Purpose Studies suggest spinal manipulation reduces migraine burden, but none have evaluated effects of a comprehensive package of chiropractic care on migraine frequency, disability, and quality of life (QOL). Methods We conducted a pilot randomized trial comparing an expert-panel-validated, multimodal chiropractic care (CC) intervention plus enhanced usual care (EUC) to EUC alone among 61 adult women with episodic migraine. EUC was comprised of usual medical care and migraine education literature. Individuals assigned to CC+EUC received up to 10 sessions of CC over 14 weeks. Primary aims assessed feasibility of recruitment, retention and adherence to the protocol, and adverse events. Secondary aims evaluated changes in number of migraine days (our main clinical outcome) using daily self-report logs, Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), and Migraine-Specific Quality of Life (MSQL). Results Of the 29 individuals randomized to CC+EUC, 24 individuals (82.8%) attended at least 75% of scheduled chiropractic visits. Fifty-seven (93.4%) participants completed daily migraine logs. We observed 98 nonserious adverse events of which 35 were musculoskeletal complaints and 45 were related to migraine attacks. Those in CC+EUC were more likely to report musculoskeletal complaints (31.0%) compared to those in EUC (6.3%). Those randomized to CC+EUC experienced a larger change in number of days with migraine from run-in to the initial follow-up (mean change = −2.90, 95% confidence interval [CI]: −4.04, −1.76) compared to those randomized to EUC alone (mean change = −0.98; 95% CI: −2.03, 0.06) (between-group difference in mean change = −1.92; 95% CI: −3.46, −0.37). CC+EUC also experienced greater improvements in MIDAS, HIT-6, and MSQL. Conclusion Recruitment, retention, and adherence to the interventions are feasible. In addition, we observed preliminary evidence of clinically meaningful reductions in migraine frequency, and improvements in disability and QOL among those assigned to CC+EUC that were greater those assigned to EUC alone.