Migraine Is More Than Just a Headache: A Conversation with Dr. Amelia Scott Barrett
By Dr. Cynthia Libert, Functional Medicine Physician | Caring for the Body, Center for Functional Medicine
This post is adapted from the Re-Think Aging podcast. You can listen to the full episode here: https://www.youtube.com/watch?v=5yEFhoGAKhY
Today's conversation is one I have been looking forward to sharing, because it touches something that affects millions of people, especially women, and yet is so often minimized or misunderstood. We are talking about migraine, but this episode is about much more than headaches. We explored migraine through the lens of brain health, inflammation, mitochondrial function, vascular health, hormones, and long-term cognitive resilience.
My guest was Dr. Amelia Scott Barrett, known as Dr. B, a Stanford trained neurologist and founder of Migraine Relief Code. She developed the first genetic testing panel designed specifically for people with migraine and headaches, helping uncover the biologic patterns behind each person's experience. She is the author of the upcoming book Decode Your Migraine: Live in Alignment with Your Biology for Lasting Relief.
The Myth of "Pop a Pill and Power Through"
Dr. B did not hesitate when I asked what people misunderstand most about migraine. As she put it, the most important myth people need to know is that migraine management is all about popping a pill and powering through. That idea, she explained, completely ignores the fact that the brain is generating that migraine for a reason.
Migraine is a signal. Dr. B described it this way: when the brain runs out of energy, it has to shut you down. It sends you to a dark room and keeps you there until the underlying problem is managed. If this keeps happening and goes unaddressed, the brain actually adapts to chronic pain over time. You never fully return to baseline between attacks, a process called chronification. Medications start working less well, new neurological symptoms can appear, and memory and cognition take a hit.
I see this constantly in my own practice. Women in their 40s, 50s, 60s, and even 70s come to me saying they simply live with headaches and push through because that is what it takes to keep functioning. Dr. B's message is one I want every one of them to hear: migraine is information from your body, and it deserves attention, not just suppression.
Four Systems Behind Migraine
Genetic research has clarified a great deal here. Dr. B referenced a large genome-wide association study comparing the genes of over 100,000 people with migraine to about 700,000 people without it. That research points to four biological systems that are not working optimally in people with migraine:
- Brain chemistry — abnormalities in neurotransmitter systems, including serotonin, dopamine, and glutamate
- Inflammation — often connected to gut health and food triggers
- Energy production — mitochondrial function at the cellular level
- Vascular function — blood flow and the nerve cells lining blood vessels, where much of migraine pain actually originates
As Dr. B said, these are "all areas that we can impact through our daily choices including functional medicine, prescription medications." Understanding your own combination of these four factors is, in her words, the path to lasting relief.
This is exactly the kind of root-cause thinking I bring to cognitive decline prevention in my own work. Migraines often improve as we address the whole person, particularly gut health and neuroinflammation.
The Migraine-Dementia Connection
One part of our conversation stayed with me. Dr. B described new research presented at the American Academy of Neurology meeting, drawn from a longitudinal study following 40,000 people over decades. A migraine diagnosis in your 60s was associated with about a 25 percent higher chance of a subsequent dementia diagnosis. Even a migraine diagnosis in your 40s was associated with roughly a 7 percent increased risk.
Dr. B put it plainly: functional medicine is medicine minus pharma. It is not a parallel system. It is solid molecular and cellular science aimed at supporting the body's own complex biological pathways, which do not fit neatly into a single-drug trial because you are rarely changing just one thing.
Hormones and the Perimenopause Connection
Because migraine disproportionately affects women, we spent time on the role of hormones, especially around perimenopause and menopause. Dr. B explained that dropping estrogen is a potent migraine trigger, both around ovulation earlier in life and during the hormonal swings of perimenopause.
Her guidance was direct: an estradiol patch can stabilize those fluctuations and has led to dramatic improvements in migraine frequency and severity for many patients. She was also careful to clarify a common point of confusion. The concern about migraine with aura and blood clot risk applies to pill-based estrogen, not patch-based forms, because of how the liver metabolizes each differently.
Nutrients Dr. B Recommends
When I asked about her favorite nutrients and supports for brain and migraine health, she named magnesium, coenzyme Q10, and riboflavin as familiar staples, along with L-theanine for calming overfiring in the brain and a small amount of supplemental melatonin to support sleep and reduce oxidative stress.
A Hopeful Note
Dr. B shared that what gives her the most hope is what we are learning about brain cells and what they need to thrive. She specifically pointed to Dr. Dale Bredesen's work as having shone a light on both the cellular mechanisms of cognitive decline and the practical steps we can take to support brain health, a perspective I share deeply in my own practice.
If migraine or any kind of chronic headache is impacting your life, Dr. B invites you to visit headachequiz.com for a short quiz that can help point you toward what might be happening beneath the surface.
Ready to take a root-cause approach to your health? Start with a free strategy session with the Caring for the Body team.
Whole-person care. Science-backed. Faith-informed.