Updated Oct. 26, 2017. Since writing this article I’m more and more convinced of the benefit of niacin to those with migraine, despite the fact that niacin is a methyl sponge.  Stay tuned for more blog posts on niacin.

Migraineurs generally have high histamine, high homocysteine, low blood sugar, dilated blood vessels and consequent low blood pressure, and liver and gallbladder problems – in addition to the splitting head pain! Niacin (nicotinic acid), as it turns out, is known to contribute to, cause, or exacerbate all of these problems.  On the other hand, niacin reduces glutamate and increases serotonin, which in and of itself is hugely relevant to those with migraine.

We need B vitamins, without a doubt.  Migraineurs especially benefit from B2 (riboflavin), B5 (pantothenic acid), and B6 (pyruvic acid).

If you have migraines, you probably have already been prescribed B vitamins, especially methylated B12 or methylfolate. The problem is that supplementation with either single or combined B complex vitamins can often trigger migraines. Clearly, we need (some or most) B vitamins, but it appears we often can’t tolerate them.  Why are we deficient and why can’t we tolerate supplementation?  How do we get out of this chicken-and-egg conundrum? And is niacin (nicotinic acid) one of the culprits in migraines triggered by B vitamins?

First, a Word about Forms of Niacin and Food Sources

Niacin is available in three forms – niacin (nicotinic acid), niacinamide (aka nicotinamide), and inositol nicotinate.  Niacin will cause a flush, while niacinamide and inositol nicotinate will not.  While all forms are good for their ability to heal schizophrenia, niacinomide is not as effective as niacin or inositol nicotinate for lowering cholesterol. It appears that niacinamide and inositol nicotinate may be more supportive of those with migraine if it is true that they don’t trigger mast cell degranulation in the same way that niacin does (this is discussed later in this article). Slow-release niacin capsules are also available (but not recommended, according to the research I’ve done).

Foods containing niacin include turkey, chicken, liver, mushrooms, peanuts, and tuna. Nutritional yeast also contains very high levels of niacin – and is a known migraine trigger (hmmmmm . . . ). Also, you can buy histamine-degrading probiotics which produce niacin. One of the histamine-reducing strains that produces niacin, b. infantis, can be purchased as a stand-alone probiotic (I found this brand, though I have never tried it so am not promoting it specifically). B infantis also produces the b vitamins folate, biotin, and thiamine.

The Benefits of Niacin

I don’t believe in demonizing any food or essential vitamin, especially not niacin.  Like all B vitamins, niacin has an important role to play in our health. Below are some of the properties of niacin, most of which are beneficial to those with migraine:

  • helps reduce nitric oxide
  • thins the blood
  • improves cholesterol levels
  • acts as a sleep aide
  • has been shown to be especially helpful in healing schizophrenia, alcoholism, and arthritis
  • increases serotonin levels by slowing the loss of tryptophan (a deficiency in niacinamide will
    drive breakdown of tryptophan. Reduced levels of tryptophan will result in decreased levels of serotonin). (Source)
  • acts as an important cofactor in glutamine synthetase enzyme, thus reducing glutamate levels (which get elevated in part due to methylfolate).
  • breaks down norepinephrine, epinephrine, and estrogen (as a cofactor for the COMT enzyme)
  • protects against both UVA and UVB damage (while sunscreen only protects against UVA.
  • helps stimulate production of hydrocholoric acid in the stomach (Source)

Potential Problems with Niacin for Migraineurs

Nevertheless, as mentioned, niacin is a “methyl sponge”.  It requires SAMe for its metabolism, and thereby contributes to a drop in methylation.  Bad reactions to niacin indicate deficiencies in SAMe.

Niacin also has a range of other effects that are known to be associated with migraine. According to the Mayo Clinic, niacin supplementation may also result in the following symptoms (I have reordered these in order of their relevance to this discussion):

  • migraine
  • headache
  • stomach upset
  • vomiting
  • diarrhea
  • dizziness
  • liver damage
  • nausea
  • hypothyroidism
  • increased homocysteine levels
  • insulin resistance
  • abnormal heart rhythms
  • heartburn

In addition, niacin also

  • Raises histamine (again, by way of mopping up methyl)
  • Contributes to a drop in methylation
  • Depletes/lowers B9 (folic acid)
  • Depletes/lowers B6 (which we need to produce the DAO enzyme among others)
  • Dilates blood vessels (and thereby lowers blood pressure)

One testament to niacin’s ability to raise histamine is the typical face flushing that accompanies it’s use.  It was previously assumed that the flushing is the result of a histamine response.  It is now understood that the flushing is a result of prostaglandins.  According to practitioners of Orthomolecular medicine, people with low histamine need more niacin to get the flush than people who already have high histamine (and migraines) do.  It is said that people with high histamine will flush with just 50mg of niacin whereas people with low histamine may need as much as 150mg to flush.

One Major Cause of Low Vitamin B (and Niacin) Levels:
Gut Flora Imbalances

It could be said that migraine is essentially, at its root, a chemical sensitivity and lymphatic congestion issue caused by gut dysbiosis and excessive chemical pollution including pharmaceutical medications.  The solution is to heal the gut by rehabilitating gut flora (with help from B vitamins), and in so doing also support the building blocks for optimal nutrient absorption, enzyme function, blood sugar metabolism, blood pressure regulation, and detoxification.

Our gut flora normally manufacture B vitamins in our body for us (with the exception of B12) – assuming the particular gut flora that produce them have not been depleted by antibiotics and medications.  When our guts are assaulted by pharmaceuticals and stress, the healthy gut flora are thrown off in favor of histamine-producing bacteria and we become deficient in B vitamins; hence, the need for supplementation.  Different B vitamins have different functions, but they work together as a whole family (which is why I question the use of single B vitamins).

The human gut microbiota supplies its host with essential nutrients, including B-vitamins.. . . [H]uman gut bacteria actively exchange B-vitamins among each other, thereby enabling the survival of organisms that do not synthesize any of these essential cofactors. . .  [I]n addition to diet, the gut microbiota is an important source of B-vitamins, and . . . changes in the gut microbiota composition can severely affect our dietary B-vitamin requirements. (Source)

If gut flora produce B vitamins, would supplementing with a probiotic to replenish the gut flora help with B vitamin production? Maybe, in theory – but because probiotics are made through fermentation they can often trigger migraine as well. Normally I am not in favor of probiotics for migraine because the “good”, histamine-degrading bacteria are mixed in with some histamine-producing bacteria.  Fine and good if you have great gut health – not so great if you already have an overload of histamine.

Dr. Stasha Gominak, a neurologist who started to help her migraine patients by improving their sleep and gut health, is NOT in favor of probiotic supplementation, but she IS in favor of vitamin D and B supplementation:

Current suggested treatments for the ‘wrong’ intestinal bacteria are probiotics and fecal transplants (poop from one person given as an enema to another person to implant the ‘right’ bacteria). Neither of these work for very long. I think  the problem is not the supply of the bacteria it is the intestinal environment. We have to supply the happy, helpful bacteria what they need to thrive and they’ll replace the bad guys.  My experience has been that the ‘happy, helpful’ bacteria need the proper amount of vitamin D (enough so we aren’t sucking up every bit of it for our own use, this is usually a D25OH blood level of greater than 40 ng/ml. ) plus larger doses of B vitamins for about 3 months. (Source)

The bottom line is that when gut flora are thrown off and detoxification pathways are compromised, inflammation and histamine increase as the body tries to flush out the waste that would otherwise have another means of exiting the body.

Which Bacteria Produce Niacin?

Recently, it was discovered which bacteria produce niacin:

The two most commonly synthesized vitamins of the human gut microbiota genomes were riboflavin and niacin, with 166 and 162 predicted producers, respectively. . . . . However, the two synthesis pathways are distributed differently over the five phyla. Riboflavin synthesis is mainly found in Bacteroidetes, Proteobacteria, and Fusobacteria, but it is only found in half of the Firmicutes genomes and very few Actinobacteria. In contrast, the niacin biosynthesis pathway is more evenly distributed over the genomes of the five phyla. Such differences between the distributions of these two pathways can have various explanations. First, this variation may reflect their evolutionary history; riboflavin synthesis appears to be more ancient than the NAD biosynthesis pathway. Second, the biosynthesis of riboflavin and its derivatives is a quite straightforward pathway, whereas the biosynthesis of NAD is very complex and includes numerous versions of salvage pathways in various bacterial taxa. (Source)

It’s also great news that at least one of the histamine-degrading probiotic bacteria – b.infantis – also produces niacin:

Niacin, or vitamin B3/nicotinic acid, is an essential nutrient, whose importance is often characterized by the consequences of insufficient intake. Symptoms such as nausea, skin problems, headaches, and, in severe cases, pellagra can result from niacin deficiency. . . . Similar to other B vitamins, B. bifidum and B. infantis appear to be good producers of niacin. (Source)

This is part 1. Continue to part 2.