Can a ketogenic diet help reduce migraines?

The link between diet and migraines is well established, with research into the area ongoing. It is thought that food-related ‘triggers’ occur in about 10% of migraine sufferers (Migraine Trust). Common reported ‘trigger foods’ include chocolate, caffeine, additives, alcohol and cheese. It is important to note though, that these ‘trigger foods’ do vary from person to person. Interestingly, in the case of chocolate, Lippi et al (2014) have suggested that chocolate is eaten to alleviate a craving for sweet food which may actually be the start of a migraine; thus blaming chocolate as a cause instead of a symptom. Research is also ongoing to identify whether following a ketogenic diet may help reduce migraines.

The proposed mechanism for ketogenic diets improving migraines

A ‘ketogenic diet’ (of which the S&S Simplicity and Lifestyle plans and other Very Low Calorie Diets (VLCDs) are examples of) is a diet that induces ‘ketosis’. These diets restrict carbohydrate intake to a level that induces ‘ketosis’ – a state where the body breaks down fat into ‘ketones’ to provide energy, causing rapid weight loss. Whilst the precise mechanism is unclear, it has been suggested that the high levels of ketones in the blood during ketosis can block the action of glutamate, a neurotransmitter, which has been found in high concentrations in people with migraine and epilepsy. It is suggested that by blocking the action of glutamate, brain excitability and metabolism is restored, and inflammation is reduced (Barbanti et al, 2017).

Is there any evidence to support this?

Whilst there is ongoing research into this area, at present evidence to support the use of ketogenic diets in the treatment of migraines is poor. There are only two published scientific papers specifically looking at whether ketogenic diets improve migraines, with both of these papers rating fairly low in terms of the level of evidence. These are summarised as follows:

• Di Lorenzo et al, 2015: 96 overweight women with migraines were recruited into the study. 51 of them were assigned to receiving a standard diet, whilst 45 of them received a ketogenic diet for three months. The women on the ketogenic diet experienced a significant reduction in migraine attack frequency, number of days with a headache and number of tablets taken within the first month of the diet. However, whilst they noticed this improvement, the researchers did not swap the women and diet therapies over, i.e. gave the ketogenic diet to the 51 women who received the standard diet. Had they done this, the evidence from the study would be more robust.
• Di Lorenzo et al, 2014: a case study where a pair of twin sisters who had high-frequency migraines followed a ketogenic diet as part of a weight loss programme. They noticed a significant reduction in their migraines. However, a case study involving only two people is not considered good evidence. This observation may have proved the springboard to the study in 2015 outlined above

What to do if you experience an improvement in your migraines

Whilst the evidence to use ketogenic diets in the treatment of migraines is poor, there is a chance that you experience a reduction in migraines as a result of being on an S&S programme. If you do notice an improvement whilst following Slim & Save, plan a visit to see your GP for when you are due to end your Slim & Save journey and ask for a referral to a dietitian to help you devise a plan with the right level of carbohydrate, fat and protein to both control your symptoms and to ensure you achieve all your nutritional requirements in the long term. VLCDs should not be followed for periods greater than 12-16 weeks. A dietitian will also be able to look at other potential dietary strategies linked to migraine improvement that may be worth exploring, such as increasing folate and altering the omega 3 and omega 6 content of your diet. It is also important to consider eliminating or investigating any other known migraine triggers, such as stress, dehydration and sleep issues.

References

Barbanti et al, 2017. Ketogenic diet in migraine: rationale, findings and perspectives. Neurological Science. 38 (1): 111-115.

Di Lorenzo et al, 2014. Diet transiently improves migraine in two twin sisters: possible role of ketogenesis? Functional Neurology. 28 (4): 305-308.

Di Lorenzo et al, 2015. Migraine improvement during short lasting ketogenesis: a proof of concept study. European Journal of Neurology. 22 (1): 170-177.

Lippi et al, 2014. Chocolate and migraine: the history of an ambiguous association.

Migraine Trust, 2017. Common Triggers. Available online from (accessed 31st July 2017).

Written by Annemarie Aburrow RD BSc (Hons) PGDip, Slim & Save Dietitian.