I got my first migraine when I was 12. The details are fuzzy, but I remember being in excruciating pain at school and coming home to my mom, who suggested I take a few Advil and lay down. The meds helped temporarily, but as time went on, the frequency of my migraines increased and no amount of medication could quell the throbbing pain that radiated all the way from my forehead to my neck and shoulders.
My mom made an appointment for me to see my primary care physician, kicking off what would become decades of doctor visits to find relief. I saw neurologists, allergists, physical therapists, chiropractors, and acupuncturists. I tried everything from OTC and prescription meds to keeping a diary headache to identify food and stress-related triggers.
Nothing worked. By college, I had accepted my fate as a chronic headache sufferer. I kept busy to distract myself and push through the never ending pain — a strategy I continued into my early 30s when a week-long headache sent me to see my primary care physician who finally diagnosed me with chronic migraine (previously, doctors told me I had tension headaches).
The diagnosis was a revelation — but that didn’t make it any easier to find relief. I started seeing a neurologist who had me try a number of prescription meds and even Botox, which worked well the first time I got it; unfortunately, subsequent injections didn’t help.
When the pandemic hit, my migraines got worse. Being home all the time meant I didn’t have my usual activities, like dinner dates with friends and yoga classes, to distract me. The walls were closing in — and so were my migraines. I hit a breaking point in the fall. I was sick of living in chronic pain and sick of swallowing so many medications, which frequently didn’t even work.
I did some research and found evidence linking a keto diet to migraine prevention. I had heard of keto but dismissed it as the latest diet fad. Could it really help with my migraines? I was desperate for relief and was eating all my meals at home anyway so I figured it was a good time to try it (no restaurant meals to throw me off track!). Here’s what I learned about my condition and the keto diet — and what happened when I went for it.
What is a migraine, exactly?
Turns out, I’m not the only one whose migraines went undiagnosed for years. Research shows that approximately 75 percent of people with chronic migraine are undiagnosed. Part of the problem has been a lack of research and understanding of how a migraine differs from a headache.
Now, doctors understand migraine to be a disabling neurological disease. “A migraine is not just a headache, ”he says Jessica Ailani, MD, associate professor of neurology and director of the Headache Center at Medstar Georgetown University Hospital. “It’s a headache, more other symptoms like nausea, vomiting, and sensitivity to light and / or sound — and it’s those symptoms that help make the diagnosis of migraine. ”
Cognitive dysfunction, like difficulty speaking or focusing, is also common during a migraine attack, she notes. When I have a migraine, my brain feels so foggy that doing something as simple as sending a text feels like an impossible task. Before an attack, some people (around 25 to 30 percent) may also experience an aura, which is a sensory disturbance such as seeing sparks or zig zags or experiencing tingling on one side of the body.
During a migraine, something triggers your brain to go haywire. “You have too many chemicals and electrical signals going off,” explains Ailani. “It’s like your brain is having a party — flashing the lights on and off and playing loud music — and it makes you miserable.”
The exact cause of migraine is unknown but it’s thought to be a genetically-inherited condition with multiple triggers including stress, fluctuating hormones, bright lights, and strong odors (like heavy perfume or cigarette smoke).
What is the keto diet?
The keto (or ketogenic) diet is a low-carb, high fat, moderate protein way of eating, explains Denise Potter, RDNa nutritionist in Toledo, OH and author of The Migraine Diet: A Ketogenic Meal Plan for Headache Relief. Eating fewer carbs puts your body in a metabolic state called ketosis, where your body burns fat — instead of carbs — for energy. When this happens, your liver produces ketones from fat, which serve as a fuel source throughout your body but especially your brain.
Keto is far from a fad diet — it’s actually been around for 100 years, says Potter. In the 1920s, doctors used the ketogenic diet as a treatment for epilepsy. It was widely used for a few decades until the invention of antiepileptic drugs.
“By the 1940s, the diet had almost disappeared,” says Potter. “But it was brought back into limelight in 1994 when the Abrahams family realized it was an effective treatment for their son Charlie’s epilepsy.” After the diet completely cured their son of his seizures within one month, the family formed The Charlie Foundationa nonprofit that educates people about the ketogenic diet as a therapy for epilepsy, other neurological disorders, and certain cancers.
Potter, who is a consultant with The Charlie Foundation, emphasizes the importance of understanding people as a medical therapy. “We want to take the word ‘diet’ out of it,” she says. “It’s not just a diet — it’s nutritional therapy. Just like you might go to physical therapy, keto is a therapy that can help you feel better. ”
How can a keto diet help prevent migraines?
Researchers are still figuring out exactly how eating keto can prevent migraines. “There are a lot of potential mechanisms that interact in a complex way so it’s challenging to determine just one way it produces benefits,” he says. Josh Turknett, MDa neurologist based in Atlanta and author of Keto for Migraine: Keys to the Ketogenic Diet for Migraine Sufferers.
One theory is that the ketones themselves offer a protective benefit. “They improve your brain’s ability to use energy between meals,” explains Turknett. On a typical Western diet that’s high in carbs, your body relies on sugar (or glucose) for energy, which causes blood sugar swings — a common migraine trigger. “When you’re dependent on carbs for energy, your brain is saying, ‘You need to eat now!'” Turknett explains. “It puts out stress hormones to try to increase blood sugar, which only adds fuel to the migraine fire.”
On a keto diet, your body can easily switch from burning glucose to burning fat for energy, getting you off the blood sugar roller coaster. “The stability in blood sugar and stress hormone levels is a huge part of the reason a keto diet is so helpful,” says Turknett.
Recent research reveals a few other potential mechanisms for how ketones may aid in migraine prevention including improved mitochondrial functioning and reduced inflammation. “Mitochondria are where energy is made in the cell,” explains Turknett. If mitochondria aren’t functioning well, then your cells can’t generate enough energy, which may result in a migraine.
Inflammation is also an underlying migraine trigger, and ketones may have an anti-inflammatory effect.
Most recently, Italian researchers studied a group of 35 migraineurs who were obese. The participants alternated between eating a low-calorie ketogenic diet and a low-calorie non-ketogenic diet for one month. The results showed a significant decrease in migraines during the month that participants ate a low-calorie, keto diet. The researchers hypothesize that the improvement is due to ketones (more than the weight loss) but say that more research is needed to see how keto would impact non-obese people.
What happened when I tried the keto diet for migraine prevention
I decided to try the diet in November 2020 after reading Turknett’s first book, The Migraine Miracle. In it, he stresses the importance of a multi-pronged eating approach to getting rid of migraines: eliminating carbs and sugar from your diet, eating whole foods (and avoiding processed ones), consuming more fat and vegetables, and choosing low-sugar fruit. like berries. In a nutshell, he recommends a keto diet.
Initially, this way of eating was difficult (and yes, I experienced the dreaded “Keto flu”). I ended up writing a list of all the foods I could eat on a giant poster board and hanging it in my kitchen so my husband and I could remember everything that was migraine-safe. But just like anything, over time, we got used to my special diet and even found some favorite recipes (like eggplant parm!).
My progress felt really slow — for the first month, I didn’t notice much improvement in my migraines. But by the second month, I started getting them less and less, and when I did have a migraine, the pain was much less severe. The sharp pinch I usually got in my left temple felt blunted somehow. By month three, I was going a few days in a row without a migraine — a huge breakthrough since previously I was getting them almost every day.
If you want to try going keto to help with your migraines, Potter suggests working with a nutritionist who can safely walk you through the process. “Rather than getting into ketosis quickly (like in two or three days), which can lead to unpleasant symptoms, we can help you get there gradually,” she says. “You’ll get to the same place but you’ll feel a lot better doing it.” A nutritionist can also monitor your blood levels to make sure your cholesterol and vitamin D stay in check.
I’ll admit, it’s been challenging to stick to the keto diet. After getting vaccinated in the spring, I started gathering with friends and family more often and eating at restaurants again. I try to avoid carbs and sugar as much as possible — for example, at a restaurant, I’ll order a burger and eat it without the bun — but it’s difficult when everyone around me is eating pasta and ordering dessert. While on vacation in July, I abandoned the diet almost entirely (is it even summer if you don’t have some ice cream?), And by August, my near-daily migraines returned with a vengeance.
The bottom line is this: Research and my own experience show that the keto diet can help prevent migraines. For me, the issue is whether or not this way of eating is sustainable. The return of my migraines has made me realize, however, that the long term benefit of more pain-free days far outweighs the momentary joy of a slice of bread or a piece of cake.
So, I’ve resolved to get back on the keto diet. There’s no cure for migraine, but knowing I can manage it with food is incredibly empowering.
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