"MO," a 47-year-old woman from London, England, presented with an eight-year history of debilitating migraine, which occasionally kept her bedridden for two or hree days at a time.

She believed that many of her migraines were brought on by "brain stimulation", and most were accompanied by nausea and vomiting. It was not unusual for her to have a migraine every day during menses.

The pain had become so severe in the past few years that MO was forced to quit her job and stay at home, attempting to find a cure. After MO left her high-stress job, she continued to seek medical care to help her “get her life back.”

While she consulted many doctors, all they were able to offer to reduce her pain were prescription drugs that produced myriad side effects. MO had also tried intravenous glutathione and vitamin C to promote detoxification in the hope that this would rid her of migraines.

In addition to migraine, MO had a history of chronic fatigue syndrome, severe depression, agitation, anxiety with intermittent panic attacks, severe mood swings, sleep disorder, and premenstrual syndrome. She also was occasionally bothered with gas and bloating. Her menstrual cycle was regular, at 28 days. She had not been sexually active for the past few years because of loss of libido, poor sex drive, and vaginal dryness. She was previously diagnosed with osteoporosis and decreased bone density in both hips.

MO reported that she had been a vegetarian when she was younger and had a history of low cholesterol. She described herself as anorexic between the ages of 16 and 20, and had suffered bouts of emotional binge eating at other times. Her current height was 5'6" and her weight was 119 pounds. While in her twenties, she used birth control pills for two years and had several breast cysts removed. MO mentioned that she previously had excessive body hair growth, which significantly decreased before the onset of migraine. A gynecological exam did not find any pathology.

After reading the Life Extension article about an innovative method of migraine treatment, she contemplated coming to the United States, since she was unable to obtain the necessary supplements, laboratory testing, and bioidentical hormone formulas in her native England. In October 2004, MO traveled to the US for further evaluation and possible management of migraine.

In talking with us after her arrival in America, MO said that for years she had felt her hormones were out of balance, which contributed to her symptoms. She had not been able to find any treatment options for rebalancing her hormones, nor could she find any medical options other than pharmacological therapy for relief of migraine. The doctors she consulted refused to do comprehensive hormone testing, saying it was not necessary, and also that their “hands were tied” in the United Kingdom. She was also limited to only the supplements available in her country.

We suggested that MO undergo a complete female hormone panel plus a lipid profile. The hormone panel included total estrogen, progesterone, total testosterone, dehydroepiandrosterone sulfate (DHEA-S), and pregnenolone. Testing was done on day 19 of a 28-day menstrual cycle.

The results of initial hormone testing were as follows, with reference ranges in parentheses: total cholesterol: 215 mg/dL ( < 200); total estrogen: 409 pg/mL (61- 437); progesterone: 22.6 ng/mL (0.2-28); total testosterone: 45 ng/dL (14-76); DHEA-S: 62 ug/dL (65-380); and pregnenolone: 216 ng/dL (10-230).

At first glance, MO had excellent blood test results, except for low DHEA-S and slightly elevated total cholesterol. The patient's history of excessive body hair, which had resolved prior to the onset of migraine, was crucial to our understanding the pathogenesis of her migraine and planning an appropriate treatment program. We posited that she had a dominance of androgens until the age of 39, when her migraine started. Based on our clinical experience, we felt that we needed to increase her testosterone to a high-normal level. We aimed to elevate all her hormones, particularly testosterone, as the initial step in our program.

The suggested initial program for MO was as follows:

• Pregnenolone: 100 mg in the morning.
• DHEA: 100 mg in the morning.
• 7-Keto DHEA: 100 mg in the morning and 50 mg at noon.

Because MO still had a regular menstrual cycle, we suggested the following schedule for bioidentical hormones:

• Triestrogen gel (containing 90% estriol, 7% estradiol, and 3% estrone): 0.1 cc in the morning until the start of menses, then discontinue and begin again when menses stops.
• Micronized progesterone gel (50 mg/mL): 0.4 cc in the morning and 0.4 cc at night for 10 days after completion of menses, then 0.6 cc in the morning and 0.4 cc at night until the first day of menses.
• Micronized testosterone gel (50 mg/mL): 0.2 cc every day in the morning.

As you can see, we recommended pregnenolone, triestrogen, and progesterone despite the patient's normal levels of these hormones, as MO's symptoms suggested that she was in fact clinically deficient in those hormones. Based on our clinical experience with similar patients, we suggested supplemental pregnenolone and progesterone.

Also included in her initial program were:

• NutriCology® ProGreens® (containing probiotics, green foods, and plant fibers): start with 1/2 scoop, increasing to one scoop daily.
• Longevity Science® MagnaCalm (magnesium citrate powder): start with 1/4 scoop at bedtime, increasing to one full scoop.
• Nutribiotic® MetaRest® (containing melatonin, vitamin B6, and kava kava): one capsule at bedtime.
• Saw palmetto: 160 mg in the morning.
• Zinc: 30 mg at bedtime.

During her first month on the program, MO had no migraines at all. Because of the absence of headaches, particularly during menses, she felt it was a real breakthrough, as this was the first time that had happened in years. She also began to feel much stronger, and acquired more stamina. She was able to be more active without becoming exhausted and developing a migraine. MO reported that she was much calmer and had begun dealing with stressful situations without getting “totally demolished.”

She continued, however, to have difficulty sleeping and began to develop slight breast tenderness and occasional bouts of diarrhea. Accordingly, we made slight adjustments to her program. Triestrogen was discontinued. Her dose of MetaRest® was increased to two capsules at bedtime. As MO thought she may have contracted stomach flu, MagnaCalm and Pro- Greens® were discontinued for a few days, and then restarted at the previously suggested doses. MO also started using Douglas Laboratories ® RheumaShield™, containing type II collagen (one capsule taken at bedtime), and glucosamine sulfate (2000 mg taken in the morning). Further minor adjustments to her program were made on a weekly basis.

After following the program for five months, MO started to work December 2005 LIFE EXTENSION 91 CASE HISTORY on a part-time basis. She also began to travel and spend time away from home. Thankfully, her life as a recluse is over. After seven months on the migraine program, MO is practically migraine-free.

This case was very interesting because of her unusually “good” blood test results prior to treatment. Physicians must remember that a blood test is a valuable additional tool-rather than a primary instrument-for assessing a patient's condition. Evaluation of the patient's problem that combines the clinical picture, medical history, and blood testing can help create an individualized program for migraine management.