12% of the United States adult population is well aware of the suffering associated with migraines.1 That’s 30 million people experiencing nausea, vomiting, dizziness, sensitization to light and/or sound, and visual difficulties along with moderate to extreme attacking headache pain.1 Migraines can last from four to 72 hours with varying degrees of severity throughout.2
The cause of migraine pain is not fully understood, but there are multifactorial connections that can help identify potential root causes.2,3 It takes a good amount of sleuthing to discover, however, common triggers which may range from lack of food or sleep for too long of periods of time, and hormonal dysregulation, to light, stress and food triggers.1
Particular genetic variants like calcitonin gene-related peptides are released from the meninges and blood vessels in the scalp and have been evidenced as having a role in vasodilation causing the pulsating and throbbing head pain associated with migraines2,4. Additionally, genetic polymorphisms that alter or affect metabolism like a mutation of the MTHFR gene causing elevation of homocysteine levels, an inflammatory marker.1 Neurotransmitters like dopamine and noradrenaline, octopamine and tyramine may play a role by initiating an aggravating response of the trigeminal nerve, a main nerve influenced in the pain of migraines.1,2
Food triggers have also been well studied as a potential causative factor and while it could indicate the food itself, the trigger could be related to its characteristic trait, for example if it’s an amine food, a histamine rich, or sulfa rich food.3 Potential common triggers are chocolate, caffeine, red wines, beer, aged cheese, nuts, processed meats and artificial sweeteners.2,3 Again, the cause or combination of causes are highly individual and need to be evaluated for the client against trends.
With dietary change, sleep improvement, identifying potential food triggers, encouraging relaxation and regulation of meals, sleep and wake times,1 one can hope to overthrow the seemingly random cycle of pain.
There is not a popular practiced diet that is considered mainstream for the treatment and/or prevention of migraines. It has been discovered that a common trend of migraine sufferers is a reduced intake of fish and olive oils.1 Thus, a potential mitigation in reducing migraines could be adding a greater intake of fatty fishes and fats overall.1 While there is not a diet ranked with high indication that proves a particular diet favors another in prevention of treatment of migraines,5 the ketogenic diet shows promise,5 partly due to the concentration of adding omega 3 foods and reducing the pro-inflammatory omega 6 fatty acids found in processed, trans and saturated fat foods.2 One particular case showed evidence that within 1-2 weeks on the diet, incidence of migraine reduced, and over 3 months on the diet, only 3 migraine episodes occurred.5 If this singular case can repeat itself in more clinical trials, researchers and sufferers can be left hopeful that this diet could be a potential effective intervention. 5
The perceived benefits could in part be attributed to increased helpful dietary fat, and also the subsequent reduction of the potential food triggers associated with migraine pain.5 The ketogenic diet, originated for use in epilepsy, has found the correlation between the seizures of epilepsy and migraines to have similar neuroprotective qualities.1 The ketogenic diet champions a high fat, low carb profile including foods like avocados, fatty fishes, and oils and excluding sugars and carbohydrates from grains and starches. With its low carb intake, blood pressure and CRP inflammatory markers can potentially partially alleviate the inflammation and vascular influences associated with migraine occurrence.6 As migraine sufferers tend to be at greater risk for cerebrovascular incidence of stroke and require close monitoring,1 this particular benefit of the ketogenic diet is especially useful as preventive measure for more than just migraine pain.
Common medications used in migraine prevention treatment and prevention can include blood pressure lowering beta-blockers and/or ACE inhibitors.1 A diet with elevated dietary intake of fat could alter the outcomes of these medications, including a risk of blood pressure drops and should be monitored closely.
One argument to this theory is the long term safety of the ketogenic diet as a sustainable healthy diet. One way the patient could overcome this concern is to utilize the diet as a type of “elimination” diet as it reduces many triggers and focuses on healthy additions like omega 3 fats, and after a period of time on the diet and lifestyle change, slowly and gradually re-introduce the eliminated foods one at a time and be observant to a return of symptoms. The client should know that the ketogenic diet should be short term while employing lifestyle strategies and then be transitioned to a more sustainable long term dietary plan.
While there are many supplements to consider including feverfew, butterbur, magnesium and white willow bark,2,3 highlighted here are potential supplements intended for repair of baseline causes that could be the originating factor in the onset of the migraine activity.
Probiotics – There have been numerous studies on the correlation between gut health and migraine attacks, with evidence linking the inflammation of migraines with potential intestinal permeability from use of antibiotics, NSAIDS, and food triggers that decrease the tight junctures of the intestinal lining.7 Further, a disturbed microbiome is a breeding grounds for the kinds of microorganisms that can cause additional disease conditions.7 Multiple studies have proven that probiotic supplementation from 10-12 weeks all showed a reduction in migraine frequency and severity.7 While there is no particular strain deemed appropriate specifically for migraine, the particular strain would be chosen based on associating potential root causes. For example, IBS and migraines are a common pairing.3 Probiotics used in IBS like lactobacillus rhamnosus at 10^9 three times daily, or B. bifidum at 10^9 once daily could be a starting point.2 Probiotics are generally deemed as safe, though should not be used during pregnancy.2
Vitamin D- The “sunshine” vitamin is responsible for 200 known genes that influence human health in multiple ways including cell growth, neuromuscular conditions, inflammation, and the immune system.8 There are also multiple diseases and conditions that have been associated with vitamin D deficiency including autoimmune disease, cancer, and pain like headaches.8 Low serum vitamin D levels were evident in 67.2 to 73% of patients tested with migraine diagnoses.8 One randomized, placebo controlled study showed a decreased frequency of migraines after 24 weeks of supplemental vitamin D,8,9 and further reduction when simvastatin was added.9 Dosing would be 1000 IUs for every 10ng/ml deficient of normal range.8 Excessive doses of vitamin D can be toxic, so the serum levels should be monitored frequently.
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Because pharmaceutical pain management offers incomplete relief coinciding with significant side effects, complementary or alternative methods are reasonable to study for use.10 Craniosacral therapy (CST) is one such non-pharmocological therapy known for its benefit supporting flexibility in myofascial tissue, improving circulation and its potential reduction in inflammation. These reasons make it a likely candidate in the treatment of migraines. In fact, several documented patient reports suggest the potential for CST to reduce levels of pain and consequently the amount of pain medications needed.10
In a 2019 a systemic review and meta analysis including 10 randomized control studies involving CST and pain, CST groups reported a greater reduction on pain intensity and disability overall due to pain over the course of 6months in comparison to other groups.11
There are many factors that facilitate the onset and subsequently, the treatment and management of migraines. While the factors are varied, identifying these highly individualized factors in each client is a necessary measure to establish effective treatment. A great start is identifying stressors and dietary triggers, employing an appropriate diet for the individual and encouraging useful supplements, establishing routine meal and sleep times, and enjoying relaxation as a way to tip the odds in favor of a future free of migraine pain.
- Stump SE. Nutrition and Diagnosis Related Care. 8th Edition. (Klein EM, ed.). Wolters Kluwer Health/Lippincott Williams and Wilkins; 2015.
- Rakel D. Integrative Medicine. In: Integrative Medicine. 4th ed. Elsevier; 2018:320-333.
- Ross K. Headaches and Migraines. Presented as part of a Masters in Clinical Nutrition, SCNM, Tempe, AZ. Accessed 1-29-22.
- Tfelt-Hansen P, Le H. Calcitonin gene-related peptide in blood: is it increased in the external jugular vein during migraine and cluster headache? A review. J Headache Pain. 2009;10(3):137-143. doi:10.1007/S10194-009-0112-8
- Slavin M, Ailani J. A Clinical Approach to Addressing Diet with Migraine Patients. Curr Neurol Neurosci Rep. 2017;17(2). doi:10.1007/s11910-017-0721-6
- Ross K. Nutritional Interventions for Chronic Disease: Cardiovascular. In: Presented as Part of a Master’s in Clinical Nutrition, SCNM, Tempe, AZ. ; 2021.
- Arzani M, Jahromi SR, Ghorbani Z, et al. Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain. 2020;21(1). doi:10.1186/S10194-020-1078-9
- Nowaczewska M, Wiciński M, Osiński S, Kázmierczak H. The Role of Vitamin D in Primary Headache–from Potential Mechanism to Treatment. Nutr 2020, Vol 12, Page 243. 2020;12(1):243. doi:10.3390/NU12010243
- Buettner C, Nir RR, Bertisch SM, et al. Simvastatin and vitamin D for migraine prevention: A randomized, controlled trial. Ann Neurol. 2015;78(6):970-981. doi:10.1002/ANA.24534
- Mann JD, Faurot KR, Wilkinson L, et al. Craniosacral therapy for migraine: Protocol development for an exploratory controlled clinical trial. BMC Complement Altern Med. 2008;8:28. doi:10.1186/1472-6882-8-28
- Haller H, Lauche R, Sundberg T, Dobos G, Cramer H. Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2020;21(1). doi:10.1186/S12891-019-3017-Y