Acid Reflux Medications Linked to Higher Migraine Risk

Analysis by Dr. Joseph Mercola

• August 21, 2024

Story at-a-glance

• Proton-pump inhibitors (PPIs), which are often prescribed to relieve acid reflux and heartburn, may increase the risk of migraine headaches
• Other acid reflux medications, including H₂ receptor antagonists (H₂RAs) and generic antacids, may also increase migraine risk
• The use of PPIs was associated with a 70% increase in migraine risk, H₂RAs with a 40% increase and generic antacids with a 30% increase compared to non-users
• Heartburn is typically an indicator you have too little hydrochloric acid, which means if you add a PPI medication, you are only going to make the problem worse
• If you’re suffering from migraine headaches unrelated to acid reflux medications, be aware that excess estrogen and inadequate progesterone, along with high linoleic acid (LA) intake, are likely key factors; lowering LA and estrogen can eliminate most migraines

Proton-pump inhibitors (PPIs), which are often prescribed to reduce stomach acid¹ in a misguided attempt to relieve acid reflux and heartburn, may increase the risk of migraine headaches.² Other acid reflux medications, including H₂ receptor antagonists (H₂RAs) and generic antacids, were also linked to an increased risk of migraine or severe headache.

The finding, from University of Maryland, College Park researchers, adds to the sizeable number of reasons why you shouldn’t take antacids. If you struggle with heartburn, it’s often possible to resolve the issue without pills or an increased risk of migraines.

Popular Acid Reflux Medications Increase Migraine Risk

An estimated 113 million PPI prescriptions are filled worldwide each year,³ but resorting to medications to relieve acid reflux may increase your risk of painful migraines. The study used data from adults in the 1999 to 2004 National Health and Nutrition Examination Survey.

Results showed that among 11,818 U.S. adults, those using acid-suppression therapy had higher odds of experiencing migraines or severe headaches. The use of PPIs was associated with a 70% increase in risk, H₂RAs with a 40% increase and generic antacids with a 30% increase compared to non-users.

These findings support previous research that migraines or severe headaches can be an adverse effect of PPIs and suggest that other acid-suppressing medications (H₂RAs and generic antacids) might also cause them. The researchers suggested that migraine risk should be a consideration in patients using acid-suppressing medications, especially in light of recent advice to reduce PPI use.⁴

It’s estimated that up to 70% of people taking PPIs shouldn’t be,⁵ and the American Gastroenterological Association released a clinical practice update in 2022 suggesting, “All patients without a definitive indication for chronic PPI should be considered for trial of de-prescribing.”⁶

Why PPIs May Cause Migraines

The exact reasons why PPIs might cause migraines or headaches are not well understood, but one possibility is that PPIs disrupt the balance of important ions in the fluid around your brain and spinal cord, which can make nerves more excitable and lead to migraines.⁷

In addition, PPIs work by strongly blocking acid production in the stomach. This can cause changes in electrolyte levels. Many PPIs also cross into the brain, where they might have a direct impact. Some evidence suggests that the same pumps PPIs block in the stomach also exist in the brain and help control the release of neurotransmitters, which are chemicals that send signals in the brain.

By affecting these pumps, PPIs might change the levels of potassium and sodium in the brain, which can affect nerve activity and potentially trigger migraines. Additionally, conditions that lower the pH (making it more acidic) in the brain, blood and cerebrospinal fluid might make it easier for PPIs to affect these pumps.

Studies in humans and animals have shown that ionic disturbances in the cerebrospinal fluid are greater during migraines. If these pumps are blocked, potassium levels might increase, leading to migraines with aura, while overactivation might raise sodium levels, causing increased nerve activity and migraines.⁸

If you’re suffering from migraine headaches unrelated to acid reflux medications, be aware that excess estrogen and inadequate progesterone, along with high linoleic acid (LA) intake, are likely key factors. Lowering LA and estrogen can eliminate most migraines. For details, read my article, “Migraines Strongly Associated With High Estrogen and Low Thyroid.”

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Why You Shouldn’t Take Acid Reflux Medications

An increased risk of migraines is just one reason to reconsider the use of PPIs and other acid reflux drugs. PPIs are associated with a number of adverse effects, including:⁹

• Osteoporosis and related fractures
• Community-acquired pneumonia
• Clostridium difficile colitis
• Cardiovascular morbidity
• Hypomagnesemia, or low magnesium levels

Research also shows taking PPIs for more than two years increases your risk of vitamin B12 deficiency,¹⁰ while the drugs are also linked to dementia, to the extent that researchers concluded, “The avoidance of PPI medication may prevent the development of dementia.”¹¹

Further, at a foundational level, PPIs often cause more harm than good. PPIs inhibit the proton pump in your body that produces hydrochloric acid. But excess stomach acid is rarely the primary trigger of heartburn and indigestion. On the contrary, heartburn is typically an indicator you have too little hydrochloric acid, which means if you add a PPI medication, you are only going to make the problem worse by decreasing your acid level even more.

Because hydrochloric acid (and pepsin) is necessary to break down protein in your intestinal tract, reduced acid levels affect your body's ability to absorb nutrients. Without adequate protein breakdown, you also increase your risk of dysbiosis, an imbalance in gut microbiome between harmful and friendly bacteria.

As these undigested protein molecules ferment in your intestines, they become food for pathogens such as Candida, C. difficile and Helicobacter pylori (H. pylori). If you’re currently taking PPIs, be aware that you can develop both tolerance to and dependence on them.

As a result, it can be extremely difficult to stop using these drugs. As soon as you stop taking them, you’ll experience rebound, and the rebound won’t stop until your stomach acid level is normalized and the lower esophageal sphincter (LES) starts closing properly, which in some long-term use cases can take up to two years.¹²

For this reason, do not stop taking PPIs cold turkey. It's important to wean yourself off them gradually to avoid severe rebound symptoms. Work with your health care provider to gradually lower the dose you're taking while simultaneously implementing the natural strategies that follow.

Once you get down to the lowest dose of the PPI, you can start substituting with an over-the-counter H₂ blocker like Pepcid (famotidine), which appears to be the safest of all the options out there. Then, gradually wean off the H₂ blocker over the next several weeks.

What Causes Acid Reflux — And How to Resolve It

Acid reflux occurs when contents from your stomach back up into your esophagus, causing stomach acid to irritate the lining of your esophagus. Other common names for this condition include acid indigestion, acid regurgitation, heartburn and gastroesophageal reflux disease (GERD).

If you experience acid reflux symptoms more than twice a week, you very likely have reflux disease or GERD, which involves bloating, burning pain in your chest and gut discomfort. As mentioned, acid reflux is typically caused by a deficiency in stomach acid, not excess. As explained by A Midwestern Doctor:¹³

"The lower esophageal sphincter is pH sensitive and only closes once sufficient acidity is present in the stomach (which makes sense since otherwise food would not be able to get to the stomach in the first place, but once it’s there, you need a way to keep it from getting back into the throat)."

As for why you may have stomach acid insufficiency, stomach acid is made from hydrogen and chloride, and ultraprocessed foods frequently do not contain the dietary sources of these components. Certain autoimmune conditions can also attack acid-producing cells in your stomach, causing production to decline. Stomach acid production is also known to decrease with age.

H. pylori infections in your stomach will lower acid production as well. Mitochondrial dysfunction may also be a major part of the puzzle. As explained by A Midwestern Doctor:¹⁴

"Stomach acid production is an energy intensive process (hence the cells which make stomach acid having a large number of mitochondria), and I have long suspected that mitochondrial dysfunction ... is partly responsible for declining stomach acid levels."

In addition to optimizing your mitochondrial function, consuming hydrogen-rich foods, such as fresh fruits, vegetables, proteins and whole grains,¹⁵ and chloride-rich foods, such as salt, seaweed, rye, tomatoes, lettuce, celery and olives,¹⁶ provides the dietary sources for your body to make stomach acid.

Natural Strategies for Heartburn Relief

Instead of PPIs and OTC antacid medications, consider the following nondrug alternatives for occasional heartburn relief:^{17,18,19,20,21}

Aloe juice — The juice of the aloe plant naturally helps reduce inflammation, which may ease symptoms of acid reflux. Drink about one-half cup of aloe juice before meals. To avoid its laxative effect, look for a brand in which the laxative component has been removed.

Apple cider vinegar (raw, unfiltered) — Take 1 tablespoon of raw unfiltered apple cider vinegar in a large glass of water before or directly after meals.

Astaxanthin — When compared to a placebo, this potent antioxidant was found to reduce symptoms of acid reflux, especially for individuals with pronounced H. pylori infection.22 The researchers concluded a daily dose of 40 mg of astaxanthin was effective for reflux reduction.

Baking soda — One-half to 1 teaspoon of baking soda (sodium bicarbonate) in an 8-ounce glass of water or orange juice will help neutralize your stomach acid and ease the burn of acid reflux. While I do not advise this as an ongoing remedy, it is effective on an "emergency" basis when you are in excruciating pain.

Ginger root — Ginger has a gastroprotective effect by suppressing H. pylori. It also accelerates gastric emptying which, when impaired, contributes to heartburn. Add two or three slices of fresh ginger root to 2 cups of hot water and let it steep for several minutes. Drink it about 20 minutes prior to your meal.

Sauerkraut — Consuming sauerkraut or cabbage juice will stimulate your body to produce stomach acid.

Glutamine — The amino acid glutamine has been shown to address gastrointestinal damage caused by H. pylori. Glutamine is found in many foods, including beef, dairy products, eggs, fish and select fruits and vegetables. L-glutamine is widely available as a supplement.

Ripe papaya or a papain supplement — Papaya contains papain, an enzyme useful for breaking down both protein and carbohydrates.

Fresh pineapple or bromelain supplement — Bromelain is a proteolytic enzyme found in pineapple that helps digest proteins.

Pepsin supplement — Like bromelain, pepsin is a proteolytic enzyme involved in protein digestion.23

Betaine HCI supplement — Betaine HCl is the hydrochloride salt of betaine, not to be confused with betaine or trimethylglycine (TMG). As noted in a 2020 review paper: "... the most common recommendation for the use of betaine HCl supplements is usually implemented using an empirical test for low stomach acid whereby increasing doses of betaine HCl are given during sequential meals until such time as an uncomfortable sensation is noticed by the patient. Along with improvements in symptoms of dyspepsia (or laboratory analysis of improved protein digestion), the lack of side effects acts as an empirical confirmation that low gastric acid production was contributing to poor digestion and/or dyspeptic symptoms."24

Bitters — Bitters have a long history of use in herbal medicinal traditions to promote digestion and/or to relieve digestive complaints.25

Slippery elm — Slippery elm coats and soothes your mouth, throat, stomach and intestines, and contains antioxidants that may help address inflammatory bowel conditions. Because it stimulates nerve endings in your gastrointestinal tract, it is useful for increasing mucus secretion, which has a protective effect against ulcers and excess acidity.

Vitamin D — Vitamin D is important for your gut health. Once your vitamin D levels are optimized, you will benefit from your body's production of about 200 antimicrobial peptides that will help eradicate gut infections.

Zinc — Your stomach needs zinc to produce stomach acid, so make sure your body has the necessary raw ingredients. The recommended daily amount for adults is 8 to 11 mg. Zinc-rich foods include oysters, lobster, beef and raw yogurt. A zinc supplement can be used if you rarely eat these foods.26

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