‍One billion people around the world experience migraines each year. In America, 1 in 6 adults has migraine disorder. There are a variety of approaches available for managing migraines, including pharmaceuticals, injectables, wearables, supplements, nutrients, lifestyle modifications, and more. If you or a loved one feel like you’ve tried everything regarding migraines but still haven’t found relief, don’t give up! A functional medicine approach to migraine management may help reduce the frequency and intensity of migraines. Ashley’s story will inspire you and demonstrate how in just six weeks, a woman who’d experienced migraines for ten years found significant improvement.

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CC: Migraines

Ashley was a 25-year-old cis female who initially presented to our clinic for help managing migraines she’d been experiencing for ten years, as well as hormone issues and gastrointestinal complaints. Her original symptom list included the following:

Patient Background

Ashley had been experiencing twice-weekly migraines for over a decade when she came to see us. These migraines affected her ability to work, engage in social activities, and enjoy hobbies. She was hesitant to take medications as they had not helped her in the past, and the over-the-counter medications she had tried were not adequate to manage her migraine episodes.

Ashley was a therapist who worked with clients on an outpatient basis. She incorporated her training as a yoga teacher into her work with clients and used this practice for her self-care and anxiety management. Ashley had been experiencing anxiety for years and was able to effectively manage it using cognitive and behavioral techniques. Still, she wanted to see if natural medicine could help her further. Additionally, Ashley wasn't sleeping well. It took her an hour to fall asleep most nights, and she woke up feeling chronically unrefreshed.

Ashley was a vegetarian who cared deeply about the health of the planet as well as her own health. She came to us seeking a vegetarian nutrition plan designed to support her overall well-being and was interested in our mind-body-spirit approach to health, which mirrored her own.

Nutrient Analysis

At intake, the nutrient analysis of Ashley's typical diet revealed that she tended to consume inadequate total energy, carbohydrates, proteins, omega 3's, and most vitamins and several minerals, including selenium, magnesium, iron, manganese, and potassium each day. This matters particularly for those who experience migraines, as some studies suggest a link between nutrient deficiencies and migraine frequency.

Laboratory Workup Presented At Initial Visit

Ashley’s primary care had already ordered a preliminary workup before she came to see us, which included basic labs like CBC and CMP, a lipid panel, thyroid panel, Vitamin D, and Vitamin B12, all of which were within normal limits. Her TSH was 2.72, which is technically normal but has room to improve, according to some functional medicine practitioners who like to see it closer to 1.0. TSH is a biomarker that increases when thyroid function is low. In Ashley’s case, her TSH of 2.72 meant we could safely provide supportive thyroid nutrients without risking any symptoms associated with hyperthyroidism.

Discussion: Clinical Picture at Start of Protocol

I suspected that Ashley’s symptoms were likely due to the combination of inadequate nutrient intake, suboptimal sleep, and estrogen dominance. Her protocol was guided towards optimizing fiber intake, boosting micronutrient and macronutrient consumption, improving her sleep, and supporting a balanced progesterone: estrogen ratio naturally.

Ashley wanted to explore the options above before further functional medicine testing for things like food sensitivities and allergies, which is often part of a migraine management protocol. We partnered with her to prioritize which approaches we thought would be most effective the fastest, with the recommendation of further testing if the first phase of management wasn’t successful.

Interventions

To help Ashley support her health and well-being, we did the following:

Nutrition

My team and I worked with Ashley to create a customized food-as-medicine meal plan that allowed her to

• Reduce the glycemic index of her diet by increasing protein.
• Increase fiber intake by adding more beans and lentils to her diet and fruits, vegetables, nuts, and seeds.
• Increase the consumption of all nutrients to meet RDI. We focused on increasing nutrients that may impact migraines, including riboflavin, magnesium, zinc, vitamin E, and Vitamin C.

Importantly, this plan had enough treats and good foods to be sustainable for Ashley so she wouldn’t feel deprived. Here’s what it looked like! The hidden science behind this is that the combined foods provide 100% RDI of nutrients each day while still being fun / easy to eat. Every person’s plan looks different in our practice depending on their unique lifestyle and preferences.

Ashley’s Stage 1 Food-as-Medicine Plan

High Omega 3, Plant-Heavy, Mediterranean, Balanced Blood Sugar, Adequate Protein, Low Allergen

Ashley's individualized nutrition plan was designed to be healthy, easy to cook, and fun to eat. It was meant to support her intake of total energy, carbohydrates, proteins, minerals, vitamins, and omega 3's. The "nutrition label" for this week of eating looks like this.

Supplements

• Once daily multivitamin that contained vitamins A-K, folate biotin, choline, iodine, zinc, selenium, manganese, chromium, molybdenum, boron, inositol, CoQ10, Alpha lipoic acid, lutein, zeaxanthin, and lycopene.
• We added an additional 100mg of CoQ10, which has been studied for its potential to support migraine management when taken daily.
• Butterbur Extra: A patent formula that contains riboflavin, magnesium, Petasites hybridus (butterbur), Ginger, feverfew, and 5HTP.
• Thyrofem, which contains zinc, copper, selenium, tyrosine, vitamin C, vitamin E, and vitamin B12, as well as the herbs ashwagandha and Rhodiola. It is meant to provide the precursors and cofactors needed to support thyroid hormone production and improve energy. However, it also provides additional nutrients that may support migraine management, including zinc, vitamin E, and vitamin C.
• Melatonin 1.5mg before bed. Melatonin supplementation may support migraine management when taken 30 minutes before bed for six months.
• Gaba Ease 1-3 caps per night. This product contains Gaba - a calming neurotransmitter - and some gentle nervine (relaxing) herbs like passionflower and skullcap. It also contains B6, which has been found to support migraine management in the literature. The blend also tends to support anxiety reduction the next day after it’s taken.

Supplement Schedule

Results from a Functional Medicine Approach for Migraines

Ashley’s migraines improved significantly within six weeks of this approach. She is no longer sidelined by severe headaches two or more days per week and has regained this time to spend doing things that are important to her. Her anxiety and bloating have also improved significantly.

Total Cost of Approach

Ashley paid $395 for our initial visit package, which included an initial naturopathic and functional medicine visit, a meeting with our registered dietitian, and a customized meal plan. She paid $133.59 for the supplements recommended at her initial visit. The total cost of her approach with us from start to finish to support her migraine management was $529, and it took less than two months for her migraines to improve after her first meetings with our team. In addition to supporting her migraine management, she also experienced reduced anxiety and bloating.

The average cost of managing migraine symptoms for someone with insurance per year in the United States is $767. This is likely an underestimate as it does not include costs associated with pain and suffering, missed social and other opportunities due to migraine symptoms.

This client will save an estimated $150 this year on migraine management, even including the cost of our care. She'll save an estimated $770+ per year moving forward as a result of her care with us. In my clinical experience, this type of functional medicine approach to migraines is an investment that truly pays off in both the immediate and long term. Ashley supported her migraine management and saved money using a functional medicine approach.

Summary

Ashley used a customized, evidence-based, cost-effective combination of a food-as-medicine plan, good nutrition, and supplementation to support her migraine management, improve anxiety and optimize her digestion. If you or a loved one have migraines, know that it's possible for you to use a functional medicine approach to support your health, too!

*Note: The client's name has been changed to protect her privacy. All other details are the same!