Migraines are often treated as a brain-only problem. Let’s look differently.

Case #5 – The Headache Weather Station

Patient: Noor, 33-year-old teacher
Chief complaint: Recurrent migraines
Duration: Since teens, worse in last 2 years

She can predict storms and hormone shifts by her head.

1. What we knew on Day One

Throbbing unilateral headaches, nausea, sometimes aura

Flares with red wine, aged cheese, weather changes, certain perfumes

Worse just before menstruation

Some GI symptoms and flushing with certain foods

On multiple medications but still frequent migraines

Pause:
Do you see hints of histamine / mast cell issues plus hormones?

2. The upstream workup

We considered:

• Histamine load (foods, gut, environment)
• Estrogen fluctuations and detox
• Gut integrity and microbiome
• Sleep and stress

We didn’t just list “triggers”; we asked:

“Why is Noor’s system so reactive?”

3. Plan and outcome

Plan:

• Short-term histamine-light diet trial (without making her fearful of food)
• Gut support and regularity
• Support estrogen metabolism (per your training, in coordination with her other care)
• Sleep, hydration, and regular meals
• Simple stress and nervous system practices

Outcome:

• Fewer and less severe migraines over months
• Clear understanding of major vs minor triggers
• Reduced medication burden (with her neurologist’s guidance)

4. Takeaways for your practice

Pearl #1: When many “triggers” cluster (foods, weather, hormones, smells), think histamine and mast cell terrain, not just brain chemistry.

Pearl #2: A short trial of histamine-light eating can be very informative.

Pearl #3: Gut and hormones strongly influence migraine terrain.

Action step:

For your next migraine patient, ask:

“Which foods, smells, or weather patterns reliably precede your headaches?”

Look for a histamine pattern.

FM 2.0 Lens

FMU students explore:

• Genes affecting histamine breakdown, detox, and estrogen metabolism
• Stepwise protocols for MCAS-aligned patterns
• Terrain strategies that integrate immune, gut, and hormonal regulation

The below single visual captures the FM 1.0 → FM 2.0 evolution in one place.

Take care,

Ron Grisanti, D.C., D.A.B.C.O., D.A.C.B.N., M.S., DIANM, CFMP

Founder, Functional Medicine University

P.S. If these Clinical Rounds are resonating and you’d like a step-by-step path to practice this level of upstream, terrain-based thinking with support and structure, the next FMU Fellowship cohort is now forming. You can hold your seat with a $150 deposit so you don’t miss the enrollment window. To learn more or reserve your seat, click here.

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