid that your own body makes.
Dr. Amelia Barrett:Everybody with bad migraines has had their doctor prescribe, you know, a steroid taper or something when they go through a really bad series of of, you know, bad several weeks of headaches that just... It just won't go away. Nothing will break it. You know, we typically do use steroids at that point. Cortisol is your own body's way of doing that.
Dr. Amelia Barrett:You withdraw that, pain comes back. I mean, it definitely tells you there's a problem.
Ravi Kumar MD:Right.
Dr. Amelia Barrett:You know? And it's it's not just the stress. There are many, many things that are gonna need to be fixed at that point. But I think that the problem with this, and I don't know if you have people come come to you and, you know, they're talking to you about their life, and you're like, oh my goodness. You are going through a lot.
Dr. Amelia Barrett:You know? And you gently suggest that, you know, maybe some stress management or stress reduction would be great. And they're like, but my stress is the same as it's always been. Like, it's not any worse now. Why does that explain my symptoms now?
Dr. Amelia Barrett:And that mindset is very difficult. It's very difficult to get people to have insight when their their mind is in that place because they have forgotten what life looked like without all the stress, and they no longer see it as a problem that needs to be solved. So I think that's incredibly challenging because they don't believe you that the effects of stress on the body are real and can produce real physical symptoms. Number two, they don't have the insight that the way they're living right now is impacting their health, that it's something that needs to be fixed. They lose their memory of what life felt like when it wasn't this way.
Dr. Amelia Barrett:And it's really hard to lead them back to prioritizing things that stabilize your nervous system. Saw that you did a podcast on yoga. I love yoga as a way of helping people find that space inside themselves. I think meditation can help. You know, there are tons of different ways to access nervous system regulation and calming.
Dr. Amelia Barrett:But I think the key insight for people is actually finding time for it. They're already busy maxed out doing 10,000,000 things, telling them to add relaxation onto their plate. I don't know. It's a tough one.
Ravi Kumar MD:Okay. So this has been a ton of awesome information. I mean, I've learned so much so far already. You're actually working with patients. You've written a a fantastic new book.
Ravi Kumar MD:Can you kinda tell us about what you're doing with people and what your book's about?
Dr. Amelia Barrett:Yeah. I mean, my my real goal here is to provide new tools for women and men who are struggling with migraines or other chronic headaches because the biology behind a lot of those chronic headaches is very similar to what's going on with migraine. And so I really want to provide people with new solutions that are science backed and effective. So that that is my whole mission. So I am using the migraine genomics test panel that I developed.
Dr. Amelia Barrett:We actually just presented data last week at the World Conference on Precision Medicine and Genomics in Munich about our first 34 people and what we're finding in the treatment resistant population. So I hope to contribute to our understanding of what's going on in those people. And I wrote the book to help people who are struggling understand this new approach because it's different from what they're seeing elsewhere. You know, people are like, what do you what do you mean it doesn't exactly matter what my diagnosis is? Why are you talking about biology?
Dr. Amelia Barrett:I can't change my genes. Right? So I wanted to help people understand why the biology matters, how you can absolutely change your biology. I mean, if you ever took a vitamin d tablet to raise your vitamin d, you changed your biology. You know?
Dr. Amelia Barrett:Yep. I think it just sounds a little more abstract than that. So I really wanted people to understand what that looks like. And in the book, I gave, three different examples of people's journey through this process and, what it what it looks like in sort of a hands on way to use this new science. So the book is called Decode Your Migraine.
Dr. Amelia Barrett:It's everywhere. Amazon. It's at decodeyourmigraine.com. It's on Barnes and Noble. So lots of different ways to access that.
Ravi Kumar MD:That's fantastic. Is there an audiobook version by any chance?
Dr. Amelia Barrett:I am working on it. I'm glad you brought that up. Yeah. I love audiobooks. So I am gonna make one.
Dr. Amelia Barrett:I just published the book within the past month. It hit number one on Amazon in new releases. I was so excited. That was just Yeah. Like, completely unexpected.
Dr. Amelia Barrett:But I was so overjoyed. And... Yeah. So the audiobook is next.
Ravi Kumar MD:You have a podcast as well. Correct?
Dr. Amelia Barrett:I do.
Ravi Kumar MD:And and that's talking about migraines. I assume... I listened to one episode, so you... And it was fantastic. It was a ton of information in, one episode.
Ravi Kumar MD:I was like, wow. There's so much here.
Dr. Amelia Barrett:Good. Good.
Ravi Kumar MD:Yeah. And you're a very efficient communicator. So that's... I mean, I think that's that's rare for a neurologist, by the way. I'll just put that out there.
Ravi Kumar MD:Fair. So... Okay. So if people wanna work with you, is that possible? Do you do you see patients?
Ravi Kumar MD:Should you help patients understand their their migraines?
Dr. Amelia Barrett:Absolutely. I do everything online. So I don't prescribe. We leave that to your doctor, but I give you the tools and education to put all the pieces in place of your recovery plan. So the best way for people to get started is to go to theheadachequiz.com.
Dr. Amelia Barrett:Super quick free quiz, which connects you to menus based on your biology, supplement bundles based on your biology. Like, let's start personalizing this stuff right away with stuff you're already doing. Doesn't cost you any extra money. And if at any point you decide you want additional testing, you can register for one of my courses, get whatever type of testing you want. Of course, there's different price points for different amounts of data.
Dr. Amelia Barrett:More data always costs more money. So you can kind of pick what what works for you.
Ravi Kumar MD:Okay. So without a cheek swab, people can take a a quiz at themigrainequiz.com and get a general idea of which buckets of migraine problems they have. Is that correct?
Dr. Amelia Barrett:Yeah. Yeah. Okay. Exactly. And it's actually at the headachequiz.com.
Dr. Amelia Barrett:I just wanna make sure that's super clear so people can find it. Yeah. Just all one word. And, that'll get you started.
Ravi Kumar MD:Okay. Fantastic. We'll put that link in the show notes along with the other links to your podcast and and to your book. This has been awesome. I hope that some people who listen to this get something that helps empower them to take control of their migraines.
Dr. Amelia Barrett:Thank you for just allowing me to be here and speak to your audience and let more people know that there are new solutions. I want everybody out there who's listening, who is suffering to know that, you know, don't ever give up. I know it's tempting when you're living with chronic pain. You feel like you've tried everything. You're just like, ugh, I can't do one more thing.
Dr. Amelia Barrett:I get it, but don't ever give up. I am seeing changes in people's lives that I never thought were possible during my years in in mainstream medicine, and I just want people to know that there really are effective solutions out there. So just try one more time.
Ravi Kumar MD:Yes. I am a 100% agree with... Agreement with that. The things you're recommending are low risk, potentially super high reward.
Dr. Amelia Barrett:Well said. Well said. Yeah. Alright.
Ravi Kumar MD:Great. Thanks for coming on the show. Okay. So I hope you enjoyed that conversation with doctor Amelia Barrett. Here's what I want you to walk away with.
Ravi Kumar MD:A migraine is really about the last trigger. It's about what has been filling the bucket to the tipping point, and if you understand what that is, it gives you a real place to start making changes. And what Doctor. Barrett said at the very end of the episode is what I'll leave you with. After years of chronic pain or a chronic health problem, it feels like you may have tried everything, and one more attempt may sound completely exhausting.
Ravi Kumar MD:But Doctor. Barrett is watching people churn a corner that she once thought was impossible, and she asked everyone listening not to give up. I agree with her. Try one more thing. A free place to start if you have migraines is her quiz at theheadachequiz.com, all one word.
Ravi Kumar MD:That link, her book, and her podcast will all be linked to in the show notes. Okay, folks, until next time. Stay curious, stay skeptical, and stay healthy. Cheers.