The keto diet (i.e. a very low-carb, moderate protein, and higher fat diet) has a rich history as a treatment for seizures and other neurological conditions. But can it work as a therapy option for migraines? Here we explore what migraines are, how they work, who is susceptible to them, and why the ketogenic diet is now being explored as a migraine treatment that may be more effective than medications.

What Defines a Migraine Headache?

A migraine is defined as a recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision. It typically strikes sufferers a few times per year in childhood and then progresses to a few times per week in adulthood, particularly in females. Migraines are different from common headaches and are far more painful. Migraines start suddenly, usually with severe pain on only one side of the head. 

According to the Migraine Research Foundation, 12 percent of the U.S. population suffers from migraines. In the U.S. alone, 18% of women, 6% of men, and 10% of children struggle with migraines. Migraines are most commonly experienced between the ages of 18 and 44. 

There are two main types are migraines: episodic migraines and chronic migraines. Generally, episodic migraines are less than 15 headache days per month, while chronic migraines are 15 or more headache days per month. There are multiple pharmaceutical options for the treatment of migraines as well as natural treatment options. 

There are also multiple subtypes of migraine headaches that help put a name to the various symptoms associated with specific types of migraines. They are as follows:

Brainstem Aura Migraine Headache

Symptoms include slurred speech, dizziness, noise sensitivity.

Hemiplegic Migraine Headache

These types of migraines cause a temporary weakness on one side of the body. There are two forms of hemiplegic migraines: familial and sporadic. In the familial form, other family members are also affected. In the sporadic form, no other family members are affected.

Menstrual Migraine Headache

These migraines typically happen two days before to three days after the beginning of menstruation. Women who get this type of migraine may also experience other types of migraines, but the migraine around menstruation is usually without brainstem-aura symptoms (see above).

Ocular (or retinal) Migraine Headache

This very rare type of migraine includes visions of flashing lights. This type may include disturbed vision or temporary loss of vision in one eye (typically for less than an hour) occuring before the headache strikes. 

Vestibular Migraine Headache

These migraines accompany vertigo or dizziness and a spinning sensation, which typically lasts a few minutes to a few hours.

Additional Migraine Symptoms

According to Angela Stanton, Ph.D. migraine expert, and author of Fighting The Migraine Epidemic: Complete Guide: How to Treat & Prevent Migraines Without Medicines, most people who struggle with migraines experience heightened sensory sensitivity (more sensitive to loud noises, touch, and lights), sometimes years before having their first migraine. They also tend to have a fight-or-flight-type stress hormone release to the sensory sensitivity. 

Some of the other common symptoms migraineurs may experience include:

  • Nausea
  • Vomiting
  • Dizziness
  • Sensitivity to light and sound
  • Flashing lights or strange shapes
  • Difficulty speaking
  • Temporary partial paralysis 

Who is Susceptible to Migraines?

Stanton says migraines are genetic, so most people who experience them have a particular genetic setup and are born with a “migraine brain”. However, she suggests environmental factors, such as injury (such as a traumatic brain injury) or surgery, can instigate migraines as well. 

Along with what Stanton calls “an excitable brain” (increased sensory neuron receptors and neurons that fire differently than the neurons of a non migraineur) migraineur brains are also characterized by glucose intolerance and low electrolytes.

What Triggers a Migraine?

Researchers have pinpointed several things that can trigger a migraine for those who have a migraine brain. These include:

  • Stress
  • Sleep loss
  • Fatigue
  • Hormonal changes
  • Weather changes
  • Sunlight
  • Loud noises
  • Smells
  • Alcohol
  • Diet, including caffeine, chocolate, and carbohydrates 

Differences in the Migraine Brain

Migraines are neurological in nature. According to Stanton, CT scans show how they vary from “normal” brains: “The white-matter in migraine brains, critical for voltage transfer and myelination, is different from non-migraineurs, and changes during a migraine attack; the entire brain anatomy is different in migraineurs.”Along with what Stanton calls “an excitable brain” (increased sensory neuron receptors and neurons that fire differently than the neurons of a non migraineur) migraineur brains are also characterized by glucose intolerance and low electrolytes. 

What Causes Migraines in “Migraine Brains”?

Since there are so many different symptoms and triggers, scientists and medical professionals are still trying to understand the exact mechanisms of migraines. 

In her book, Stanton suggests the primary reason for migraines is an over- or undersupply of electrolytes that sets off changes in the brain’s electrical activity. Where these electrical changes occur in the brain determines the symptoms experienced. Regardless, Stanton theorizes that migraines are a result of malfunctioning neurons due to ionic electrolyte imbalances and that maintaining proper ionic balance is critical for migraineurs.

Why Medications May Not Be the Answer for Migraines

There are different classes of medications that are prescribed for migraine prevention and for migraine pain relief. According to Mark Hyman MD, New York Times bestselling author of Eat Fat Get Thin,  migraines are difficult to treat with traditional medical approaches. Hyman suggests there are many preventative and pain management drugs, such as calcium-channel blockers, beta blockers, seizure medications, and even antidepressants. But many of these pharmaceuticals don’t work and come with negative side effects and potential for addiction. 

Some migraineurs are prescribed blood-pressure medications as a treatment option, despite the fact that migraineurs typically have low blood pressure, according to Stanton. Using blood-pressure medications can lead to dizziness and other complications. There are also medications like Imitrex, which are prescribed because they can stop a migraine once it starts. Though these may help in the short term, they can be pricey and, according to Hyman, have serious potential side effects, including strokes. 

The Ketogenic Diet as Migraine Intervention or Treatment

Based on her research, Angela Stanton believes there’s a better way to combat migraines: a controlled diet. She says all migraineurs are carbohydrate-intolerant, glucose-sensitive, and in need of a lot more sodium than other people. Additionally, higher fat intake is essential, because the myelin (the insulating white matter of the brain that helps expedite fast brain communication and is troubled for migraineurs) is made of cholesterol and fat. She suggests migraine sufferers follow a keto diet, which focuses on very low carbs and very high healthy fat and salt, to help with migraine relief. 

There are other brain benefits of a ketogenic diet, too. On a keto diet, your body uses ketones rather than glucose as its primary fuel source, and ketones are protective of your brain. Recent research in the journal Nutrients showed that betahydroxybutyrate, the main ketone body used for energy on keto, has the potential to positively influence other pathways commonly believed to be part of migraine pathology: mitochondrial functioning, oxidative stress, cerebral excitability, inflammation, and the gut microbiome. Additionally, a study in the journal Neurological Sciences suggests ketones can help restore brain excitability and metabolism and counteracts neuroinflammation in migraine brains.

The Final Word

Migraines are not typical headaches; they are genetically or environmentally triggered and are significantly more painful and reoccurring. There are many different symptoms and types of migraines. Medications don’t always help, and they come with undesirable side effects. Migraineurs tend to do best on a very-low carb and high-fat diet. If you’re struggling with migraines, consider trying keto as an adjunct therapy; science is showing some promising results.




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