Severe chronic pain is devastating. It can rob individuals of who they are and what they can become. In this heartfelt blog, Josette Herdell LDN, CNS, and former nutrition resident in our clinic, generously shares her own family’s challenging journey from chronic, debilitating migraines, to a full, pain-free life through Functional Medicine. Please share this with anyone you know who suffers with chronic migraines. And if you have your own stories of healing you wish to share to inspire and help others, please contact us at kara@drkarafitzgerald.com – Romilly Hodges, Nutrition Programs Director
Migraines are a neurological disorder ranked as the third most common disease in the world, affecting nearly 1 out of 7 or 29.5 million Americans. Women experience migraines three times more frequently than men. Although this disorder is largely treatable, it is under-recognized, under-diagnosed and undertreated 1, 2, 3, 4.
Migraines typically present as one-sided head pain combined with additional symptoms such as sensitivity to light, sound and smell, nausea, vomiting, anxiety, depression and neck pain, and last an average of 4-72 hours. Some individuals experience migraine with aura, characterized by visual symptoms such as zig zag lines or a dark spot affecting visual acuity as well as changes in speech or sensations. In addition, migraine sufferers often experience “prodrome” symptoms before actual onset of head pain, such as sleep disturbances, fluid retention, change of appetite and thirst, irritability, yawning, difficulty concentrating and changes of alertness 4, 5, 6, 7, 8, 9.
I personally experienced many of these migraine symptoms for over a decade. After struggling with an average of 25 migraine days per month and trying every available treatment at the time, doctors told me they were out of options … I felt they had given up on me. I was ready to give up too. I had reached what seemed like a dead-end of despair. I couldn’t sustain myself in this life-sentence of suffering and decided to attempt suicide.
I wasn’t the only one suffering. My younger brother, Jake, had migraines since the age of four, my father struggled with them for decades, and my paternal grandmother experienced them as well. Watching Jake curled up on the bathroom floor crying and vomiting in agony pleading with us to help him left my family desperate to find an alternative to the dozens of failed migraine treatments we had tried. After exhausting all other options, the solutions offered to my brother included a trip to the Emergency Room to be treated as a drug seeker or self-injectable medications with side effects that were worse than the migraine symptoms.
Jake and I as children in a rare moment without pain
As my father recalls Jake saying to him, “’Dad, you know I have little reason to wake up in the morning.’” This comment summed up our family’s efforts over the years. We had gotten to a point of increasing sickness and disillusionment. We worried that it was only a matter of time before his suffering would overcome his will to survive.
The beautiful part to our family’s story of suffering is that we discovered a new approach to healing our migraines and the associated systemic imbalances contributing to them. As a result, we are no longer plagued by migraines.
I would like to share the hope I have as a result of my own and my family’s experience in healing. This hope comes as a result of discovering the power of using food as medicine and supporting the interconnected systems of our body through a functional medicine approach. This paradigm shift in medicine evaluates imbalances at a cellular level and utilizes a patient-empowered approach to treat the body as a whole.
As our esteemed colleague, Dr. Mark Hyman so pointedly explains, “Food is medicine, it’s not like a drug, it is a drug. It works faster, better, and cheaper than any drug on the planet… Food causes disease and food can cure disease. Food can harm and food can heal.”
The Current Pharmacological Approach
Migraines are most commonly treated with preventative and acute medications such as antiepileptic drugs, beta-blockers, antidepressants, angiotensin receptor blockers, Botox injections, CGRP injections, neuromodulation devices and lifestyle and dietary interventions. The pharmacological options often include undesirable side effects and potential long-term risks. Migraine patients frequently go through a cycle of trying different medications with varying levels of success while managing new side effects with additional medications. Research shows that medication overuse is a common cause of chronic migraines. The current pharmacological approach attempts to address symptoms versus looking upstream to investigate and address underlying causes 10, 11.
Digging Beneath the Surface
Functional medicine is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms. Read more about Functional Medicine here.
Causes of migraine vary for each individual, however, when we look at migraines through a functional medicine perspective, the following predisposing factors, triggers and imbalances may contribute to them:
Genetics: Migraines are common among family members. Research suggests genetic variants specifically linked to hemiplegic migraines, which mimic stroke symptoms such as temporary one-sided paralysis. Other common genetic mutations seen in migraine patients include genes involved in pain-sensing pathways and brain vascular function. Functional medicine takes into consideration the interplay between genes, lifestyle and dietary habits, environmental exposures, trauma and other factors to turn on and off genes that may contribute to migraine 12, 13, 14.
Diet: Common dietary triggers include dairy, gluten, eggs, processed foods and refined sugars, chemical preservatives such as aspartame, monosodium glutamate, nitrates, sulfites, and foods containing tyramines or histamines. In addition, nutrient depletion is an important consideration. Common symptoms related to food allergies or sensitivities can show up as fatigue, brain fog, bloating, chemical sensitivities, joint or muscle pain, sinus congestion, and more 15, 16, 17, 18.
Detoxification: Exposure to toxins (poisons produced naturally) or toxicants (artificial products introduced into the environment due to human activities) in our food, water, air, clothing, pharmaceuticals, and more place an excess burden on the body’s detoxification system. Many migraine patients say they are sensitive to smells such as perfumes, automobile exhaust and other chemicals, which suggests the need for detoxification support 19, 20.
Gastrointestinal: Gut health is an important area of consideration within the Functional Medicine approach for migraine. Various factors can contribute to altered gut flora including the inflammatory Standard American diet, nutrient deficiencies, antibiotic and over-the-counter drug use, a stressful lifestyle, toxic exposure, and infections. In addition, intestinal hyperpermeability (“leaky gut”), gastroparesis, gluten sensitivity, inflammatory bowel disease and Celiac disease have been associated with migraines 21, 22, 23, 24, 25, 26.
Immune: The gut contains more than 70% of the immune system. Therefore, when we see an imbalanced gut, we also see an imbalanced immune system. Diet, lifestyle, environmental exposures, physical and emotional trauma, and many other factors affect the immune system. Migraines have been associated with autoimmune diseases such as inflammatory bowel disease, Hashimoto’s thyroiditis, and systemic lupus erythematous disease 27, 28, 29, 30.
Nervous system: Migraine is closely tied to the functioning of the nervous system, which regulates the fight or flight response to acute stress or trauma. Stress causes changes in neurotransmitters and hormones such as dopamine, adrenaline and cortisol. When this stress is chronic, the functioning of the nervous system becomes dysregulated and further contributes to the migraine cycle 31, 32.
Structural: Changes to musculoskeletal structure and cellular membranes can trigger or exasperate migraines. Some of the triggers may include a motor vehicle accident, a concussion, poor fitness and health habits. Neck pain is experienced in up to 80% of migraine patients 33, 34.
Hormonal: Menstrual migraine is the most common type of migraine in women and menarche is a common time for a teenage girl to experience her first migraine. Research suggests menstrual migraines are related to a drop in estrogen and a pro-inflammatory cascade triggered by fatty acids called prostaglandins. Many women are prescribed oral contraceptive pills in an effort to reduce menstrual migraine, however there is little evidence of their efficacy 35, 36.
Each of the above systems are interconnected. Imbalances in one area often lead or contribute to imbalances in another area and so on. Functional medicine takes these into account and organizes them in a way to create a healing plan unique to each patient.
10 Tips to Start the Healing Process Today
- Become your own health advocate, but don’t do it alone. It is important to partner with a functional medicine-trained practitioner to get the support you need. These practitioners utilize a variety of laboratory tests to pinpoint specific imbalances, such as IgG food sensitivity testing, IgE food allergy testing, a complete hormone panel, gut permeability and stool tests, genetic testing, and nutrient testing.
- Hydration is a commonly overlooked migraine trigger and a “low hanging fruit” that will benefit all systems of the body. Aim to drink at least half your body weight (in pounds) in fluid ounces per day. Drink filtered water and carry a non-toxic water bottle with you to measure your water intake throughout the day 37, 38.
- Research shows dietary allergens and food intolerances are a common trigger of migraines and systemic inflammation. Consider eliminating the most common food triggers, including dairy, gluten, eggs, corn, caffeine, alcohol, chocolate, processed meats, fermented foods, and refined sugar. Foods containing monosodium glutamate, histamines, tyramines, nitrates and artificial colorings and sweeteners are also common triggers 39, 40. It is best to work with a healthcare practitioner to guide you through the elimination, challenge, and reintroduction of specific foods to determine reactivity so as not to avoid foods unnecessarily long term.
- A variety of dietary approaches have been studied for migraines. Scientific and anecdotal evidence support eating an anti-inflammatory diet rich in phytonutrients and whole plant foods. Aim for at least 6 cups of colorful vegetables per day, a variety of low-glycemic fruits and adequate fiber intake. Common nutrient deficiencies in migraines include magnesium, niacin, riboflavin, cobalamin, coenzyme Q10, carnitine, alpha lipoic acid, vitamin D and omega-3 fatty acids. While it may be helpful to supplement with specific nutrients, this should be determined with the help of a functional medicine practitioner and nutrient testing. Educate yourself on healthy food sources of these nutrients as a helpful place to start, being mindful to avoid any potential triggers 41, 42 43, 44.
- Balance your blood sugar to reduce hypoglycemia-triggered migraines. Low blood sugar is associated with symptoms such as fatigue, brain fog, irritability, dizziness or lightheadedness. Skipping meals and fasting can trigger migraines. Enjoy a well-balanced meal with fat, fiber and protein alongside any complex carbohydrates (avoid refined carbs). Start your day by eating breakfast within 30 minutes of waking up adding in a mid-afternoon snack if you find yourself fatigued or experiencing migraines in the afternoon or evening 45, 46.
- Reduce your toxic exposure by eating organic when possible or shopping with the “Dirty Dozen and Clean 15 Guide”. Educate yourself about the risks of chemical exposure from kitchen cookware, storage containers, cleaning supplies, personal care products and any other products you are exposed to using the Environmental Working Group’s website. Make a goal to switch out products for less-toxic environmentally-friendly option 47, 48.
- Regular exercise can prevent migraines, however, studies show it can also be a migraine trigger. It is important to prioritize movement throughout the day at a pace and intensity that is beneficial and tolerable. Start slow and cautiously, with the goal of working up to moderate-intensity activity for 30 minutes 4-5 times per week. Explore options that are enjoyable, such as a walk on the beach, learning how to swing dance, or take a group fitness class 49.
- Carve out time every day for stress reduction. Mindfulness-based meditation has been shown to lower the stress response and improve pain tolerance in migraine patients. A great technique if you find yourself feeling stressed and anxious is to use the 4-7-8 breathing technique developed by Dr. Andrew Weil. Read more about this technique here. You can do this exercise while you are at work, driving in the car or before you go to sleep 50, 51.
- Lack of sleep, too much sleep, or changes in sleeping patterns can each trigger migraines. A regular sleep schedule has been shown to help reduce migraine frequency. Unplug from all electronic devices at least 2 hours before bedtime, use blue-light blocking filters on your devices and set aside time for mindfulness meditation or prayer 52, 53.
- Additional complementary therapies that can be helpful as an integrative approach for migraines include acupuncture, chiropractic manipulation, physical therapy and massage 54, 55, 56, 57.
As you address various imbalances throughout your body, you will likely find that you increase your migraine threshold, meaning you are less sensitive to various triggers and have greater overall resilience.
A Message of Hope for Healing
It is my hope that this article gives you a better understanding of how a functional medicine approach may be able to help heal migraines. I also desire to encourage you or a loved one not to give up. There is great power in believing that the body can heal itself when given the proper support to do so.
Our family has welcomed a new person back into our lives – someone who we knew was beneath the surface of the pain of migraines – the brother and son that we longed to know. Jake now has the freedom to express himself as a talented artist, loving husband, adventurous athlete and expert connoisseur and chef in using food to heal.
A quote from Nobel Laureate Albert Schweitzer summarizes how I feel as a healed migraineur:
“Those who bear the mark of pain are never totally free, for they owe a debt to those who suffer.”
**Update from a reader
I just read your email regarding migraines and asking for stories of healing through functional medicine. I have a great story! I am a 68 year old female and had suffered with migraines since the age of three. I had 15-16 migraines per month. Tried many different types of preventative RX’s which never seemed to help and lived on Imitrex so I could function and work.
Six years ago I started going to the Functional Medicine Institute at The Cleveland Clinic. One of the first tests to return showed that I had a sensitivity to eggs. I removed eggs from my diet immediately, in all forms, and to this day I read every single food label to ensure no eggs are added. I drill servers at restaurants about egg content in menu items, for I learned that many restaurants add egg whites to salad dressings! Other changes I made, even though I had always had a fairly good diet, is to eat mostly whole foods, I prepare most meals at home, stay away from processed and packaged foods, plus, I stick mostly to a Paleo diet and sometimes switch it up with Keto.
Testing also showed that I had systemic candida and many of the bad bacteria was out of control. I also had a lot of internal inflammation. However, it was removing eggs from my diet that immediately stopped the migraines. Overall health continued to improve…glowing skin, more easily maintain a constant weight, more energy…by working to rid myself of candida and building up good bacteria and eliminating the bad. The candida was a four-year battle but I finally got a clean bill of health. I also got the internal inflammation from red to green on tests!
What is ironic is that I was a patient of a neurologist that specialized in migraines for 10-12 years and he never once asked me to try to eliminate eggs. In fact, he never once did a food allergy/sensitivity test. My food sensitivity test came back with 13 food sensitivities and through elimination diets and healing my gut I’ve been able to reintroduce all foods except for eggs. I have come to the conclusion that eggs will never clear up for me because in addition to causing migraines for days, it also causes diarrhea for days.
I am a huge believer in functional medicine and how it can turn the health of individuals around. I tried doing it on my own until The Cleveland Clinic opened it’s functional medicine institute, but I didn’t have the testing on my own to really pinpoint changes that needed to be made. Functional Medicine provided that. It’s a 2-½ hour drive for me, but worth every trip.
This is my migraine story and I only wish someone had simply mentioned, “Have you tried to eliminate eggs from your diet?”, about 60 years ago!