By symptom
Headaches and migraines.
Recurring headache patterns the standard workup hasn't solved.
What’s actually going on
How I think about this.
Recurring headache is one of the most undertreated symptoms in adult medicine. The conventional workflow is to rule out the dangerous causes (which is the right starting move) and then prescribe a class of medications for the symptom. That is not the same as understanding the trigger.
The drivers I see most are blood sugar volatility (sharp glucose swings reliably trigger headaches in susceptible patients), gut inflammation (the gut-brain inflammatory axis is one of the most underappreciated drivers of migraine), magnesium and B-vitamin gaps (B2/riboflavin and magnesium have real prophylactic data for migraine), hormonal patterns (estrogen swings in perimenopause and the menstrual cycle, testosterone in men), food sensitivities operating below the IgE allergy threshold, sleep disruption (both fragmented sleep and apnea), and the dehydration and caffeine withdrawal patterns most patients already know about.
The clinical handle that often gets missed: mitochondrial dysfunction is increasingly recognized in chronic migraine, and the metabolomic panel reads it directly. CoQ10, riboflavin, and the broader mitochondrial cofactor status often shift in ways that respond to targeted intervention.
The physician’s lens
How I read this in practice.
I read recurring headache across the metabolic, gut, hormonal, and mitochondrial axes together. Fasting insulin and HbA1c. The thyroid panel. Sex hormones timed to cycle. Magnesium, B-vitamin, and CoQ10 status from the metabolomic panel. If the gut story warrants it, a stool panel. I work with the patient to build a trigger log against the data so the pattern resolves into a treatment plan.
The systems behind it
Where this symptom comes from.
Most cases touch more than one. Open each area to read the biology underneath.
Biological pillars
Pillar
Mitochondria.
Mitochondria produce the ATP that powers every function in your body. Directly assessable. Directly correctable.
Read this pillarPillar
Gut-Immune health.
The microbiome runs 70% of your immune system, shapes inflammation, mood, and metabolism. Read the ecosystem directly.
Read this pillarPillar
Metabolomics.
Urinary organic acids read the upstream patterns of energy production, neurotransmitter balance, detoxification, and recovery.
Read this pillarWhat I’d test first
The data that explains it.
Headache work needs the metabolic axis, the hormonal context, and the mitochondrial nutrient story together. The metabolomic panel is particularly informative here because it reads the cofactors most prophylactic migraine interventions actually depend on.
Blood work
Cardiometabolic blood panels
Reads fasting insulin, HbA1c, inflammation, and the thyroid axis. The metabolic context most headache workups skip.
Read the panelAdvanced testing
Metabolomix+
Reads B-vitamin status (especially B2), magnesium, CoQ10, and the mitochondrial energy story. The cofactors that often resolve migraine when supplemented properly.
Read the panelWhile you wait
Moves worth making before testing.
These are the levers I’d pull while we set up the workup. Most of them produce real signal inside two weeks.
- Track your headaches against food, sleep, cycle, and hydration for two weeks. The pattern is usually there in the data.
- Eat protein at breakfast. The post-glucose-spike crash is a reliable trigger in many patients.
- Hydrate aggressively. Coffee counts against you in this column, not for you.
- If you are female and cycling, note headache timing against your cycle phase. The hormonal pattern is often readable from your own data before any lab confirms it.
If two weeks of the basics doesn’t move the needle, that is exactly the kind of presentation a Precision Call exists for. Your biology is telling you something the lifestyle layer cannot fix on its own.
More reading
What I’ve written on this system.
Article
Mitochondrial health and aging.
Aging is, to a meaningful degree, mitochondrial. The decline is not inevitable on a fixed trajectory. The interventions that slow it are the same ones that improve your function right now.
Read thisArticle
Fasting and mitochondrial biogenesis.
Fasting drives mitochondrial biogenesis through a specific signaling pathway. Done well, it improves metabolic flexibility. Done badly, it undermines the same biology it is supposed to support.
Read thisArticle
Mitochondria and brain health.
The brain is your most energy-hungry organ. When mitochondrial function slows, cognition slows with it. Most brain symptoms in modern adults have a mitochondrial layer worth reading.
Read thisBrowse other symptoms
Something else on your mind?
Fatigue and low energy
When the tank stays low no matter how much you sleep.
Brain fog
The lights are on but the signal feels weak.
Poor sleep
Either you can't fall asleep, or you can't stay asleep.
Digestive issues
Bloating, irregularity, sensitivities that keep widening.
Mood and stress
Patience runs short, recovery from stress takes longer.
Hormonal imbalance
Energy, sleep, libido, and weight stop responding to the basics.
Perimenopause
The years when the body's hormonal rhythm changes, before the period stops.
Low libido
Desire that used to be reliable is gone or muted. Both sexes, both directions.
Hair loss
Thinning, shedding, or texture changes that didn't used to happen.
Erectile dysfunction
ED is the canary. The body is telling you something about vascular and hormonal health.
Weight loss resistance
You eat well, you train, the scale doesn't move. Something deeper is in the way.
High cholesterol concern
Your last lab flagged it. You want a second opinion before you take a statin.
High blood pressure concern
The reading came back elevated. You want the full picture before you start a prescription.
Insomnia
You can't get to sleep. You can't stay asleep. Or both.
Athletic recovery problems
You train hard. You don't bounce back. Something physiological is in the way.
Headaches and migraines
Recurring headache patterns the standard workup hasn't solved.
Joint pain
Pain in one joint is often a local problem. Pain that travels, or pain in multiple joints, is usually a systemic one.
Anxiety
Some anxiety is psychological. Much of what shows up in clinic is biological with a psychological face.
Acne and skin issues
The skin is rarely the problem. It is the most visible report on what is happening one layer down.
Thyroid symptoms
Cold all the time. Hair shedding. Sluggish mornings. A 'fine' TSH that explains none of it.
PMS and cycle issues
A difficult cycle is often a window into how your body handles hormones across the rest of the month.
Food cravings
Cravings are biology pulling for what it needs, often dressed up as what it can get easily.
Chronic allergies
New or worsening allergies in adulthood usually point to a barrier and an immune tone, not a specific allergen.
Start here
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