Functional Medicine Migraines

Migraines are debilitating headaches that affect millions of people worldwide, often significantly impairing their quality of life. In fact, migraines are the second leading cause of disability worldwide (1). Functional medicine offers a holistic approach to understanding and treating migraines by addressing the underlying causes rather than merely managing symptoms. 

In this article, we’ll review our functional medicine migraine approach, including possible root causes and treatment options. 

Migraines are a type of headache characterized by intense, throbbing pain, usually on one side of the head. They often come with additional symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines can last from a few hours to several days and can be classified into several types:

This is the most common type of migraine, featuring headache pain with the possibility for nausea/vomiting, and sensitivity to light and sound.

Also called a classic migraine, migraines with aura include visual or sensory disturbances such as flashing lights, blind spots, or tingling sensations before the headache begins.

Chronic migraine is defined as having headaches on 15 or more days per month for more than three months, with at least eight days involving migraine-like headaches.

There are other classifications for migraines including menstrual migraines and migraines related to other conditions, like PCOS migraines. 

Unfortunately, there is not one underlying cause for all migraines. However, functional medicine aims to identify and address the root causes of migraines, which can vary from person to person. Understanding these underlying factors is crucial for developing an effective treatment plan. 

Hormonal fluctuations, particularly in women, are a common trigger for migraines. Changes in estrogen levels, such as those occurring during menstruation, pregnancy, or menopause, can provoke migraine attacks. Low serotonin levels and reduced serotonin production in the brain may also trigger migraines (2). Serotonin is known as the “happy” brain chemical. It is believed to act as a mood stabilizer among many other important functions.

Deficiencies in certain nutrients, such as magnesium, riboflavin (vitamin B2), and coenzyme Q10, have been linked to an increased risk of migraines. Ensuring adequate levels of these nutrients can be beneficial in migraine prevention and management.

Researchers suggest that oxidative stress also plays a significant role in causing migraines. 

Oxidative stress occurs when there’s an imbalance between harmful molecules called reactive oxygen species (ROS) and the body’s ability to neutralize them or fix the damage they cause. High levels of ROS can damage cells and tissues, including in the brain. This can lead to inflammation, which can trigger pain pathways and make the trigeminal nerve more sensitive, a major factor in migraines. 

Functional medicine offers a range of treatment options aimed at addressing the root causes of migraines. These treatments are often personalized to meet the specific needs of the individual. 

Our functional medicine dietitians may recommend dietary changes to incorporate nutrient-rich foods. An anti-inflammatory diet rich in antioxidants is particularly beneficial in supporting mitochondrial function and reducing oxidative stress. Plant-based foods, like fruits and vegetables, are generally the best sources of antioxidants. Learn more about a mitochondria diet. 

We may also suggest appropriate supplements to further boost antioxidants and reduce oxidative stress, like CoQ10 and/or Omega-3 fish oil. A large review study found that people taking CoQ10 had reduced migraine days per month and reduced migraine duration than the control group (3).  Omega-3 has been shown to reduce migraine duration and significantly increase antioxidant levels (4, 5). 

Some individuals may also experience sensitivity to blood sugar fluctuations. To help maintain balanced blood sugar levels and potentially prevent migraines, we recommend incorporating protein, healthy fats, and fiber into each meal and snack. 

Ashna came to Root after struggling with an autoimmune condition, Rheumatoid Arthritis (RA), for years. Her main symptom of joint pain had been somewhat controlled with an IV infusion every 6 weeks, but other symptoms that she felt may be related started popping up: fatigue, brain fog, weight gain/water retention, and dry skin. 

She wanted to get to the root cause so she asked her Rheumatologist about this. He replied, “I treat symptoms, not root causes.” At that moment, she knew that she needed to work with a doctor in a completely different mindset and model of care to complement her conventional team. The nutrition first approach at Root was what initially drew her to our practice, especially since she was given no helpful or personalized nutrition guidance with respect to RA in the conventional system.

In her first doctor’s visit, Ashna learned more about her body and her condition than she had in years. Things started to make so much sense. The body is connected and inflammation that starts in the gut does not stay there. Her organs work together, not in separate silos. Foods can contribute to or improve her symptoms (something she had already thought based on experience, but had never had validated).

In her first dietitian visit, her dietitian did a thorough intake and they decided together on next steps. No one had told her about the gluten connection to auto-immunity as well as the heightened risk of celiac in people with autoimmune disease. She and her dietitian decided together to start with a celiac blood test and an additional food sensitivity test called MRT due to the strong connection of her symptoms to foods and the fact that she preferred a very spelled out and personalized diet plan that could also address her brain fog, fatigue, weight gain, and water retention. 

Her doctor and dietitian reviewed her blood work with her in detail. She had some important nutrient deficiencies that we began to replace right away:

Her dietitian began to guide her on a customized diet based on her testing results. She would eliminate the most inflammatory foods for her and gradually reintroduce them in stages over the next three months. Her celiac screen was negative for celiac disease, but her genetics were positive for risk of developing celiac. She and her dietitian decided it would be best for her long-term health to remain gluten free.

Within the first 2 weeks of MRT, she was feeling like a different person. Her joint pain, energy, brain fog, and skin had all improved and she lost 5 pounds. She wanted to continue to feel this way forever. To help her be successful with food introduction, her team recommended stool microbiome testing to guide her next steps in gut healing.

Ashna went through a personalized gut healing protocol to gently rebalance the microbiome and repair intestinal permeability. Interestingly, her wheat antibodies were still positive 3 months after eliminating gluten/wheat. Her dietitian helped her pinpoint potential sources of gluten. One of the foods she was eating, a healthier version of kettle chips, had barley listed down on the ingredient list (who would have thought barley would be on a potato chip?). Barley is a source of gluten. Unfortunately, since gluten is not listed as an allergen on nutrition labels (only wheat), this one snuck past her. It’s not uncommon for us to uncover sources like this in people who have thought they were gluten free for years. Working with a dietitian skilled with helping those with celiac and other autoimmune disease is a vastly different experience for our members.

She continued to learn valuable tools to help her naturally calm her autoimmune condition while optimizing her health. The medication she had been taking works by blocking TNF-alpha (produced in the body with inflammation). She was surprised to learn of foods that can also block TNF-alpha as well as the vagus nerve being involved in the production of TNF-alpha. She did Root’s limbic system retaining and she’s never felt like a more calm, confident person.

Ashna knows how important it is to monitor her biomarkers including gut and microbiome health and she’s remaining a Root member. Her visits to her Rheumatologist have spaced out, saving her thousands of dollars a year. 

Certain B vitamins have shown to significantly reduce migraines. For example, riboflavin (vitamin B2) has shown significant promise in research studies for preventing migraines. A large review study found that taking 400 milligrams (mg) of riboflavin every day for at least three months significantly reduced days, duration, frequency, and severity of migraine attacks (8). Niacin, folate, and vitamin B12 are also suggested to help treat migraines (9). While we often suggest a separate and higher dose of riboflavin than is typically found in multivitamins, you can find the rest of these B vitamins in our B-complex supplement. 

Poor sleep is associated with migraine headaches. Improving sleep hygiene and addressing sleep disorders can significantly impact migraine frequency and severity. Taking your magnesium supplement before bedtime can support better quality sleep in many individuals. Consider reducing screens at least an hour before bedtime and implementing a relaxing bedtime routine at the same time every night. If you have any symptoms of sleep apnea (loud snoring, excessive daytime fatigue, morning headaches, etc.) consider asking your primary care doctor about requesting a sleep study. 

Migraines are complex and require a comprehensive approach to treatment. Functional medicine offers a promising pathway to preventing and treating migraines by addressing their root causes. Through personalized treatment plans that incorporate nutritional therapy, supportive supplements, lifestyle changes, and other holistic approaches, individuals can find relief and improve their quality of life. 

If you suffer from migraines, learn about our functional medicine program to explore these options and develop a tailored plan to address your unique needs.