The migraine community has recently been buzzing about a possible new approach to migraine prevention: a ketogenic diet. On the surface, it sounds enticing: Stick to a high-fat, minimal-carb diet, and you could lose weight and experience fewer migraine attacks. But keto is a big commitment, and the research is still incomplete.

What Is a Ketogenic Diet?

There are two common conceptions of a keto diet. One is the trendy version: the Atkins Diet, South Beach Diet or the Paleo diet. These low-carb, high-protein plans are intended for weight loss and overall health. If a participant keeps carb intake low enough and hits the right ratio of protein and fat, they enter a state called ketosis. This means the body is no longer deriving energy from carbohydrates, but instead has switched to consuming ketone bodies, which are produced by burning fat.

But these are not really keto diets! A true ketogenic diet consists almost entirely of fats. It was first developed in the 1920s to treat epilepsy; doctors had discovered that a ketogenic diet reduced seizures in children.[i] Once effective medications were developed for epilepsy, use of the keto diet decreased.

So, Does the Keto Diet Help Migraine?

A few years ago, a study rekindled interest in the keto diet for migraine. Researchers followed 96 women with migraine who were also overweight. 45 of them followed a ketogenic diet for a month, followed by five months on a standard low-calorie diet. Compared to the control group, these women saw a significant improvement in migraine attack frequency and headache days in the first month. These improvements faded after they stopped the keto diet.[ii]

Intrigued by these results, other researchers examined the connection between keto diets and migraine symptoms. A study published in 2019 tried to determine if it was the ketogenic diet or weight loss that resulted in migraine improvement. The results confirmed that a very low-calorie ketogenic diet “is effective for rapid, short-term improvement of migraines in overweight patients.”[iii]

However, this keto-migraine research is still in its infancy. More studies will need be done before we understand the relationship between migraine and ketosis.

How to Try a Keto Diet for Migraine

Adopting a ketogenic diet is not a casual endeavor. “Because the keto diet has such a high fat requirement, followers must eat fat at each meal,” the Harvard Health Letter explains. “In a daily 2,000-calorie diet, that might look like 165 grams of fat, 40 grams of carbs, and 75 grams of protein.”[iv]

165 grams of fat is a lot. An 8-ounce ribeye contains just 30 grams. A handful of macadamia nuts? 32 grams. Two tablespoons of coconut oil have 28 grams of fat. See what 30 grams of fat looks like in other types of foods.  You’ll also have to say goodbye to added sugars, breads and grains, most fruits and many vegetables.

This high-fat diet carries some health risks. These include:

  • High LDL cholesterol levels
  • Vitamin and mineral deficiencies
  • Liver problems
  • Kidney problems
  • Constipation
  • Brain fog
  • Health problems (like heart disease) linked to saturated fats[v]

People with migraine also should be wary of foods that may trigger migraine, such as cheese, dried meats, fermented foods and nuts.

The best course of action is to consult your healthcare provider and/or a nutritionist before trying a keto diet for migraine. You may want to ask for a personalized nutrition plan to ensure you’re getting the right amount of nutrients while maintaining the correct proportions of carbs, proteins and fats.

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[ii] Di Lorenzo C, Coppola G, Sirianni G, Di Lorenzo G, Bracaglia M, Di Lenola D, Siracusano A, Rossi P, Pierelli F. Migraine improvement during short lasting ketogenesis: a proof-of-concept study. Eur J Neurol. 2015 Jan;22(1):170-7. doi: 10.1111/ene.12550. Epub 2014 Aug 25. PMID: 25156013.

[iii] Di Lorenzo C, Pinto A, Ienca R, et al. A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones?. Nutrients. 2019;11(8):1742. Published 2019 Jul 28. doi:10.3390/nu11081742