FAQ Episode 50: Do you have rosacea and migraines?

Frequently Asked Questions about Natural Migraine Relief

When looking at two seemingly unrelated health problems, it is not uncommon to find that they may share underlying root cause biochemical imbalances as provocative factors. We talk about this extensively in the Natural Migraine Relief course for paid subscribers.

An useful example of this overlap is the recent study published in the April 17, 2025 JAMA journal Dermatology¹ which showed that a monthly injection of the CGRP receptor antibody therapy erunumab significantly reduced the facial redness and flush of rosacea by the second and third month of therapy. Specifically, the days of extreme flushing per month were reduced 30% and the number of days per month with moderate to severe redness was reduced 56%. This isn’t suprising, as patients with rosacea have elevated levels of CGRP present in their blood and facial skin biopsies, which would suggest that CGRP inhibition might have a role in the management of rosacea.

If you’ve had rosacea, this kind of improvement could make a big difference in your self-image and everyday confidence. If you also had a 40-50% reduction in headache severity as seen by some patients taking this same therapy for migraine, if could be a double plus. If you fit this profile, you may want to discuss this therapy option with your personal physician.

Migraine and Rosacea: What’s at the core of the problem?

Migraine and rosacea are both disorders that are incompletely understood and for which typical medical therapy leaves many patients with only partial benefit or relief. Like migraine, rosacea affects women some three times more often than men. Let’s see what additional root cause factors and action considerations they might have in common.

Is elevated vasodilation a shared cofactor in rosacea and migraine?

One element theses two problems share is a state of neurovascular reactivity. Nerve mediated vasodilation or constriction of blood vessels can provoke local trigeminal nerve sensitivity, which can become a vicious cycle for propagating migraine pain. In rosacea, neurovascular dilation sends excess blood flow to the surface of facial skin. This produces redness and flushing, and eventually can result in secondary inflammation. Over time, this is the source of the chronic rosacea changes that are asthetically unappealing.

Anonher interesting similarity between these two disorders is that peak rosacea incidence in one’s 30s to 50s, which are also years that are often affected by the menopausal transition. Reduced levels of estrogen or an aggravation of the estrogen/progesterone ratio during these years can promote neurovascular dilation which, in turn, can promote both rosacea and migraine.

The variable role of Vitamin D3

If you’ve previously read my blog or the Natural Migraine Relief course you know I preach that Vitamin D can be a key immune modulator as a benefit for migraine. I advise almost everyone, especially those with migraine, to aim for the upper half of normal in a serum Vitamin D level. If you have rosacea, however, you should be aware that there is some conflicting data on this. A study from 2013² found that those with rosacea had about 25% higher Vitamin D level than average. This could be related to how Vitamin D promotes immune system defenses by increasing the production of cathelicidin peptides. These molecules act as endogenous ‘natural antibiotics’ against a range of bacteria, fungi, and enveloped viruses. Unfortunately, the related inflammation of this war on potential infection could also result in the bumps and pimples of rosacea. Its interesting that over the years a mainstay of rosacea therapy have been several types of antibiotics. Some versions of rosacea could have a low grade infectious cause and this, coupled with a too vigorous immune response, may produce the unhappy cosmetic result. So, if you have rosacea and migraines, you may want to assess and moderate your Vitamin D intake.

Action items for consideration:

If you have both migraines and rosacea:

1. Consider moderating your dosage to get a Vitamin D3 level at the mid-range of normal, say a 50-55 ng/ml, as your top-end target (with a ‘normal’ scale’ blood test being 30-100 ng/nl.)

2. If you are in the perimenopausal age range, consider getting a consult for individualized bio-identical hormone support, addressing:

   -estrogen and progesterone support if you are having vasomotor (hot flash/night sweat) symptoms

   -daily or cycled progesterone support to reduce estrogen dominance if you are still having periods, especially if you are having late cycle ‘PMS’ type symptoms.

   The Natural Migraine Relief course has a Lesson devoted to finding qualified professional consultation: Lesson 24: Getting another opinion: finding an integrative or functional medicine minded practitioner.

3. You may be as candidate for one of the CGRP inhibitors, like the erunumab (Aimovig) used in the study referenced above. I’d give any such therapy a full 90 days to see potential benefit. You could discuss this option further with your primary care physician or neurologist.

Whatever your medical history, always consider that multiple symptoms and even having more than one medical diagnosis often have several interlocking biochemical root cause factors. When you find and address as many such underlying factors as possible, your odds of making progress go up considerably!

1. “Potential Role of Calcitonin Gene-Related Peptide Inhibitors in the Treatment of Rosacea Flushing and Erythema.” John S. Barbieri, MD, MBA JAMA Dermatology. 04/17/2024;160(6):620. doi:10.1001/jamadermatol.2024.0397 https://jamanetwork.com/journals/jamadermatology/article-abstract/2817742

2. Ekiz O, Balta I, Sen BB, et al. Vitamin D status in patients with rosacea. Cutaneous and Ocular Toxicology 2013 May 28 https://www.rosacea.org/rosacea-review/2013/fall/is-rosacea-affected-by-too-much-vitamin-d