Can the Keto Diet Help with Migraines? Evidence, Theories, and Expert Insight
Exploring whether a ketogenic diet can reduce migraine attacks, what current research says, and important caveats you should know.
Can the Keto Diet Help with Migraines?
Millions of people worldwide struggle with migraines—often debilitating headaches accompanied by symptoms like sensitivity to light, sound, and nausea. While many rely on medications to manage migraines, a growing number of sufferers are exploring lifestyle strategies, including dietary interventions. One approach generating particular buzz is the ketogenic (keto) diet, a low-carb and high-fat eating plan. But can the keto diet truly help prevent or reduce migraines? Here’s what science and experts have to say.
What Is the Ketogenic Diet?
The ketogenic diet is a nutritional plan characterized by high fat, moderate protein, and very low carbohydrate intake. Typically, keto dieters consume less than 50 grams of carbs daily, which is dramatically lower than the 200–350 grams most adults eat. This triggers a metabolic state called ketosis, where the liver converts fats into ketones—an alternative fuel source for the body and brain.
- Main macronutrient ratios: Around 70–80% fat, 10–20% protein, and 5–10% carbohydrates.
- Usual foods: Meat, fish, eggs, non-starchy vegetables, oils, nuts, and seeds; eliminates or restricts bread, pasta, rice, sweets, most fruits, and starchy vegetables.
Keto was first developed as a treatment for epilepsy in the 1920s, especially in drug-resistant children, due to its effect on brain metabolism. Its therapeutic impact in epilepsy led scientists to explore if similar mechanisms might help other neurological conditions—including migraine.
How Might Keto Impact Migraines?
Scientists are still piecing together how migraines develop, but several theories suggest why keto might help:
- Energy supply: Migraine sufferers often have disruptions in brain energy metabolism. Ketones can serve as a stable, efficient fuel source for the brain, possibly reducing energy deficiencies that trigger migraines.
- Neuronal excitability: Abnormal firing of neurons in parts of the brain is believed to contribute to migraines. Ketosis may stabilize neuronal activity, making attacks less likely.
- Anti-inflammatory effects: Brain and body inflammation play a role in migraine development. Ketones have been shown to reduce levels of inflammation and oxidative stress.
The Ketones Theory
One popular hypothesis: when blood ketone levels rise during ketosis, the brain gets a more reliable energy source, helping restore normal function and lower inflammation—all factors implicated in migraine attacks.
What Does the Research Say?
A combination of historical records, case reports, and emerging small-scale studies point toward potential benefits, although the evidence is still early and sometimes limited in size or design.
Historical and Early Observations
- 1928: An early report found 39% of people with migraines saw improvement in attack frequency and severity when following a ketogenic diet.
- 1930: Another study found 28% of migraine sufferers had no attacks for up to three months on keto, while 25% had reduced frequency or severity.
Interest in keto’s use for migraines faded as medications improved, but research has re-emerged in recent years.
Modern Studies
- 2015 Observational Study: Overweight women following a very low-calorie ketogenic diet for one month experienced a significant reduction in migraine frequency compared to those on an equally restrictive non-keto diet. However, both groups lost weight, complicating the results.
- Follow-up Research: To untangle whether the benefit was due to weight loss or ketosis, a follow-up study had both groups lose similar amounts of weight. Only the keto group saw a greater reduction in migraine attacks (about three fewer attacks per month), supporting a ketone-specific effect.
References: , - Recent Clinical Report (2022): A small study found monthly headache days dropped among migraine sufferers using a ketogenic diet. Notably, participants also lost weight, suggesting an added benefit but again raising the question of causality.
References: - Retrospective Study (2022): In a study of 23 migraine patients who followed a keto diet for 3 months, monthly headache days dropped from 12.5 to 6.7, and days requiring acute medication fell from 11.1 to 4.9. Importantly, improvements remained even after accounting for weight loss, implying the keto diet works through more than just weight-related mechanisms.
References: ,
What others are reading
| Study / Source | Sample | Duration | Key Results |
|---|---|---|---|
| Historical (1928, 1930) | 29–70 patients | 3 months | 28–39% improved or attack-free |
| 2015 Observational Study | Women with overweight/obesity | 1 month | Significant reduction in migraine frequency in keto group |
| Follow-up, Controlled Diet | Women | Several months | Keto group had 3 fewer attacks/month independent of weight loss |
| 2022 Retrospective Study | 23 patients | 3 months | Headache days cut by nearly half; benefit not only from weight loss |
Why Might Keto Work for Migraine—Beyond Weight Loss?
Weight loss alone is associated with fewer migraines, since higher body fat correlates with increased inflammation and higher migraine risk. However, mounting evidence suggests keto’s benefits may go beyond just dropping pounds.
- Ketone-fueled brain: Ketones may support brain metabolism and reduce the energy crisis thought to underlie migraine attacks.
- Stabilizing neurons: Ketosis may dampen abnormal neuronal activity, decreasing the frequency or intensity of attacks.
- Fighting inflammation: Ketones may have direct anti-inflammatory and antioxidant effects.
Some studies found no significant difference in migraine improvement between those who lost weight on keto and those who did not, pointing to ketone-specific effects .
Experts Weigh In: Cautious Optimism
Neurologists, headache specialists, and registered dietitians share a note of cautious optimism about the keto diet for migraines. The diet’s plausible mechanisms, supportive but limited data, and positive anecdotal reports all suggest it’s worth further study. However, they highlight several important caveats:
- Limited Evidence: Most studies have small sample sizes, short durations, or focus on overweight and obese individuals, limiting broad conclusions.
- Variability in Response: Not everyone with migraines will benefit from keto, and diet response can be highly individualized.
- Adherence Challenges: Strict carb limits make keto hard to sustain long-term for many people. Lapses in consistency can trigger withdrawal migraines or lessen benefit.
- Nutritional Risks: The keto diet restricts multiple food groups, increasing the risk of vitamin and mineral deficiencies if not carefully planned.
Nearly all experts agree: anyone considering keto for migraines should consult a registered dietitian or healthcare provider for guidance.
Potential Downsides and Considerations
- Nutrient Deficiencies: Restricting carbs eliminates many sources of fiber, vitamins, and minerals, possibly leading to deficiencies in the long term (e.g., vitamin C, magnesium, potassium).
- Keto Flu: During the early days, symptoms like fatigue, headache, and nausea can occur as the body adapts; these may temporarily worsen migraine symptoms in some people.
- Long-Term Uncertainty: The effects of remaining in extended ketosis are not fully understood, especially in people with chronic health conditions.
- Possible Interactions: Keto can affect how the body metabolizes certain medications. Always discuss with a healthcare provider.
Should You Try Keto for Migraines?
The keto diet shows promise for reducing migraine attacks in some people, particularly those with overweight or obesity. However, more robust and diverse clinical trials are needed before healthcare providers can make broad, reliable recommendations.
If you are considering keto:
- Consult your primary care provider or a board-certified neurologist who treats headache disorders.
- Seek guidance from a registered dietitian to ensure proper nutrition.
- Consider a modified ketogenic diet or a low-glycemic diet, which may offer some benefits with less restriction.
Frequently Asked Questions (FAQs)
Q: Does keto work for all migraine sufferers?
A: No, responses vary widely. Current research suggests keto may help some but not all individuals with migraine, and benefit may depend on underlying metabolic, genetic, and lifestyle factors.
Q: Is weight loss or ketosis the key factor in migraine improvement?
A: Both weight loss and ketosis are associated with fewer migraines. However, several studies suggest that ketosis alone, rather than weight loss itself, can reduce migraine frequency and severity.
Q: Are there risks to starting a keto diet?
A: Yes. Risks include nutrient deficiencies, digestive changes, and possible effects on cholesterol, kidney function, and medication metabolism. It’s essential to work with experienced healthcare professionals.
Q: Can children or teens with migraines try keto?
A: Keto has been studied for epilepsy in children, but its use for migraine in younger people should be carefully supervised by a doctor. Children have greater nutritional needs, making guidance crucial.
Q: Are there less restrictive alternatives?
A: Yes. Modified Atkins, low-glycemic, or Mediterranean-style low-carb diets may offer benefits with greater flexibility and fewer risks.
Key Takeaways
- The keto diet may help reduce migraine frequency, duration, and severity in some individuals, likely due to brain metabolism changes, anti-inflammatory effects, and possibly beyond weight loss alone.
- Adherence can be difficult and nutritional risks exist, so expert guidance is necessary.
- More research is needed before making broad recommendations for all migraine sufferers.
When to See a Healthcare Provider
If you experience frequent, severe headaches or migraines, consult a board-certified neurologist or headache specialist to rule out other conditions and discuss all potential therapies, including dietary approaches.
References
- https://www.healthline.com/health/nutrition/keto-migraine
- https://blog.cefaly.com/keto-diet-and-migraine/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9456603/
- https://pubmed.ncbi.nlm.nih.gov/36078876/
- 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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