Jan. 30, 2024
34 | Migraine Management: Finding Relief with Food
Is there a migraine-friendly diet? Does sugar trigger migraines? Are there any vitamins that treat migraines? How much water should I be drinking? With at least 39 million Americans living with migraines, your patients are sure to seek your help finding relief. Joining me today is The Migraine Dietitian Kelli Yates, to unpack the complex world of migraine management through the lens of nutrition.
Key Takeaways:
- Hydration Goals: Encourage patients to consume 65-100 ounces of water daily.
- Caffeine and Migraines: Individual tolerance varies; limit caffeine intake to below 200 mg per day.
- Sugar Management: Balance sugar intake with protein and fiber to avoid blood sugar spikes.
- Supplements: Consider magnesium, riboflavin, and CoQ10 for migraine prevention; start with one and evaluate. Ensure vitamin is third-party tested.
- Consider environmental triggers: sleep, stress, smells, and bright lights
Connect with Kelli on Instagram: @the.migraine.dietitian
Connect with Colleen:
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Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.
00:00 - Nutrition and Migraine Treatment
11:12 - Impact of Hydration, Caffeine, Sugar on Migraines
23:15 - Managing Sugar and Migraine Supplements
29:58 - Multiple Triggers and Holistic Treatment
WEBVTT
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Is there a migraine-friendly diet?
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Does sugar trigger migraines?
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Are there any vitamins that manage migraines?
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If you suffer from migraine or work with patients who do, you won't want to miss today's episode.
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I'm Colleen Sloan, a pediatric PA and registered dietitian, and this is the Exam Room Nutrition Podcast where each week, I'm giving you the nutrition education you never had in school to help you become a more confident, compassionate clinician.
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But migraine affects an estimated 10% of people worldwide, and the American Migraine Foundation estimates that at least 39 million Americans live with migraine.
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Migraine occurs most often among people aged 20 to 50 years and is about three times more common in women than in men.
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So what role does nutrition play in migraine treatment and prevention?
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Today's episode will discuss the importance of having your patients keep a food symptom log which vitamins might provide symptom relief, what effect sugar and caffeine have on migraines and so much more.
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Gone are the days of just providing a handout with a list of foods your patient should avoid.
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Spoiler alert if you're still doing this, you might be causing more harm than good.
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But don't worry, friend.
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After today's episode, you will confidently be able to help your patient find relief from their migraine.
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Joining me today is Kelly Yates.
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Kelly is a registered dietitian who specializes in helping people with migraine find relief using food supplements and lifestyle changes.
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You can find Kelly on Instagram at themigrainedietitian Kelly.
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I am so excited for our discussion today.
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Thank you so much for being here.
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Welcome to the show.
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Yeah, thank you so much for having me.
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I'm excited.
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I love this topic and, you know, in pediatrics I actually do get quite a lot of kids who complain more along the lines of headache, but I know migraine is a huge, huge concern for so many patients, so I can't wait to give our listeners some really good, helpful tools.
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So let's first start off by discussing if there are any specific foods that actually trigger migraines.
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Yeah, so that's a really common question and a common approach to migraine, I think, is to look for any foods that could be causing a problem, and migraine patients can have food triggers that increase their likelihood of experiencing an attack.
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It's not necessarily going to cause an attack, but it can contribute to the onset of one.
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But there truly are no specific foods that, just because you have migraine, you should avoid, Like there's no universal migraine food triggers and some patients have no food triggers at all.
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This is actually more common than we might even think.
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So food triggers are very unique patient to patient.
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So if a patient is coming to you concerned about food triggers or you're concerned yourself, for a patient, a food and symptom journal would be a really good tool to attempt to uncover some food triggers that could be contributing to their symptoms.
00:03:01.939 --> 00:03:05.903
Now, regarding the food symptom log how long do you recommend they keep a log for?
00:03:07.159 --> 00:03:15.829
So it depends on the situation, I think, but for many patients even just a couple of weeks to a month can be helpful.
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Some patients will keep a food and symptom journal long term, but this oftentimes isn't necessary to figure out what food triggers are, or at least what the most prominent food triggers are for that patient.
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Oftentimes, if it's something that's really going to impact them, it's something that they're eating frequently or drinking frequently.
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So that can be found out relatively quickly and two to four weeks typically.
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Perfect, thank you so much.
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So how about any nutritional deficiencies that might be linked as the cause of a migraine that, as clinicians, we need to be aware of?
00:03:49.781 --> 00:03:58.421
Yes, so there are some relatively common nutritional deficiencies that are linked with worsening migraine.
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So the ones I see most often are going to be magnesium, iron, b12, vitamin C, and then even, like, omega 3, fatty acids can be something that we want to think about as well, because we know that that ratio of omega 3 to omega 6 fatty acids can be really important for migraine patients.
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Now, they, of course, don't cause migraine, but they can contribute to it.
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They can lower a patient's threshold for experiencing an attack.
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So if we can uncover and address these deficiencies, it can really help them see a big improvement in their ability to control migraine and, of course, in their health overall and other symptoms that they may be experiencing and it's interesting that you said that it doesn't necessarily cause it, because I think as patients who are so desperate to find the answer to their migraines and relief for their migraines.
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but I love that you pointed out that it's just an important aspect of the overall total health of the patient.
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Exactly, and I think that can be a really useful tool to help educate patients and how migraine works.
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We're really looking for things that are worsening it, looking for triggers, but we don't know really what the cause of migraine is at this point other than genetic factors and things like that.
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So it can be a helpful tool.
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All right.
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So let's kind of go over this, and I think you alluded to it in the beginning but is there a migraine-friendly diet?
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Yes.
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So I do think there is, in general, a migraine-friendly diet, and this can be another really big tool when used thoughtfully and appropriately for patients.
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However, I don't think that the basis of a migraine-friendly diet should be about restricting foods or removing any specific foods in general, right Like oftentimes you might hear we need to remove chocolate, or we need to remove aged cheeses, or there are a bunch of different foods out there that are flagged as problematic.
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However, when we're looking to construct a migraine-friendly diet for a patient, there are some things that I think about, and that's going to be supporting blood sugar balance, which is nice for everyone, but particularly helpful for people who have migraines.
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So eating regularly, not skipping meals, having balanced meals, protein, carbs, fat, nutrient density is going to be another really helpful one.
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So helping prevent those deficiencies that we talked about, making sure we're getting plenty of antioxidants from fruits and veggies and different plant foods.
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And then we also want to think about some other things like supporting gut health, because this is a newer area of research for migraine and we know that supporting a healthy gut environment and a healthy microbiome can be really beneficial for that gut brain connection and, in turn, for migraine itself.
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So fermented foods, prebiotic foods so foods that support the microbiome those can be really helpful.
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Viber can make a huge difference.
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And then we also want to be practical and search for ways that we can make eating easy for someone with migraine, because oftentimes migraine can be debilitating and some people deal with attacks every single day.
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So we really want to look for ways to make putting together balanced meals easy and doable.
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We want to look for ways to help them eat despite nausea or high pain or vertigo.
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So that's another really important strategy that we can help patients with to actually incorporate all of the other things I just talked about.
00:07:37.142 --> 00:07:41.093
Oh my gosh, that was talk full of so much information and that was just so helpful.
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I think the basis, though it sounds like really we should be recommending just an overall well balanced diet, and if it is full of fruits and vegetables, then hopefully they are getting their fiber.
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But I mean, I probably talk about fiber on every episode, and it is just so important for every disease and symptom, and more and more research is coming out on like how amazing fermented foods are and how awesome probiotics and fiber is, so I love that it's helpful in migraine as well too, because it's kind of like this beautiful miracle food that it can help symptoms and so many things.
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So you mentioned about kind of helping the patient navigate when they're having like a really bad attack and alleviating those symptoms and making sure that they are eating during those symptoms of vertigo and nausea and when the pain is just debilitating.
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Are there any specific foods that can actually help alleviate migraine symptoms when they are currently in an attack?
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So there, are some foods that have been looked at a little bit for their ability to help alleviate some of the symptoms that we might experience during a migraine attack.
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Now we also again have to be practical in this situation, because there are some attacks where a patient won't be able to eat.
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So in that situation, you know sipping on electrolyte solutions or you know broths or something like that can be helpful.
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But if they can continue eating every three to four hours or whatever works for that patient, then we can love to incorporate some foods like ginger, which can be helpful for some patients with a little bit of pain.
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Support, nausea, support even like a ginger tea can be really soothing for a patient dealing with nausea.
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And same thing with peppermint teas or adding peppermint to smoothies.
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That can be really helpful for some nausea.
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So there are some foods that may have a therapeutic benefit for some patients, but with migraine one thing isn't going to work for everyone.
00:09:36.251 --> 00:09:41.308
So it's really helpful to help the patient experiment to figure out what's going to work for them.
00:09:42.130 --> 00:09:49.821
Good point, kind of lingering here, where you had said you know what the balanced meals is super important but can be really challenging when they are just in so much pain.
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What would you suggest that the clinician suggests to their patient who might say my head hurts so bad, I just feel like I can't eat?
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You kind of mentioned some electrolytes and some broth.
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What other things would be helpful that the clinician to suggest?
00:10:03.062 --> 00:10:16.441
right so broth, electrolyte drinks you can also look for, like a meal replacement shake or protein shake that the patient might tolerate Well, that can help them get some calories and some protein.
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Even a homemade smoothie can be really beneficial.
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And then, honestly, for some of my clients I'll recommend a Greek yogurt ice cream kind of product, because that can be really soothing, even on, you know, some head pain.
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That cold food can be really helpful.
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And Then some patients can tolerate a soup really well, like a pureed vegetable soup that they can keep in the freezer.
00:10:40.769 --> 00:10:42.436
That's another tool that I'll use.
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But, honestly, if it's a patient who is, you know, dealing with attacks that don't happen every single day, if the attacks don't last more than a couple of hours, then not eating during that attack is not the end of the world.
00:10:54.450 --> 00:10:59.029
We don't need to push it, especially if they're dealing with a lot of nausea and maybe vomiting.
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But if it's a patient who's dealing with, you know, intractable migraine that can go on for 72 plus hours, then of course we need to use these strategies to help them get some nourishment.
00:11:11.072 --> 00:11:11.936
That is so helpful.
00:11:11.936 --> 00:11:23.149
So before we jump into kind of some supplements and vitamins that can help to prevent and treat migraines, I want to talk about some big three things that can be kind of triggers or that maybe I've heard that are triggers.
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So let's first jump into the association between hydration and water intake and if there is any impact on migraine occurrences and how important is water for those who suffer from migraines.
00:11:36.811 --> 00:11:40.201
Yes, water is a big one, dehydration is a big one.
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Even Mild dehydration can act as a migraine trigger and, you know, even those of us or people who don't have migraine Know if you get dehydrated you're likely going to experience a headache, maybe some lightheadedness.
00:11:53.793 --> 00:12:05.090
So we know that lower water intake is associated with significant increases in migraine disability, as well as attack severity, frequency, duration.
00:12:05.090 --> 00:12:09.219
So it is a big deal and, honestly, most migraine patients do know that.
00:12:09.219 --> 00:12:16.929
But I think a big part of Helping them get the amount of water that they need each day is actually figuring out where they're starting from.
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I think a lot of people think they're drinking more water than they may actually be.
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So the first thing I like to do with clients is doing a water intake log, figuring out where we're starting from, and then help them gradually get to a goal of 65 to 100 ounces a day, depending on the person, and then looking for, you know, electrolytes that we can maybe add to increase hydration, really educating the patient on what counts as a hydrating fluid.
00:12:45.350 --> 00:12:52.443
Those are all some things that we can look into to help prevent that dehydration that is such a prominent trigger for migraine.
00:12:53.191 --> 00:12:54.635
So what is the best way?
00:12:54.635 --> 00:12:58.990
Number one, to ask if they're getting enough water, because it's so easy to be like do you drink water during the day?
00:12:58.990 --> 00:13:04.409
Yes, okay, then they're good right, but, like you said, most people underestimate how much water they're actually drinking.
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So what are some really good ways to actually find out how much they're drinking and how do we determine how much they need?
00:13:11.157 --> 00:13:13.376
Yes, so honestly.
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I will like to ask if you're doing especially a telehealth session like this, I'll ask my client what do you typically drink your water out of?
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We figure out how many ounces is in their typical Water bottle or their water glass, and then that's a really easy way to figure out how much they're drinking, because they can probably more easily say I'm drinking like one and a half of these a day, rather than I'm drinking 35 ounces of water a day.
00:13:37.870 --> 00:13:51.183
Most people don't know how many ounces they're drinking a day, so we can use that as a good tool and then For most people, at least for adults, that two liter or, you know, 65 ounces is a good end goal.
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So we can just work up gradually to that.
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Rather than going from 35 ounces to 65 overnight.
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We can just gradually increase that for them and then using tools like adding Citrus fruits or other flavorings to water if they really hate water can be another good way to get that up too, and what else counts for, like total fluid intake.
00:14:14.065 --> 00:14:15.309
So, yes, we've got our water.
00:14:15.309 --> 00:14:24.533
Hopefully they're eating plenty of fruits, because I know that has a lot of water in it as well but what are the things that we can suggest to help them increase their total fluid intake?
00:14:25.024 --> 00:14:30.731
Yes, so of course water, but we can also be thinking about if they're making smoothies.
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The fluid that they're putting in there absolutely counts.
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Any decaffeinated or herbal teas that they're drinking will count.
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Any suits that have broth in them, we can count that.
00:14:41.509 --> 00:14:47.149
So there are a lot of sources that I think people are forgetting about and not giving themselves credit for.
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Even like a seltzer water or something like that can also count, and oftentimes people will enjoy that more as in plain water.
00:14:54.229 --> 00:14:58.509
So these are all things we can be adding to the tally to help them get to that.
00:14:58.690 --> 00:15:06.331
you know, 65 to 100 ounces a day, I think that number is so helpful because, again, as clinicians sometimes it's hard for us to remember.
00:15:06.331 --> 00:15:08.873
You know there's formulas and you register dieticians.
00:15:08.873 --> 00:15:18.750
You're so great at all your formulas, but in a quick clinic visit, so if you guys can just remember 65 to 100 ounces a day, that would be a really good goal, especially on the lower end.
00:15:18.750 --> 00:15:22.429
And then if they are eating soups and fruits, then they can add those in.
00:15:22.429 --> 00:15:24.812
So thank you so much for that, kelly.
00:15:24.812 --> 00:15:26.672
That is such a good, helpful number.
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I hope you guys store that in your pocket for later today.
00:15:28.971 --> 00:15:34.751
So I wanna move on to my favorite beverage, and this is coffee or caffeine.
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And so this is another big one.
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And is there a connection between caffeine and migraines?
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Should it be limited?
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Does this trigger migraines or treat migraines?
00:15:44.614 --> 00:15:48.448
So give us the facts on coffee and please don't tell me that I need to stop drinking my coffee.
00:15:49.572 --> 00:16:06.133
Well, I definitely won't do that, because I'm also a daily coffee drinker and the role of caffeine in migraine is very confusing, honestly, for everyone for patients and providers alike because it does depend on the person with like so much with migraine.
00:16:06.133 --> 00:16:09.732
It depends on the person, and caffeine can help, it can hurt.
00:16:09.732 --> 00:16:16.652
So let's talk a little bit about how to figure that out for the patient and kind of what we know about caffeine.
00:16:16.652 --> 00:16:39.671
Each patient's tolerance and sensitivity is gonna be a little bit different, so I think it's really helpful to have a conversation with the patient to figure out, one, if they're even consuming caffeine and if that's something they care about, and two, how they feel when they're drinking caffeine, which they may not know just right off the top of their head might be something you need to revisit.
00:16:39.671 --> 00:16:53.726
But figuring out if they feel jittery or anxious or even headache-y after having a cup of coffee in the morning, that they may just be kind of pushing through for that energy, that's some really helpful information to tell us.
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Okay, this may be an issue for them.
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We might wanna dial that back.
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Caffeine can act as a trigger for some patients, so assessing that response can help you figure that out, as can that food and symptom journal that we talked about earlier.
00:17:07.048 --> 00:17:17.428
But in general, if someone is drinking caffeine daily and they want to continue doing that which, like I said, I'm a coffee drinker, so it's fine.
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If that's something that they wanna work into their life, then keeping it below 200 milligrams of caffeine per day is where we wanna be.
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And then, to make sure that we're considering sleep quality, we wanna cut that caffeine intake off at 3 pm, max 12 noon if they have trouble with sleep already is gonna be where we wanna cut it off.
00:17:40.984 --> 00:17:47.174
Drinking too much caffeine every day can be an issue, as can variations in caffeine intake.
00:17:47.174 --> 00:17:55.308
So if they're gonna be a caffeine drinker, they need to drink it every day or just save it for acute management.
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Otherwise they can start to have some withdrawal symptoms and that can be a trigger as well.
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So avoiding variability and intake and keeping it below 200 milligrams is what we wanna tell our coffee drinkers.
00:18:06.251 --> 00:18:25.454
And then for people who have episodic migraine so like less than 15 migraine days a month and they don't drink caffeine every single day we can use a cup of coffee as an acute migraine management tool, and that can actually be pretty effective for helping cut down the severity of a migraine attack.
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So that's where the helpfulness of caffeine can come in.
00:18:30.265 --> 00:18:31.329
That was so helpful.
00:18:31.329 --> 00:18:37.111
So again, you're just giving us these little golden nuggets of numbers that we can keep in our pockets and suggest to patients.
00:18:37.111 --> 00:18:38.630
So 200 milligrams?
00:18:38.630 --> 00:18:44.270
I want you to educate us a little bit on that, because all I know is I like my cup of coffee.
00:18:44.270 --> 00:18:47.113
So how many cups of coffee is 200 milligrams?
00:18:48.065 --> 00:18:56.574
Yes, so that is where it gets a little bit tricky because it's gonna depend on how it's brewed, the strength of the coffee, all kinds of stuff.
00:18:56.574 --> 00:19:06.732
But in general I typically tell people that a cup of coffee in the morning not a big, huge cup, but like eight-ish ounces of coffee you can call that 100 milligrams.
00:19:06.732 --> 00:19:08.470
That's gonna be a good average.
00:19:08.470 --> 00:19:12.990
So two cups of coffee max a day is gonna be where you wanna sit.
00:19:12.990 --> 00:19:15.069
Awesome, very, very helpful.
00:19:16.205 --> 00:19:17.130
What about espresso?
00:19:17.130 --> 00:19:19.211
Does that have more about the same?
00:19:20.164 --> 00:19:24.238
Espresso and Belive is about 70 milligrams per little shot.
00:19:25.161 --> 00:19:26.826
Okay, so it's actually a little bit less.
00:19:26.826 --> 00:19:42.106
So we're going to move nicely into my next question, and that's about the role of sugar in migraines, because as we talk about coffee, unfortunately so many people are putting so much sugar in there and sweetened creamer in there.
00:19:42.106 --> 00:19:48.949
So I'm curious what role does sugar in all forms play in triggering migraines?
00:19:49.701 --> 00:19:56.006
Yes, and this is a really common question you'll hear from patients too because sugar is kind of the new fat.
00:19:56.006 --> 00:19:57.916
Right, we were all afraid of fat for a while.
00:19:57.916 --> 00:20:14.305
Now we're all afraid of sugar and, just like fat, sugar is not evil, but it is something we want to be thoughtful around because if we're consuming it in excess or on its own, then it can act as a migraine trigger for a lot of people.
00:20:14.305 --> 00:20:30.942
So the biggest issue when we're thinking about sugar is the potential for it to cause those blood sugar spikes and then blood sugar dips, and that, like blood sugar roller coaster, is what can act as a trigger for a lot of people with migraine.
00:20:30.942 --> 00:20:32.627
So that's what we're looking to avoid.
00:20:33.592 --> 00:20:50.368
And for patients who are sensitive to sugar, which is going to be a lot of them, then combining sugar with that protein fiber can help slow that blood sugar response, slow the absorption of sugar and prevent those spikes and dips that are going to be so problematic.
00:20:50.368 --> 00:20:55.727
So that's one really helpful education piece for patients when it comes to sugar.
00:20:55.727 --> 00:21:02.045
Strict avoidance of sugar is honestly not something I recommend for anyone.
00:21:02.045 --> 00:21:24.750
Unless there's a special circumstance, it can lead to cravings, you know, binging, disordered eating, just stress and anxiety around food so we can really help our patients learn how to have not only healthy blood sugar responses but also how to have an easier and healthy relationship with food at the same time.
00:21:24.750 --> 00:21:31.191
Because of that, you know, kind of imbalanced conversation that's happening around sugar right now.
00:21:31.191 --> 00:21:38.207
We can help kind of correct some of that, but moderation and balance is definitely key, as with most things, when we're talking about sugar for migraine.
00:21:39.799 --> 00:21:47.763
What an excellent point, because unfortunately, I hear way too many clinicians tell patients you need to cut out all sugar.
00:21:47.763 --> 00:21:49.950
I think that's a horrible recommendation.
00:21:49.950 --> 00:21:52.207
Because number one well, what is all sugar Like?
00:21:52.207 --> 00:21:52.911
What does that mean?
00:21:52.911 --> 00:21:57.288
I mean, sugar isn't everything that's baked, cooked, you know, like it's in sauces, it's in everything.
00:21:57.288 --> 00:21:59.625
I think that's just a terrible recommendation.
00:21:59.807 --> 00:22:07.971
And so, like what you had said, helping our patients have that healthy relationship with food is so important just for their life and vitality in general.
00:22:07.971 --> 00:22:15.451
And I want to linger here a little bit because I love that you said hey, you could still have, you know, a cookie at the end of the day or a cake because it's your birthday.
00:22:15.451 --> 00:22:16.742
I love that.
00:22:16.742 --> 00:22:18.650
All the dieticians I have on talk about that.
00:22:18.650 --> 00:22:22.442
Add in approach rather than making it district avoidance.
00:22:22.442 --> 00:22:29.439
So let's say, if a patient does you know want to have some sweets you had mentioned pairing it with a protein or a fat what would that look like?
00:22:29.439 --> 00:22:37.607
Can you give us just an example of how they can include some sugar foods in their diet but still managing their blood sugar and preventing those spikes?
00:22:38.641 --> 00:22:39.403
Oh, absolutely.
00:22:39.403 --> 00:22:44.093
This is a conversation I have all the time, so let's use the cake example.
00:22:44.093 --> 00:22:45.482
So it's someone's birthday.
00:22:45.482 --> 00:22:46.586
They want to have a piece of cake.
00:22:46.586 --> 00:22:48.450
Awesome, sounds amazing.
00:22:49.259 --> 00:22:58.730
So what we can do to make that a easier experience when it comes to migraine is to try and have that piece of cake after a balanced meal.
00:22:58.730 --> 00:23:12.362
So if we're having it as dessert and we've just had a nice, you know, protein rich, fiber rich meal, then we're probably going to have a pretty easy time tolerating that cake because we've already got that good foundation hanging out in our stomach.
00:23:12.362 --> 00:23:14.907
So that's one thing that we can be thinking about.
00:23:14.907 --> 00:23:29.577
I think also, helping your patients get in tune with those hunger and fullness cues can be another really powerful tool, because that can help them manage their intake of those sweets more easily.
00:23:29.577 --> 00:23:38.251
So they can have maybe a few bites of that cake and then realize, actually, I'm satisfied, I'm full, I'm good, I don't need any more cake.
00:23:38.251 --> 00:23:40.221
Or, of course, if they want more, they can have it.
00:23:40.221 --> 00:23:49.891
But that's another way that they can use their own body's cues to manage sugar intake, along with those, you know, balancing blood sugar reactions.
00:23:50.720 --> 00:23:58.518
So helpful and I love that you're not just saying that you have to avoid all sugar, because it's part of life, it's part of enjoying food and it can be done so healthfully.
00:23:58.518 --> 00:24:05.545
And I talk about this with my pediatric population all the time, because when you do restrict it, what do you want more of?
00:24:05.545 --> 00:24:09.402
You know you really want more of the sweets and of the sugar and of those things.
00:24:09.402 --> 00:24:17.970
So if you learn early on how to just incorporate it into your regular meals, then you really don't have any of those binge restriction issues at all.
00:24:17.970 --> 00:24:20.207
So that was such a helpful piece of advice.
00:24:20.207 --> 00:24:29.785
So I want to round out this conversation with if there are any supplements or vitamins that are effective in preventing or treating migraines that we can suggest our patients try.
00:24:30.826 --> 00:24:38.445
Yes, so there are kind of the migraine prevention supplement trifecta that we talk about.
00:24:38.445 --> 00:24:43.163
So that's going to be magnesium, riboflavin and CoQ10.
00:24:43.163 --> 00:24:51.205
Those are probably the most recommended supplements for managing migraine and there are recommended dosages for these.
00:24:51.205 --> 00:25:03.262
Of course you want to make sure it makes sense for your individual patients, but with magnesium we're usually looking around 400 to even 1200 milligrams per day, depending on the person.
00:25:03.262 --> 00:25:10.786
Riboflavin is 400 milligrams a day and then CoQ10, between 100 and 300 milligrams is what we're looking at.
00:25:10.786 --> 00:25:13.571
So these can be pretty helpful.
00:25:13.571 --> 00:25:14.784
Again, depending on the patient.
00:25:14.784 --> 00:25:20.346
They're not going to work for everyone, but trialing these one at a time, I think can be really helpful.
00:25:20.346 --> 00:25:28.743
Just to make sure that they're going to tolerate it in the first place and then seeing if it's worth keeping in their routine can also be good to evaluate.
00:25:29.306 --> 00:25:36.128
You read my mind because I was going to ask you do you just kind of throw all these at them, three at a time or one at a time?
00:25:36.128 --> 00:25:37.392
So we try them one at a time.
00:25:37.392 --> 00:25:40.527
Let's just say we do magnesium first and it's working really well.
00:25:40.527 --> 00:25:43.683
Do you recommend adding on any of the other ones?
00:25:43.683 --> 00:25:45.471
Is there any benefit to?
00:25:45.471 --> 00:25:48.289
More is better, or just kind of sticking with one of them?
00:25:49.497 --> 00:25:52.506
So it depends on what type of response you get.
00:25:52.506 --> 00:25:59.680
So usually I will start with magnesium and that one I find tends to be the most helpful for the most amount of people.
00:25:59.680 --> 00:26:11.027
So if we add that in, let's say, three months later they're doing pretty well, but they're still dealing with some major fatigue or maybe some brain fog, migraine symptoms.
00:26:11.027 --> 00:26:17.247
Of course, then we might try something like CoQ10, which is going to help with mitochondrial support, energy production.
00:26:17.247 --> 00:26:20.744
We might add that in and see if we can get any further improvements.
00:26:20.744 --> 00:26:26.638
So that's kind of how I would evaluate whether we need to use all three of these or not with somebody.
00:26:27.795 --> 00:26:29.782
And now, where should people buy these?
00:26:29.782 --> 00:26:31.039
Because I know that's not a prescription.
00:26:31.039 --> 00:26:39.723
What should they look for specifically on a label when they are kind of in the madness of a vitamin store, because there's probably like 30 different kinds that they can look at?
00:26:39.723 --> 00:26:43.704
So can you give us a little bit of guidance on selecting a high quality vitamin?
00:26:44.835 --> 00:27:04.121
So if you are buying a supplement, then buying it from a store or from if your provider has a formulary that they use, those are going to be your best options, rather than Amazon, because, believe it or not, there are counterfeit supplements out there which is hard to believe, but it happens all the time.
00:27:04.121 --> 00:27:07.537
So you want to make sure you're buying from somewhere reputable, that's number one.
00:27:07.537 --> 00:27:24.564
And then if you can find a product that is third party tested, that means that a separate you know, third party, a separate company that isn't the supplement brand itself, has evaluated that product for purity, for potency.
00:27:24.564 --> 00:27:31.363
Basically it says you know, this product has what it's supposed to have in it and it doesn't have anything that it's not supposed to have in it.
00:27:31.363 --> 00:27:36.065
So that third party testing, if I can find it, that's going to be my gold standard.
00:27:37.355 --> 00:27:51.663
And it will specifically say that on the label that this was third party tested or something like that Ideally sometimes you'll need to find that information on the website, and you can even email or call the company I have done that many times to check and then you can even request results.
00:27:52.584 --> 00:27:53.226
That's awesome.
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