The ketogenic, or keto, diet is a diet rich in fats, moderate in protein, and very low in carbs.

It has long been used to treat epilepsy, a brain disorder that causes seizures.

Owing to its therapeutic effects in managing epilepsy, the keto diet has been suggested to alleviate or prevent other brain disorders like migraine.

This article examines the evidence to determine whether the keto diet can help prevent migraine.

The keto diet and migraine

Keto refers to a diet that consists primarily of fats with very few carbs — usually less than 50 grams daily (1, 2).

For reference, the average American adult consumes 200–350 grams of carbs daily (2).

Carbs are found in a variety of foods, such as fruits, breads, cereals, pasta, milk and other dairy products, as well as starchy vegetables like potatoes and corn.

Normally, your body breaks down carbs from these foods into glucose to supply your cells with energy.

Yet, when you severely restrict carbs from your diet for 3–4 days, your body must look for alternative fuel sources to meet its energy needs (1).

It does so by breaking down fats in your liver to produce ketones, which your body and brain can easily use for energy.

Your body enters a metabolic state called ketosis when blood ketone levels rise above normal.

It has been suggested that these ketones have protective effects against migraine (3).

Migraine is characterized by headaches that cause severe throbbing or pulsing pain, usually on one side of your head (4).

This pain may be accompanied by other symptoms, such as nausea and sensitivity to light or sound.

While the exact mechanism remains unclear, it’s thought that the ketones produced while on a keto diet restore brain excitability and energy metabolism to counteract brain inflammation in people with migraine (5, 6, 7, 8).

summary

Consuming a low number of carbs on a keto diet forces your body to shift its metabolism from using carbs as fuel to using ketones. These ketones have been suggested to alleviate migraine.

Ketones may protect against migraine attacks

Early research has suggested that the keto diet may be beneficial for preventing or treating migraine.

The first report dates back to 1928, when medical literature reported that 39% of people experienced some improvement in migraine frequency and severity with the keto diet (9).

A later study in 1930 demonstrated that 28% of people with migraine who followed a keto diet experienced no migraine attacks for up to 3 months after entering ketosis, with another 25% reporting less severe or less frequent migraine attacks (10).

However, since these reports, interest in the keto diet for migraine steadily declined, likely related to the diet’s strict nature and the development of over-the-counter and prescription medications for managing the condition.

Interest was later renewed when a 2015 observational study found that migraine frequency was significantly reduced in women who followed a low calorie keto diet for 1 month, compared with a standard low calorie diet (11).

Still, compared with the standard diet, women who followed the keto diet lost significantly more weight, suggesting that the reduction in migraine frequency may also be linked to weight loss rather than the keto diet itself.

To determine whether weight loss is linked to a decrease in migraine attack frequency, researchers performed a follow-up study.

The study noted that participants with migraine experienced an average of three fewer attacks per month while on a very low calorie keto diet, compared with a very low calorie non-keto diet, despite similar weight loss between the diets (12).

Strengthening these findings, another study observed significant reductions in migraine frequency, duration, and severity after a 1-month keto diet (8).

Collectively, these results suggest that the keto diet may treat migraine but not prevent the condition entirely.

summary

Studies have demonstrated that the keto diet may help reduce migraine frequency, duration, and severity.

The jury is still out

The current evidence suggests that a keto diet can help reduce migraine frequency, duration, or severity.

However, there’s still much to be learned about the keto diet before it can be routinely recommended as a primary or supplementary treatment option for people with migraine.

For example, it’s unknown whether a state of ketosis must be maintained continuously or only some of the time to experience its protective effects against migraine.

Moreover, all of the studies showing the beneficial effects of the keto diet on migraine were performed in adults who had overweight or obesity based on their body mass index (BMI).

Therefore, it’s unknown whether adults with a BMI in the “normal” range would experience the same benefits.

Most of the studies were also performed by the same group of researchers in the same geographical location and setting, which could bias the results and limit the generalizability of the findings to other populations.

Aside from these study weaknesses, the keto diet can be difficult to follow long term and cause changes to bowel habits. Plus, it may be contraindicated in people with certain liver conditions, such as pancreatitis, liver failure, and fat-metabolism-related disorders (2, 13).

Interestingly, a study is underway to determine whether ketone supplements prevent migraine (14).

Exogenous ketone supplements are produced synthetically but have been shown to increase blood ketone levels, mimicking what happens when you follow a keto diet (15, 16).

That said, ketone supplements may be an alternative to following a keto diet for managing migraine attacks.

Still, additional studies are needed to confirm the keto diet’s ability to manage migraine.

summary

While the keto diet may be a promising treatment option for migraine, additional studies are needed.

The bottom line

The keto diet is a diet that shifts your metabolism from burning carbs to ketones for fuel.

These ketones may have protective effects against migraine, a brain disorder that causes throbbing head pain.

While promising, additional studies are needed to determine the efficacy of the keto diet for managing migraine.

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