Can Ketogenic Diet Therapy Improve Migraine Frequency, Severity and Duration?

Rebecca L. Haslam,Jaimee Herbert,Neil Spratt,Megan E. Rollo,Clare E. Collins,Aaron Bezzina

doi:10.3390/healthcare9091105

Abstract

Migraine is the third most common condition worldwide and is responsible for a major clinical and economic burden. The current pilot trial investigated whether ketogenic diet therapy (KDT) is superior to an evidence-informed healthy “anti-headache” dietary pattern (AHD) in improving migraine frequency, severity and duration. A 12-week randomised controlled crossover trial consisting of the two dietary intervention periods was undertaken. Eligible participants were those with a history of migraines and who had regularly experienced episodes of moderate or mildly intense headache in the previous 4 weeks. Migraine frequency, duration and severity were assessed via self-report in the Migraine Buddy© app. Participants were asked to measure urinary ketones and side effects throughout the KDT. Twenty-six participants were enrolled, and 16 participants completed all sessions. Eleven participants completed a symptom checklist; all reported side-effects during KDT, with the most frequently reported side effect being fatigue (n = 11). All completers experienced migraine during AHD, with 14/16 experiencing migraine during KDT. Differences in migraine frequency, severity or duration between dietary intervention groups were not statistically significant. However, a clinically important trend toward lower migraine duration on KDT was noted. Further research in this area is warranted, with strategies to lower participant burden and promote adherence and retention.

Highlights

Migraine is the third most common condition worldwide and the sixth leading cause of disability, measured as years lived with disability (YLD) [1]
Of the 431 people screened for eligibility 72 were eligible, of whom 26 (24 females and 2 males) provided informed consent and were randomised into either the anti-headache” dietary pattern (AHD) or the ketogenic diet therapy (KDT)
Findings from the current trial indicate that adults who experience migraine are unable to sufficiently alter their dietary intake in line with KDT prescriptions, and for those more closely aligning with prescriptions, following KDT is not without side effects

Summary

Introduction

Migraine is the third most common condition worldwide and the sixth leading cause of disability, measured as years lived with disability (YLD) [1]. Concentrations reported to elicit physiological benefits have been reported as needing to be as high as 80–160 mg/dL (13.8–27.5 mmol/L) [8] During ketosis, these ketone bodies are used as the major energy source for all cells, including brain cells [6]. Elevated ketone body concentrations have exhibited anti-convulsive and neuroprotective properties in both in vitro and in vivo experimental studies [5,7,9] These properties include ketone-induced changes in neurotransmitter balance, changes in neural membrane polarity to dampen elevated neuronal excitability associated with seizures and improved mitochondrial function due to increased energy reserves combined with decreased production of reactive oxygen species (ROS) [5,7,9]

Methods

Results

Conclusion