Diagnosis and Treatment
We suggested that CH undergo blood testing to ascertain his hormone levels. Blood testing—including lipid profile, pregnenolone, DHEA sulfate, total testosterone, estradiol, and progesterone—confirmed a severe, underlying hormonal imbalance. His total cholesterol level was high (257 mg/dL, compared the recommended range of less than 200 mg/dL). As reported in previous studies,6-8 we believe that elevated total cholesterol reflects insufficient steroid hormone production. Patient’s total testosterone, pregnenolone, and DHEA sulfate levels were below the standard ranges for these hormones (laboratory ranges for the 20-29 age group).
The lab report numbers were as follows: total testosterone was 187 ng/dL (standard range is 241-827), pregnenolone was less than 10 ng/dL (standard range is 10-200), and DHEA sulfate was 199 ug/dL (standard range is 280-640). Progesterone, at 1.6 ng/mL, was slightly higher than the maximum standard level (standard range is 0.3-1.2). Estradiol was within the standard range, at 18 pg/dL (standard range is 0-53).
Patient’s initial program included:
- 100 mg of pregnenolone taken in the morning
- 25 mg of DHEA taken in the morning
- 420 mg (one scoop) of Magna- Calm (magnesium citrate) at bedtime
- one capsule of MetaRest (con- taining 3 mg of melatonin, 250 mg of kava root extract, and 10 mg of vitamin B6) at bedtime
- one scoop of ProGreens probi- otic formula (including lacto- bacillus group 3.5 billion, bifi- dobacterium group 1 billion, and streptococcus thermophilus 0.5 billion) in the morning.
We discussed with CH the necessity of replacing all three deficient hormones (pregnenolone, DHEA, and testosterone), but he preferred to stay with this initial program without testosterone for a couple of weeks.
About a week later, patient began to experience night sweats and his body temperature soared from 95.6 to 102.7 degrees F. His doctor prescribed an antibiotic, and a week or so later the symptoms ceased. Based on his very low testosterone level, we sent him to a urologist for further tests and a testosterone prescription. The urologist ordered a CT scan of his pelvis and head, which apparently showed nothing abnormal. The urologist said he thought CH’s testosterone levels might be low as a result of his vasectomy years ago. He also said he was unaware of any correlation between testosterone levels and migraine incidence.
On April 15, 2004, the urologist prescribed TestimTM 1% testosterone gel. Patient began using the gel daily. As of today, CH reports he is completely migraine free. He has also experienced an improvement in sexual function and energy levels, without any negative side effects.
We have called attention to CH’s case because we believe that most migraine sufferers can be free of this devastating disorder. Migraine is a very complex disease, and affects up to 12% of males and 24% of females.9 Feedback from peripheral organs can be disrupted and disregulation may occur, leading to physiological instability and functional disease. Because migraine usually is characterized by combinations of neurohormonal, metabolic, and (quite often) gastrointestinal manifestations,5 a multimodal treatment strategy is required.
Prophylactic treatment of migraine patients is desirable because the currently prescribed prescription drugs are not always effective in all patients and allow recurrence of headaches in a high percentage of patients, occasionally with severe adverse side effects.
It has been previously reported that sex hormones play an important role in the creation and regulation of migraine.10 Significantly low plasma testosterone levels were found in active cluster headache patients.11 CH’s case shows that hormonal restoration is a key element of any program recommended for the management of migraine.
Several studies have shown that magnesium and melatonin can provide relief from migraine.12-15 We recommend that both agents be included in treatment programs that aim to eliminate migraine.
Because major depression is approximately three times more common in persons with migraine16 and fatigue likewise is common in migraine patients,17 we must stress the importance of the association between hormonal therapy and kava root extract, which may represent an excellent therapeutic tool for treating migraine, particularly for those suffering from anxiety and depression. Kava kava therapy accelerates the resolution of psychological symptoms without diminishing the therapeutic action of hormones.
Restoration of natural intestinal flora, from our point of view, is also extremely important in treating migraine, because migraine patients usually take different drugs over the years that change intestinal flora and diminish intestinal absorption.
We recommended our program to CH to restore youthful levels of hormones, rebalance the autonomic nervous system (sympathetic and parasympathetic systems), improve the calcium:magnesium ratio, and enhance intestinal absorption. Because CH’s migraines and concomitant symptoms have disappeared, we believe that this case report suggests that similar treatment methodologies may have a wider application in patients with migraine.
A quick “thank you” to Dr. Dzugan.
I’ve suffered from migraine for about 14 years, and for the last nine or so I have absolutely lived on Imitrex® injections, pills, and other prescription drugs. During this time, I had five different doctors, and saw two neurologists, all of whom simply told me to continue taking Imitrex® when I got headaches. I would conservatively estimate that I averaged one to two headaches a week, and have taken hundreds of doses of Imitrex®, and likely a couple of thousand Midrin®, Excedrin®, and other such drugs.
Dr. Dzugan suggested a couple months ago that I have my hormone levels checked, and he was not surprised by what my results showed. After talking with Dr. Dzugan, my physician, and a urologist, it was determined that supplements alone wouldn’t likely correct my hormone imbalance, and I’m now taking a hormone replacement. Since starting on this treatment, I have not had a single migraine headache.
In all of these years, not one doctor, or any article or study, suggested that I should check for a hormone imbalance as the cause of my migraines. Dr. Dzugan has done what no one else ever could.
I can’t thank him enough, nor endorse his abilities enough, to ever repay him for his help. Thanks again.