Migraine frequency greatly changes quality of life. Headache disorders are the third cause of disability worldwide,1 and migraine and severe headache affect roughly one out of every six US adults (one in five women).2 Migraine and tension-type headaches are the most prevalent headache disorders,3 and migraine, specifically, is associated with other physical and psychiatric comorbidities like anxiety and depression.4 Yet despite their prevalence and severity, some studies have found that migraine prevention treatments are underutilized in clinical practice.5
I’m seeing more and more migraine patients come into my practice looking for help outside of the typical medications. Functional Medicine is such an excellent tool to be able to discern the issues and the underlying mechanisms (the triggers and mediators) that keep our migraine patients caught in these [chronic pain] patterns.
While the exact pathophysiology of migraine remains unclear, there is evidence that inflammation plays a role, and food has been identified as a triggering factor.9 About 25% of patients report that their symptoms can be triggered by certain foods.10 In some patients, food sensitivities may be involved, and IgG antibodies may be correlated with inflammation.9 IgG can suppress inflammation acutely, but long-term elevated IgG is associated with systemic inflammation.11
Strategies to reduce migraine frequency, including nutritional interventions, might greatly increase the quality of life of many patients. Nutritional interventions for migraine often affect systemic inflammation, vasodilation, cerebral glucose metabolism, attack frequency, and severity.12
Several randomized controlled trials have found that some plants of the genus Petasites (like butterbur), and the nutritional supplements coenzyme Q10 (CoQ10) and magnesium citrate, are beneficial prophylactic medications in patients with migraine.6,7 Riboflavin, which improves energy metabolism similarly to CoQ10, has also been found to be effective and well-tolerated.8
A 2007 study found preliminary evidence that IgG-based elimination diets successfully reduced migraine frequency without the need for medication,9 and a 2011 randomized controlled trial of a food elimination diet based on IgG antibodies for the prevention of migraine headaches showed a significant reduction in the number of migraines or migraine-like headaches at four weeks.10
Other allergens may also play a role in migraine. In an interesting 2017 study of 49 migraine patients and 49 healthy individuals, the frequency of migraine attacks was higher in allergy-test-positive patients than in negative ones.13 The allergy tests were positive for house dust, red birch, hazel tree, olive tree, nettle, and wheat.13
A larger, 2018 study in children suggests that children with allergic diseases, including atopic dermatitis, allergic conjunctivitis, allergic rhinitis, and asthma, are at increased subsequent risk of migraine when they reach school age, and the risk shows a cumulative effect of more allergic diseases and more allergy-related health care.14
Other nutritional interventions have shown to be effective for treating migraines. A 2018 study suggests that an adherence to the dietary approaches to stop hypertension (DASH) diet is associated with lower headache severity and duration in migraine patients.9
A six-month randomized crossover study in 2015 found that a low-lipid diet significantly affected the number and severity of migraine attacks in a group of 83 patients, as compared to a normal-lipid diet.15 A small study in 2018 also suggests that a low glycemic index diet may be an effective and reliable method to reduce migraine frequency.16 As well, an exploratory study has found that the administration of alpha-lipoic acid may be associated with a reduction in the number of attacks and the days of treatment in migraineurs with insulin resistance.17
The Role of Fatty Acids
Self-reported studies have shown that a large percentage of US adults are not consuming USDA-recommended amounts of omega-3 fatty acids, particularly women and young adults.18 For migraine patients, this may be particularly relevant.
A study of 105 Iranian migraine patients found that lower intake of EPA and DHA was correlated with higher migraine frequency.19 Neither age nor BMI factors accounted for the correlation. The dietary survey asked about all food consumption (168 items), not specifically about fat consumption, and intake was evaluated for food, not additional supplements. This study suggests that a higher consumption of foods containing omega-3 polyunsaturated fatty acids (PUFAs) such as DHA and EPA may reduce the frequency of migraine attacks.19 A double-blind randomized and placebo-controlled clinical trial in 2018 of 60 patients with chronic migraine underscored these findings, suggesting that polyunsaturated omega-3 fatty acids are useful for migraine prophylaxis.20
A 2017 study provided evidence that supplementation with omega-3 fatty acids plus curcumin may reduce both migraine frequency and ICAM-1 serum levels in patients.21 Intercellular adhesion molecule-1 (ICAM-1), as an endothelial factor, leads to the adhesion of leukocytes to the walls of the cerebral blood vessels, which is an important step in the inflammation process. The authors report that supplementation with these two nutrients may lead to improvements in the function of metabolic pathways, and can also be used effectively as a treatment or prevention of migraine complications.21
A meta-analysis of randomized controlled trials aimed at the effectiveness of omega-3 fatty acids on the frequency, severity, and duration of migraine suggests that omega-3 intake leads to a significant reduction in the duration of migraine,22 while a randomized controlled trial also supports the use of omega-3 fatty acids to improve quality of life for patients with migraines.23 Recommending appropriate consumption of omega-3 fatty acids provides an avenue for helping many patients reduce migraine frequency.
All of the IFM food plans emphasize consuming the right fats. As well, one of the most important aspects of Functional Medicine’s ReNew Food Plan is the emphasis on consistent intake of anti-inflammatory foods. Patients who suffer from pain, autoimmune disease, and fatigue are ideal candidates for this plan.
Clearly, research indicates that there is a need for non-drug options to relieve migraine, and there are a wealth of non-pharmacological therapies for clinicians to consider. Each person’s genetic, biochemical, and lifestyle factors are considered in the Functional Medicine model, and clinicians leverage that data to direct personalized treatment plans. Many of the nutrient interventions discussed here support mitochondrial function, which may play a key role in migraine frequency and severity.
- Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P. Headache disorders are third cause of disability worldwide. J Headache Pain. 2015;16:58. doi:10.1186/s10194-015-0544-2
- Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: figures and trends from government health studies. Headache. 2018;58(4):496-505. doi:10.1111/head.13281
- Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013;53(3):427-436. doi:10.1111/head.12074
- Green MW. Headaches: psychiatric aspects. Neurol Clin. 2011;29(1):65-80, vii. doi:10.1016/j.ncl.2010.10.004
- Silberstein SD. Preventive migraine treatment. Continuum. 2015;21(4 Headache):973-989. doi:10.1212/CON.0000000000000199
- Pringsheim T, Davenport W, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 Suppl 2):S1-59.
- Köseoglu E, Talaslioglu A, Gönül AS, Kula M. The effects of magnesium prophylaxis in migraine without aura. Magnes Res. 2008;21(2):101-108.
- Sándor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology. 2005;64(4):713-715. doi:10.1212/01.WNL.0000151975.03598.ED
- Alpay K, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010;30(7):829-837. doi:10.1177/0333102410361404
- Mitchell N, Hewitt CE, Jayakody S, et al. Randomized controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutr J. 2011;10:85. doi:10.1186/1475-2891-10-85
- Aschermann S, Lux A, Baerenwaldt A, Biburger M, Nimmerjahn F. The other side of immunoglobulin G: suppressor of inflammation. Clin Exp Immunol. 2010;160(2):161-167. doi:10.1111/j.1365-2249.2009.04081.x
- Andreeva VA, Szabo de Edelenyi F, Druesne-Pecollo N, Touvier M, Hercberg S, Galan P. Macronutrient intake in relation to migraine and non-migraine headaches. Nutrients. 2018;10(9):E1309. doi:10.3390/10091309
- Bektas H, Karabulut H, Doganay B, Acar B. Allergens might trigger migraine attacks. Acta Neurol Belg. 2017;117(1):91-95. doi:10.1007/s13760-016-0645-y
- Wei CC, Lin CL, Shen TC, Chen AC. Children with allergic diseases have an increased subsequent risk of migraine upon reaching school age. J Investig Med. 2018;66(7):1064-1068. doi:10.1136/jim-2018-000715
- Ferrara LA, Pacioni D, DiFronzo V, et al. Low-lipid diet reduces frequency and severity of acute migraine attacks. Nutr Metab Cardiovasc Dis. 2015;25(4):370-375. doi:10.1016/j.numecd.2014.12.006
- Evcili G, Utku U, Ö?ün MN, Özdemir G. Early and long period follow-up results of low glycemic index diet for migraine prophylaxis. Agri. 2018;30(1):8-11. doi:10.5505/agri.2017.62443
- Cavestro C, Bedogni G, Molinari F, Mandrino S, Rota E, Frigeri MC. Alpha-lipoic acid shows promise to improve migraine in patients with insulin resistance: a 6-month exploratory study. J Med Food. 2018;21(3):269-273. doi:10.1089/jmf.2017.0068
- Papanikolaou Y, Brooks J, Reider C, Fulgoni VL. U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003–2008. Nutr J. 2014;13:31. doi:10.1186/1475-2891-13-31
- Sadeghi O, Maghsoudi Z, Khorvash F, Ghiasvand R, Askari G. The relationship between different fatty acids intake and frequency of migraine attacks. Iran J Nurs Midwifery Res. 2015;20(3):334-339.
- Soares AA, Louçana PMC, Nasi EP, Sousa KMH, Sá OMS, Silva-Néto RP. A double-blind randomized, and placebo-controlled clinical trial with omega-3 polyunsaturated fatty acids (OPFA ?-3) for the prevention of migraine in chronic migraine patients using amitriptyline. Nutr Neurosci. 2018;21(3):219-223. doi:10.1080/1028415X.2016.1266133
- Soveyd N, Abdolahi M, Djalali M, et al. The combined effects of ?-3 fatty acids and nano-curcumin supplementation on intercellular adhesion molecule-1 (ICAM-1) gene expression and serum levels in migraine patients. CNS Neurol Disord Drug Targets. 2018;16(10):1120-1126. doi:10.2174/1871527317666171213154749
- Maghsoumi-Noroyuzabad L, Mansoori A, Abed R, Shishehbor F. Effects of omega-3 fatty acids on the frequency, severity, and duration of migraine attacks: a systematic review and meta-analysis of randomized controlled trials. Nutr Neurosci. 2018;21(9):614-623. doi:10.1080/1028415X.2017.1344371
- Ramsden CE, Faurot KR, Zamora D, et al. Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain. 2013;154(11):2441-2451. doi:10.1016/j.pain.2013.07.028
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