PPIs are the worst, but all heartburn drugs increase the risk of severe headaches

A new study just published in Neurology showed that people taking proton pump inhibitors (PPIs) such as omeprazole (Prilosec) and esomeprazole (Nexium) have a 70% higher risk of having migraines or severe headaches. The risk was 40% higher with the use of H2 blockers such as famotidine (Pepcid) and 30% higher in those taking generic antacids.

The study analyzed data from 11,818 participants out of 31,127 in the National Health and Nutrition Examination Survey who were taking acid-suppressing drugs. Interestingly, those on H2 blockers had a higher migraine risk if they also had a higher intake of magnesium, though this finding was based on only 75 H2 blocker users, making it potentially unreliable.

The likely cause of the association between acid-suppressing drugs and headaches is the previously documented decrease in absorption of magnesium, vitamin B12, and other nutrients. PPIs have been also found to increase the risk of dementia.

These acid-suppressing drugs are available without a prescription and people assume that they are safe. They are indeed safe when used for short periods of time. Once a person starts taking PPIs, they are very difficult to stop because stopping them often leads to a rebound of acid production. This sometimes makes heartburn worse than before a PPI was started. One way to try to stop them is to switch to an H2 blocker and then, to an antacid such as Gaviscon or Rolaids.

For those who require long-term PPI use, supplementing with magnesium, sublingual vitamin B12, and a multivitamin may help mitigate potential nutrient deficiencies. Vitamin B12 is often poorly absorbed and getting a monthly injection is more reliable. Some of our migraine patients, even some who are not on acid-suppressing drugs, also require monthly infusions of magnesium.