Can the Ketogenic Diet Help Prevent Migraines? Science, Evidence, and What to Know
Examining the science behind the keto diet and its potential role in preventing, managing, and reducing migraine attacks.
Migraines are more than just headaches; they can be debilitating, often accompanied by symptoms like nausea, vision changes, and sensitivity to light or sound. While many people use medication to manage migraine attacks, there is growing interest in dietary interventions—specifically, the ketogenic (keto) diet. Could switching your diet help keep migraines at bay? Here’s an in-depth look at the scientific evidence, potential mechanisms, benefits, caveats, and expert views on using keto for migraine relief.
What Is the Ketogenic Diet?
The ketogenic diet is a high-fat, moderate-protein, and very low-carbohydrate eating pattern. Originally developed in the 1920s to treat drug-resistant epilepsy, keto has re-emerged in recent years for weight loss and various metabolic and neurological conditions. The typical macronutrient breakdown is:
- 70–80% Fat: Emphasizes sources like avocados, nuts, oils, fatty fish, and meats.
- 10–20% Protein: Includes eggs, chicken, fish, beef, tofu, and other protein-rich foods.
- 5–10% Carbohydrate: Strictly limits carbs to under 50 grams per day, avoiding bread, most fruits, pasta, grains, and sugar.
By dramatically reducing carbohydrate intake, the body shifts from using glucose (from carbs) for energy to using fats, producing molecules called ketones in the liver. This metabolic state—ketosis—is thought to have neurological effects beyond energy metabolism.
How Might the Keto Diet Affect Migraine?
While migraines have complex and multi-factorial causes, researchers have proposed several mechanisms by which the keto diet could influence migraine frequency and severity:
- Restoring brain energy balance: Ketones may stabilize brain metabolism, reduce neuronal hyperexcitability (a key factor in triggering migraines), and provide an alternative, efficient fuel for brain cells.
- Reducing brain inflammation: Ketones exhibit anti-inflammatory properties that could help counteract inflammatory processes implicated in migraine attacks.
- Stabilizing blood sugar and insulin: Compared to a standard high-carb diet, keto avoids sharp fluctuations in blood glucose, which can sometimes trigger migraines in sensitive individuals.
- Influencing neurotransmitters: The diet may affect levels of neurotransmitters such as GABA and glutamate, both involved in migraine pathways.
It is important to note that while these theories are plausible and partially supported by laboratory and animal research, human data is still emerging.
The Research: What Studies Say About Keto and Migraine
The clinical evidence on the ketogenic diet’s effect on migraine includes early case studies, small trials, and several modern observational studies. Key findings include:
Historical Observations and Early Reports
- 1928: Early medical literature found that about 39% of people with migraines experienced some degree of improvement (either fewer or less intense migraines) after following a ketogenic diet.
- 1930: A follow-up study reported that 28% of patients had no migraine attacks for up to three months after entering ketosis; another 25% had fewer or less severe attacks.
Interest in the keto diet as a migraine therapy faded as new medications became available, but the diet is seeing renewed investigation as many patients seek alternatives to drug management or experience medication side effects.
What others are reading
Modern Studies and Clinical Trials
- 2015 Observational Study: Women with migraines following a low-calorie keto diet for one month had significantly fewer migraine attacks compared to those on a standard low-calorie diet, although the keto group also lost more weight, which may have influenced outcomes.
- Weight Loss vs. Ketosis: A follow-up study separated the effect of weight loss from ketosis. Even when weight loss was similar, those in ketosis experienced about three fewer migraine attacks per month compared to a non-keto group, suggesting a direct effect of ketogenic metabolism.
- Severity and Duration: Other research indicates that a keto diet may help decrease not only frequency but also the duration and intensity of migraine episodes.
| Study Year | Design & Participants | Main Findings | Notes |
|---|---|---|---|
| 1928/1930 | Case series, migraine patients | ~39% improved or 28% migraine-free | First clinical documentation |
| 2015 | Observational, women with migraines | Keto group: Fewer attacks than standard diet | Weight loss confounder |
| 2019-2022 | Open-label, single-arm & comparative | Reduced frequency, severity, duration even after accounting for weight loss | Some studies limited sample size |
| Recent | Comparative, “anti-headache” diet vs. keto | No significant difference found; small group | Dietary triggers, hydration also matter |
Most of these studies show short-term benefits, with improvements sometimes diminishing once the diet is discontinued or carbohydrates are reintroduced. There is a need for more rigorous, long-term, large-scale trials to establish efficacy and define who is most likely to benefit.
Migraine, Obesity, and Weight Loss: Is the Effect Only Due to Shedding Pounds?
Obesity and excess weight are recognized risk factors for more frequent and severe migraines, especially in women. Weight loss alone can reduce migraine frequency, raising the question: is ketosis itself important, or is simply losing weight enough?
- In trials where both keto and non-keto diets led to similar weight loss, those in ketosis still had greater migraine reductions, suggesting a specific effect beyond weight loss alone.
- A study involving overweight migraineurs found headache reductions were sustained only during the period of active ketosis, with the effect diminishing when carbohydrates returned to the diet.
- However, not all researchers agree: one study found that an “anti-headache” diet (avoiding triggers, eating more raw foods, good hydration) also reduced headaches similarly to keto, though the sample size was small.
What Do Experts Say? Cautious Optimism and Practical Warnings
Headache specialists, registered dietitians, and neurologists acknowledge the promising early data on keto and migraine, but emphasize a few critical considerations:
- Most studies are small or observational: There is a lack of definitive, placebo-controlled trials.
- The diet is restrictive and can be hard to sustain: Keto requires major lifestyle changes and can be socially isolating or difficult for some people to maintain. Tracking food content and eating out may pose challenges.
- Potential short- and long-term side effects: These may include constipation, nutrient deficiencies, gallstone risk, increased LDL cholesterol, and rarely, kidney stones or liver issues, especially in people with pre-existing conditions.
- Possible contraindications: The keto diet is not suitable for everyone—people with certain metabolic disorders, liver or pancreatic issues, or those who are pregnant or breastfeeding should avoid keto unless guided by their health team.
- Medical supervision is strongly recommended: Anyone considering keto for migraine prevention should consult a knowledgeable healthcare provider to rule out risks and ensure nutritional adequacy.
Other Dietary Approaches for Migraine
Keto is one of several dietary strategies migraine sufferers sometimes use. Comparison diets include:
- Trigger avoidance diets: Identifying and eliminating foods that trigger migraines (e.g., chocolate, cheese, MSG, caffeine).
- Mediterranean-style diets: Emphasize whole foods, plenty of fruits/vegetables, olive oil, and fish, which may reduce inflammation and promote overall brain health.
- Hydration and regular meals: Many people find migraines are less likely when they stay hydrated and avoid skipping meals.
Some studies indicate these alternative approaches can be at least as effective as keto for certain individuals, and may be easier to maintain long-term.
Is the Keto Diet Right for You?
If you suffer from chronic or frequent migraines and have not found relief with medications or other lifestyle changes, it is reasonable—under expert supervision—to consider a trial of the ketogenic diet. Factors to weigh include:
- Personal health status: Assess whether you have any conditions that would make keto inadvisable.
- Current diet and lifestyle: Keto may be easier to adopt if you already eat fewer carbs or enjoy high-fat foods.
- Support system: Coordination with a dietitian or nutritionist can help ensure food variety, micronutrient adequacy, and monitoring for side effects.
Tips for Starting Keto Safely (If Advised by a Healthcare Professional)
- Transition gradually and seek individualized nutrition advice.
- Emphasize nutrient-dense, whole foods—avoid “dirty keto” based on processed meats and fats.
- Stay well-hydrated and supplement with electrolytes (sodium, potassium, magnesium).
- Aim for a variety of vegetables (non-starchy) to avoid micronutrient deficiencies.
- Be aware of possible “keto flu” symptoms during the early adaptation phase: headache, fatigue, nausea, irritable mood—usually transient.
Potential Risks and Limitations
The ketogenic diet is not risk-free, and these side effects must be considered:
- Digestive issues: Constipation, nausea, and abdominal discomfort are common at the start.
- Micronutrient deficiencies: Restricting many fruits, grains, and dairy can lower intake of vitamins and minerals.
- Cholesterol/lipid changes: Saturated fat intake may increase cholesterol in some; periodic blood work is advised.
- Potential for kidney stones: Low fluid intake and certain foods may raise kidney stone risk for susceptible individuals.
Frequently Asked Questions (FAQs)
Q: How quickly might someone see changes in migraine frequency after starting keto?
A: In published studies, some people noticed benefits after about 3-4 weeks of sustained ketosis, although individual results may vary. Effects often persist only while the diet is maintained.
Q: Do I have to be in permanent ketosis to see benefits, or can a less strict low-carb diet help?
A: Most data on migraines support sustained ketosis, not just reduced carbs. However, diets moderately low in carbohydrates may help some people, particularly if combined with trigger avoidance and hydration.
Q: Are there groups of people who should not attempt the ketogenic diet?
A: Yes. Those with liver or pancreatic disease, specific metabolic disorders, certain rare inherited conditions, pregnant or breastfeeding women, and people on some medications should avoid keto or consult a medical professional before making major diet changes.
Q: Does the keto diet cure migraines?
A: The evidence suggests that the keto diet may reduce attack frequency, severity, and duration for some people, but it is not a definitive “cure.” Effects may lessen if the diet is stopped.
Q: Can children or teens with migraine try the ketogenic diet?
A: In pediatric epilepsy, keto is sometimes used under close supervision, but for migraines in children or teens, it is not routinely recommended outside a specialist setting due to growth and nutritional concerns.
Summary Table: Keto Diet for Migraines—Pros and Cons
| Potential Benefits | Potential Risks |
|---|---|
|
|
Key Takeaways
- The ketogenic diet may offer relief from migraines for some, but more research is needed.
- Benefits may depend on sustained ketosis, not just weight loss alone.
- The diet should be tried only with medical supervision, especially for those with underlying health issues or who are pregnant, breastfeeding, or on medications.
- Keto is not the only dietary approach for migraine; trigger avoidance and a balanced anti-inflammatory diet can also be effective.
- Future larger, long-term studies are needed to clarify keto’s role in migraine management.
References
- https://www.healthline.com/health/nutrition/keto-migraine
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9456603/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3951260/
- https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1204700/full
- https://www.news-medical.net/news/20231012/Ketogenic-diets-found-to-slash-migraine-frequency-and-fatigue-in-new-study.aspx
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