Root Causes & Treatment Strategies for Chronic Migraine

An estimated 87 million people worldwide suffer from migraine, with a higher incidence among women.¹ Chronic migraine has been noted as the most common type of daily headache seen by specialists and is a condition that often occurs as a typical progression from episodic migraine (less than 15 headache days per month) and displays its own unique physiology.²

Clinical, neurophysiologic, and functional imaging studies have suggested that alterations can occur in the brains of patients with chronic migraine compared to those with episodic migraine.² Also, patients with chronic migraine often experience higher rates of comorbidities, including anxiety and depression,² gastrointestinal (GI) disorders,² and inflammatory diseases,³ all of which can greatly impact quality of life.

Migraine Complexity & Support

Migraine is a complex issue related to the interaction between genetic, environmental, and lifestyle factors. This interaction may manifest differently for each individual patient. While the exact pathophysiology of migraine is unclear, some etiologies have been suggested, such as:

• An overall pro-inflammatory and oxidative state.⁴
• Mitochondrial dysfunction.^5-7
• Common migraine triggers such as stress, hormonal changes, skipped meals, disturbed sleep, environmental allergens, and food allergens or sensitivities.⁸

Functional GI disorders such as irritable bowel syndrome (IBS), reflux, and dyspepsia have also been shown to be frequently comorbid with migraine.^9-11 Further, the intestinal microbiome is suspected to play a role in the progression of migraine via the gut-brain axis.^12,13

A range of underlying causes that potentially contribute to chronic migraine have been noted; however, if the exact causes for an individual patient are not known, this may create difficulty in selecting an appropriate treatment intervention. In the following video, IFM educator Lisa (Perry) Portera, DC, IFMCP, discusses possible chronic migraine etiologies, such as mitochondrial dysfunction, and specific nutrients that could be used as effective personalized treatment or prevention strategies.

(Video Time: 1 minute). Dr. Portera-Perry is an adjunct clinical faculty member of Bastyr University’s teaching clinic in San Diego, CA, as an integrative Doctor of Chiropractic. She is also a member of Bastyr’s adjunct teaching faculty, teaching courses in integrative nutrition and physical medicine.

Treatment Considerations

Nutrition is an important lifestyle-based treatment approach for clinicians to consider when working with a patient who has chronic migraine. Nutritional interventions that emphasize nutrients that support mitochondrial function are of specific importance.¹⁴ The following are examples:

• The ketogenic diet is a therapeutic intervention that targets cerebral metabolism and has suggested relevance in migraine prevention, according to some observational studies.^15,16 Some of the proposed pathways and mechanisms include levels of neuroprotection and mitochondrial function, serotoninergic dysfunction, calcitonin gene-related peptides (CGRP) levels, and neuroinflammation.¹⁷
• Micronutrients such as riboflavin,¹⁸ coenzyme Q10,¹⁹ and magnesium²⁰ may be beneficial in migraine prevention through support of the mitochondria. In addition, a recent cross-sectional study of US adults found a negative association between consumption of vitamin B6 and folate on severe headache and migraine incidence, suggesting that increased dietary intake of these two nutrients may be beneficial in the prevention of migraine.²¹

Conclusion

Primary goals of migraine treatments are to relieve pain, restore function, reduce frequency, and prevent progression from episodic to chronic migraine. From a functional medicine perspective, supporting mitochondrial function and gut health, avoiding potential triggers, and engaging patients in their treatments are strategies that may improve long-term outcomes.

Functional medicine is a model that can assess an individual patient’s genetic, biochemical, and lifestyle factors to help create a personalized treatment plan. Learn more at IFM’s Bioenergetics Advanced Practice Module (APM).