Migraines affect between 10 and 15 percent of Australians. Nearly all migraine sufferers experience reductions in social activities and work capacity from the debilitating nature of the headache pain. The trigger for bringing on a migraine can vary between people and there is no one sure way to avoid all triggers.

For extreme sufferers of migraines, one novel area of research is looking at diet modification. The diet change is to a low-carbohydrate ketogenic diet. Such a diet involves eating less than 50 grams of carbohydrates a day.

The rationale for a low-carbohydrate diet is to switch the body (and brain) to using less carbohydrate and more fat as its energy substrate. A low-carbohydrate diet has been used with some benefit in treating children with some forms of epilepsy so a direct effect on reducing brain excitability could also apply to using such a diet in migraines.

Italian researchers used a high-fat, low-carbohydrate diet in 96 women all of whom suffered from migraines. Of the women, 45 followed a low-carbohydrate ketogenic diet for a month, then swapped to a standard low-kilojoule diet for the next five months. The remaining women followed a standard diet for the full six months.

After one month on the low-carbohydrate diet, the average number of headaches in a month fell from 2.9 to 0.71. The number of days with a headache per month also fell from a baseline of 5.11 days to 0.91 days. Medication use also fell from 4.91 doses per month before the study, to 0.51 doses per month.

On reverting back to the standard diet, migraine attacks did increase, but were still much lower than before they started following a low-carbohydrate diet.

For women following the standard diet, frequency of headaches did fall, but it was less than those on the low-carbohydrate diet. And a reduction in migraine frequency wasn’t seen until after 3 months of following a low-kilojoule standard diet.

An important point was that weight loss was seen in both groups over the six months. Because the women were overweight to begin with, the weight loss may offer some explanation for the benefit in migraine symptom reduction seen in both groups.

The low-carbohydrate diet offered a benefit on migraines when it was followed for the first month which points to it having additional benefits outside of weight loss.

A limitation of the study was that it was observational so there could be defining differences between women in each of the groups as each woman could choose what type of diet they wished to follow. As the study was only in women, and was in the setting of a weight-loss clinic, it is unknown how the findings apply to the wider population.

Implications

With a plausible physiologic mechanism, this proof-of-concept research has opened up a new field of study into the use of a low-carbohydrate ketogenic diet as a potential treatment for relief from migraines.

Last Reviewed: 03/12/2019

Norman Swan Medical Communications



References

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