What Actually Causes Chronic Migraine? A Mechanistic Reading of Treatment-Resistant Migraine — What restoration looks like

For Driver 1 (mitochondrial) cases: high-dose riboflavin (400 mg daily), CoQ10 ubiquinol (200-400 mg daily), magnesium glycinate (400-600 mg daily). Address upstream causes of bioenergetic compromise. Sleep optimization and consistent meal timing. For Driver 2 (mast cell) cases: mast cell stabilization (cromolyn, ketotifen, or quercetin), low-histamine dietary trial, H1 and H2 antihistamine combination where appropriate, and addressing the upstream driver of mast cell activation. For Driver 3 (gut-brain) cases: address SIBO if present, comprehensive gut workup, vagal tone restoration (slow-paced breath work, cold exposure within tolerance, vagal nerve stimulation devices when accessible). For Driver 4 (hormonal) cases: assess hormonal status comprehensively including progesterone, consider hormone replacement therapy under appropriate medical supervision, address the estrobolome (see the endometriosis article ). The full sequence operates on the timescale of six to twelve months for substantial improvement.