I was recently reviewing a patient case involving migraine headaches. Let’s call her Sabrina. I was in our “cloud” e-file looking for another patient’s chart, and accidentally clicked on hers. I remembered Sabrina fondly and wondered how she was. I hadn’t seen her in a good year or more, because she’s a happy, busy, new mom, who is no longer a “migraineur” (one who suffers with migraine headaches).
The main culprit in her case? FOOD SENSITIVITIES. She also happened to have very low red blood cell magnesium, but if I were forced to create a hierarchy for these two important interventions, food would still top magnesium.
In my experience thus far, food is ALWAYS an issue in my patients with migraines (with or without aura, associated with hormones or not). Magnesium insufficiency is often an important factor, but not always.
My brilliant friend, Alex Vasquez, ND, DC, DO, introduced me to an older Lancet paper demonstrating that, on average, a full 10 foods needed to be removed from a migraineur’s diet. (Volume 313, Issue 8123, 5 May 1979, Pages 966-969) This is a great, interesting paper validating the multiple-foods-as-headache-trigger we see clinically time and again.
Functional clinicians understand that 10 food reactions suggest underlying intestinal hyperpermeability (IP), a.k.a. leaky gut. Treating the IP almost always means that some of these foods can be reintroduced and tolerated. In fact, in my experience, I have NEVER found that a migraineur needs to avoid 10 foods indefinitely. Usually, just a couple of foods are the problem children, and migraineurs gladly make the pain/food trade-off. For some, additives and preservatives may be continued triggers and, therefore, a very “clean” diet needs to be followed—but that’s a good thing. Who wants to consume those chemicals anyway?
One more case. Another patient suffered with migraine for an unimaginable 56 years. She even received an occipital nerve stimulation implant, which was unsuccessful in addressing her headaches, so she had it removed. Were foods a factor in her case? Oh, yes. (Was magnesium? Probably, but I can’t remember off the top of my head. Foods were first. And low serotonin turnover, contributing to depression and insomnia, was another issue.)
My experience is that the underlying migraine mechanism includes a Th2 (allergic) bias. Research does appear to offer some support for this idea as well. And for the menstrual migraineur, estrogen appears to push Th2-associated cytokines (inflammatory chemicals). (Curr Drug Targets Inflamm Allergy. 2004 Mar;3(1):97-104) Thus, controlling estrogen dominance has a secondary effect on the allergic response. Interesting. I prefer the IgG4 food panel for these people, because IgG4, particularly in its role as IgE- blocking antibody, is regulated by Th2.
So for the migraine patient, a standard approach for me includes an IgG4 food sensitivity test. I also investigate for evidence of lower serotonin and other nutrients using organic acids and amino acids (the TRIAD has all of these components—a perfect assessment tool for migraine patients.) We base our initial treatment on the laboratory findings and—lo and behold—it works.
~ Kara Fitzgerald, ND
To read a detailed, referenced case study involving migraine headaches and depression, please see Case Studies in Integrative and Functional Medicine.
Dr Fitzgerald is co-author of Case Studies in Integrative and Functional Medicine, and is on faculty for the Institute for Functional Medicine. She has a clinic and consulting practice in Sandy Hook CT. To schedule with Dr. Fitzgerald, or learn more about her work, visit www.drkarafitzgerald.com.