Proton pump inhibitors (PPIs), often prescribed to reduce stomach acid1 Misguided attempts to relieve acid reflux and heartburn may increase your risk of migraines.2 Other acid reflux medications including H2 Receptor antagonist (H2Taking RA and common antacids has also been shown to increase the risk of migraines or severe headaches.
The findings by researchers at the University of Maryland, College Park, add to the considerable number of reasons why you shouldn’t take antacids. If you suffer from heartburn, there are many ways to solve the problem without taking medication or increasing the risk of migraines.
Popular Acid Reflux Medications Increase Migraine Risk
It is estimated that approximately 113 million PPI prescriptions are written worldwide each year.3 But using medications to relieve acid reflux may increase your risk of painful migraines. The study used data from adults who participated in the National Health and Nutrition Examination Survey from 1999 to 2004.
Results showed that among 11,818 U.S. adults, those who used acid-suppressing therapy were more likely to experience migraines or severe headaches. PPI use was associated with a 70 percent increased risk.2RA had a 40% increase compared to non-users, and common antacids had a 30% increase.
These findings support previous research suggesting that migraines or severe headaches may be a side effect of PPIs and other acid suppressants (H).2RA and common antacids) may also cause it. The researchers suggested that the risk of migraine should be considered in patients using acid suppressants, especially in light of recent advice to reduce PPI use.4
It is estimated that up to 70% of people taking PPIs should not take them.5 And the American College of Gastroenterology released a clinical practice update in 2022 suggesting that “all patients without a clear indication for chronic PPI use should be considered for a discontinuation trial.”6
Why PPIs Can Trigger Migraines
The exact reason why PPIs cause migraines or headaches isn't well known, but one possibility is that PPIs may upset the balance of important ions in the fluid around the brain and spinal cord, making the nerves more excited and triggering a migraine.7
PPIs also work by potently blocking stomach acid production. This can cause changes in electrolyte levels. Many PPIs can also travel to the brain and have a direct effect. Some evidence suggests that the same pumps that PPIs block in the stomach are present in the brain, helping to control the release of neurotransmitters, chemicals that send signals to the brain.
PPIs can affect these pumps, altering potassium and sodium levels in the brain, which can affect neural activity and potentially trigger migraines. Also, conditions that lower the pH of the brain, blood, and cerebrospinal fluid (make them more acidic) can make it more likely for PPIs to affect these pumps.
Studies on humans and animals have shown that ion disturbances in the cerebrospinal fluid are greater during migraines. Blockage of this pump can lead to increased potassium levels, which can cause migraines with aura, while overactivation can lead to increased sodium levels, which can increase neural activity and cause migraines.8
If you suffer from migraines that are not related to acid reflux medication, know that too much estrogen, not enough progesterone, and high linoleic acid (LA) intake are likely the main causes. Lowering LA and estrogen can eliminate most migraines. For more information, read my article “Migraines Are Strongly Linked to High Estrogen and Low Thyroid.”
Why You Shouldn't Take Acid Reflux Medications
The increased risk of migraines is just one reason to reconsider your use of PPIs and other acid reflux medications. PPIs are associated with a number of side effects, including:9
- Osteoporosis and related fractures
- Community-acquired pneumonia
- Clostridium difficile colitis
- Cardiovascular disease morbidity
- Hypomagnesemia, i.e. low magnesium levels
Studies have shown that taking PPIs for more than two years increases the risk of vitamin B12 deficiency.10 The drugs have also been linked to dementia, with researchers concluding that “avoiding PPI drugs may prevent the onset of dementia.”11
Also, at a basic level, PPIs often do more harm than good. PPIs inhibit the body’s proton pump, which produces hydrochloric acid. However, excess stomach acid is rarely the primary cause of heartburn and indigestion. On the contrary, heartburn is usually an indicator of too little hydrochloric acid, so adding PPI drugs only makes the problem worse by lowering acid levels even further.
Hydrochloric acid (and pepsin) is needed to break down proteins in the intestines, so when acid levels are low, it affects the body’s ability to absorb nutrients. If proteins are not broken down properly, the risk of dysbiosis, an imbalance of gut microbes between harmful and friendly bacteria, also increases.
As undigested protein molecules ferment in the intestines, they become food for pathogens such as Candida, Clostridium difficile, and Helicobacter pylori (H. pylori). If you are currently taking PPIs, be aware that both resistance and dependence to PPIs can develop.
As a result, it can be very difficult to stop using this drug. You will experience a rebound as soon as you stop taking it, and the rebound will not stop until your stomach acid levels return to normal and your lower esophageal sphincter (LES) begins to close properly. In some cases of long-term use, this can take up to two years.12
For this reason, do not stop taking PPIs abruptly. It is important to stop gradually to avoid severe rebound symptoms. Work with your healthcare provider to gradually lower your dose, while also implementing natural strategies such as:
If you lower your PPI dose to the lowest possible dose, you can replace it with the generic drug H.2 Blockers such as Pepcid (famotidine) appear to be the safest of all options. Then gradually wean off the H.2 The circuit breakers will be tripped for the next few weeks.
Causes and Solutions for Acid Reflux
Acid reflux occurs when stomach contents flow back up into the esophagus, causing stomach acid to irritate the esophageal mucosa. Other common names for this condition include acid indigestion, acid reflux, heartburn, and gastroesophageal reflux disease (GERD).
If you experience acid reflux symptoms more than twice a week, you most likely have acid reflux disease, or GERD. GERD is accompanied by bloating, burning chest pain, and intestinal discomfort. As mentioned earlier, acid reflux is usually caused by a deficiency, not an excess, of stomach acid. As explained by A Midwestern Doctor:13
“The lower esophageal sphincter is pH-sensitive and will only close when there is enough acid in the stomach (which is understandable since food can't reach the stomach in the first place, but once it does, there needs to be a way to keep it from going back up into the throat).”
The reason why stomach acid deficiency occurs is because stomach acid is made of hydrogen and chloride, and ultra-processed foods often do not have dietary sources of these ingredients. Certain autoimmune diseases can also attack the stomach’s acid-producing cells, reducing their production. It is also known that stomach acid production decreases with age.
H. pylori infection above also reduces acid production. Mitochondrial dysfunction may also be a major piece of the puzzle. As explained by Midwestern Doctor:14
“Stomach acid production is an energy-intensive process (hence the fact that the cells that make stomach acid contain a large number of mitochondria). I have long suspected that mitochondrial dysfunction is partly responsible for low stomach acid levels.”
In addition to optimizing mitochondrial function, eat hydrogen-rich foods such as fresh fruits, vegetables, proteins, and whole grains.15 Foods rich in chloride, such as salt, seaweed, rye, tomatoes, lettuce, celery, and olives.16 Provides a food source that enables the body to produce stomach acid.
Natural Strategies for Heartburn Relief
Instead of PPIs and OTC antacids, consider these non-drug alternatives to relieve occasional heartburn:17,18,19,20,21
Aloe juice – The juice of the aloe plant naturally helps reduce inflammation, which can help ease acid reflux symptoms. Try drinking half a cup of aloe juice before a meal. Look for a brand that has been laxative-free to avoid the laxative effect. |
Apple cider vinegar (raw, unfiltered) – Drink 1 tablespoon of unfiltered apple cider vinegar in a large glass of water before or immediately after a meal. |
Astaxanthin — Compared to a placebo, this powerful antioxidant was shown to relieve acid reflux symptoms, especially in people with severe H. pylori infection.22 Researchers concluded that taking 40 mg of astaxanthin daily was effective in reducing reflux. |
Baking soda — Adding a half teaspoon to a teaspoon of baking soda (sodium bicarbonate) to 8 ounces of water or orange juice will help neutralize stomach acid and relieve pain caused by acid reflux. It is not recommended as an ongoing treatment, but it is effective as an “emergency” treatment when you are experiencing severe pain. |
Ginger root – Ginger has a stomach-protecting effect by suppressing H. pylori. It also accelerates stomach emptying, which, when impaired, contributes to heartburn. Steep two or three pieces of fresh ginger root in two cups of hot water for a few minutes. Drink about 20 minutes before meals. |
Sauerkraut — Drinking sauerkraut or cabbage juice causes your body to produce stomach acid. |
Glutamine — The amino acid glutamine has been shown to help with stomach damage caused by H. pylori. Glutamine is found in many foods, including beef, dairy products, eggs, fish, and some fruits and vegetables. L-glutamine is widely available as a supplement. |
Ripe papaya or papain supplements — Papaya contains papain, an enzyme that helps break down proteins and carbohydrates. |
Fresh pineapple or bromelain supplements — Bromelain is a proteolytic enzyme found in pineapple that helps digest proteins. |
Pepsin supplements – Like bromelain, pepsin is a proteolytic enzyme involved in protein digestion.23 |
Betaine HCI Supplement — Betaine HCl is the hydrochloride salt of betaine, and should not be confused with betaine or trimethylglycine (TMG). As noted in a 2020 review article: “… the most common recommendations for betaine HCl supplementation are usually implemented using empirical testing for low stomach acidity, with increasing doses of betaine HCl during successive meals until the patient experiences discomfort. “The absence of side effects or improvement in dyspeptic symptoms (or laboratory results showing improvement in protein digestion) is empirical confirmation that low stomach acid production contributes to dyspepsia and/or dyspeptic symptoms.”24 |
Bitters — Bitters have long been used in herbal medicine to promote digestion and relieve digestive disorders.25 |
Slippery Elm — Slippery elm coats and soothes the mouth, throat, stomach, and intestines, and contains antioxidants that may help resolve inflammatory bowel disease. It is useful for increasing mucus secretion because it stimulates the nerve endings in the gastrointestinal tract, which has a protective effect against ulcers and excessive acidity. |
Vitamin D — Vitamin D is important for gut health. When your vitamin D levels are optimized, your body produces about 200 antimicrobial peptides that help fight gut infections, which can benefit you. |
Zinc – The stomach needs zinc to produce stomach acid, so make sure your body has the raw ingredients it needs. The recommended daily intake for adults is 8 to 11 milligrams. Foods rich in zinc include oysters, lobster, beef, and raw yogurt. If you rarely eat these foods, you can use a zinc supplement.26 |
