Nutrition Notes

For Migraine Relief – Cut Out the Carbs?

If you suffer from migraines or know someone who does, you know these debilitating attacks are far more than mere “headaches.” A migraine is to a headache as a monsoon is to a gentle spring rain. There’s just no comparison. While some people are able to identify specific foods, weather changes, or environmental compounds that trigger their migraines, for others they occur seemingly without rhyme or reason.

Nutritional interventions for migraines often focus on adding something to one’s diet or supplements. For example, magnesium, rosemary, and the herb feverfew are effective for reducing the frequency and severity of these crippling attacks—at least in some people. Other strategies to ward off migraines, or at the very least make them more bearable, involve taking things out of the diet. People vary in what triggers their migraines, but common culprits include beer, wine, cheese and chocolate. (As if having migraines wasn’t bad enough! Now those favorites are off the menu!) Sulfites, nitrates and MSG are other potential triggers, so for some people, migraines might be related to sensitivity to dietary histamines or tyramines.  (Aged and fermented foods contain high levels of these compounds.) Then, of course, there are changes in barometric pressure, but no matter how diligently someone controls their diet, they can’t do anything about the weather.

But what about taking something else out of the diet—something that has the potential to fundamentally alter energy metabolism and electrical signals in the brain? Removing gluten might be a good place to start—migraines are more prevalent in individuals with celiac disease and gluten sensitivity. Gluten-free diets may improve a host of physical and psychological ailments, but for some people, going gluten-free might not be enough. If someone replaces the missing gluten with gluten-free bread, crackers, cookies, pasta, and cereal, that’s still a pretty big load of carbohydrates. So what if going a couple steps further—removing almost all starch and sugar from the diet—could have a more powerful effect?

Remove almost all starch and sugar? That’s madness, right?!

Talk to someone who suffers from migraines, and they’ll probably tell you nothing’s too crazy if it might actually give them some relief. In removing the vast majority of carbohydrates from the diet and replacing them with fat, we’re talking about a ketogenic diet. This dietary intervention has been used for almost a century for epilepsy, and it also shows promise for a slew of other neurological conditions, such as Parkinson’s disease, ALS (“Lou Gehrig’s disease”), and multiple sclerosis. To the extent that migraines might be triggered by a brain energy deficit or an over-excitability, the ketogenic diet is promising as a non-toxic nutritional therapy.

There isn’t a mountain of scientific evidence on ketogenic diets for migraines, but there’s enough supportive and promising data that it would be worth giving a try for someone who’s incapacitated by these terrible occurrences. (What have they got to lose? They’ll have to go without some of their favorite foods for a while, but the flipside is they’d likely have lower blood glucose and blood pressure, higher HDL, lower triglycerides, and they might lose a couple pounds if they’re struggling with fat loss. More and more people are using low-carb, high-fat diets to lose weight, reverse type 2 diabetes and other conditions associated with insulin resistance and metabolic syndrome.)

A group of Italian researchers became interested in the potential for a ketogenic diet to be effective for migraines after two patients—twin sisters—reported a significant reduction in frequency and severity of migraines after implementing the diet for weight loss—talk about a nice unintended consequence! According to “headache diaries” the subjects kept, they experienced “5–6 attacks/month of severe throbbing headache, of up to 72 hours’ duration; the severity was increased by movement and the attacks were accompanied by photophonophobia [fear/avoidance of light & sound], nausea and, very occasionally, vomiting.” In both cases, remission of migraines coincided with following the diet (headaches disappeared within three days), and they returned during the periods of following the normal higher-carb diet.

An interesting thing to note about this case study is that the subjects did not avoid potential dietary triggers, such as tyramine, aspartame, MSG, nitrates, nitrites, and caffeine. They took several nutritional supplements, but not at levels that would be considered to have any therapeutic effect. (As an aside, tests for celiac disease were negative in these patients, although that doesn’t rule out a non-celiac gluten sensitivity.) So the study authors dismissed some of the potential reasons for migraine remission during the ketogenic periods, writing, “we attribute the improvement observed in these patients to ketogenesis, the sole event found to be time-locked to the disappearance (and recurrence) of their migraine attacks.”

This promising result prompted a larger study, this one involving 96 overweight female migraine sufferers. In the intervention group, 45 subjects followed a very-low-calorie ketogenic diet (KD) for one month, followed by a 5-month standard (higher carb) low-calorie diet. (The other 51 subjects followed the standard diet for all 6 months.) According to the study, At baseline, the group that followed the ketogenic diet experienced an average of 2.9 migraines per month, 5.11 days per month with a migraine, and 4.9 doses of medication per month. After just one month on the diet, these were reduced to 0.71, 0.91, and 0.51, respectively. In the group following the standard diet, there was no decrease in number of days without headaches until 3 months in, and no decrease in attack frequency until 6 months in. It would have been even more interesting if the KD group had followed the KD for all six months, because it takes some people the better part of a month (if not longer) to become fully “keto-adapted,” since it’s such a radical change for most people.

There are numerous mechanisms by which the KD could be reducing the frequency and severity of migraines. Ketones are a kind of “superfuel” for the brain. Their metabolism generates fewer harmful free radicals than the breakdown of glucose does, and ketogenic diets are very anti-inflammatory. This dietary intervention has powerful and wide-ranging effects and the multiple mechanisms by which it works point toward it potentially helping to alleviate crippling migraines. At the very least, it’s worth trying. If someone experiences no relief after some period of time of genuinely sticking to the diet, they can easily switch back to their usual foods.



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