Researchers reviewed 50 studies about how a ketogenic diet (a high-fat, low-carb eating plan) might help people with chronic migraines. They found that migraines may involve problems with how the brain uses energy, and a keto diet might help fix this. Studies show the diet could reduce how many migraine days people have and how much pain they feel. However, scientists say we need bigger, better-designed studies to be sure it really works before recommending it to everyone.
The Quick Take
- What they studied: Whether a ketogenic diet (eating mostly fats and proteins, very few carbs) could help people with chronic migraines by fixing how their brain uses energy
- Who participated: The review looked at 50 different studies that included case reports, small clinical trials, and observational studies. The exact number of people studied wasn’t specified, but the studies were generally small in size
- Key finding: People who tried a ketogenic diet appeared to have fewer migraine days, less intense pain, and needed fewer pain medications. However, the evidence is still preliminary and comes mostly from small studies without strict controls
- What it means for you: A ketogenic diet may help reduce migraines for some people, but it’s not proven yet as a standard treatment. Talk to your doctor before trying it, especially if you have other health conditions or take medications
The Research Details
This was a systematic review, meaning researchers searched through medical databases and read 50 different studies about ketogenic diets and migraines. They looked at all types of studies, including case reports (stories about individual patients), small clinical trials, and observational studies (where researchers watch what happens without controlling the experiment).
The researchers searched three major medical databases up until May 2024 to find all available studies on this topic. They then summarized what these studies found about how ketogenic diets affect migraines and the brain’s energy use.
This approach helps scientists understand what we currently know about a topic by combining information from many different studies, even though those studies may have been done differently.
A systematic review is important because it brings together all available evidence on a topic rather than looking at just one study. This helps doctors and patients understand the big picture. However, the strength of the conclusions depends on the quality of the individual studies included. In this case, most studies were small and not carefully controlled, which limits how confident we can be in the findings.
This review has some important limitations to know about: Most of the studies included were small and didn’t use strict scientific controls. Many studies didn’t follow people for very long to see if benefits lasted. The studies used different methods, making it hard to compare results across them. No large, well-designed randomized controlled trials (the gold standard in research) have been done yet on this topic. The review itself is thorough and well-conducted, but the underlying studies it reviewed were not as rigorous as ideal.
What the Results Show
The review found that people with chronic migraines who followed a ketogenic diet appeared to experience positive changes. Specifically, they had fewer days with migraines, reported less intense pain during migraines, and needed to take fewer pain-relieving medications.
The researchers also found that migraines may be connected to problems with how the brain uses energy (called hypometabolism). Brain imaging studies showed that people with migraines have lower energy use in certain brain areas. The ketogenic diet might help by changing how the brain gets and uses energy, potentially fixing this mismatch.
The biological explanation makes sense: a ketogenic diet changes the body’s main fuel source from glucose (sugar) to ketones (made from fat). This might help brain cells work better and reduce inflammation, which could decrease migraines.
The review identified several related problems that may contribute to chronic migraines, including: problems with mitochondria (the energy factories inside cells), an imbalanced gut microbiome (the bacteria in your digestive system), inflammation in the brain, oxidative stress (damage from unstable molecules), weight imbalance, and problems with how the body processes glucose. The ketogenic diet might help address several of these issues at once, which could explain why it might be helpful for migraines.
This review adds to growing interest in using diet to treat migraines. Previous research has suggested that certain dietary changes can affect migraine frequency, but the ketogenic diet is relatively new as a migraine treatment. This review is one of the first comprehensive looks at all available evidence on this specific approach. The findings align with emerging research showing that metabolic problems play a role in migraines, supporting the idea that fixing these problems through diet could help.
The researchers were honest about important limitations: The studies they reviewed had small numbers of participants, making results less reliable. Different studies used different methods, so researchers couldn’t combine the results statistically. Most studies didn’t follow people for long periods to see if benefits lasted over time. There were no large, well-controlled randomized trials (the strongest type of study). Some studies may have had bias because people knew they were trying a new treatment. The review couldn’t determine the best way to do a ketogenic diet for migraines or who would benefit most.
The Bottom Line
Based on current evidence, a ketogenic diet may help reduce migraines for some people (moderate confidence level). However, it should not replace standard migraine treatments without doctor approval. If you’re interested in trying it, work with your doctor and ideally a registered dietitian to do it safely. Start slowly and monitor how your migraines change. This approach is most promising for people with chronic migraines who haven’t found relief with other treatments.
People with chronic migraines (15+ headache days per month) who want to explore dietary approaches may find this interesting. People with certain health conditions (diabetes, heart disease, kidney disease), pregnant women, children, and people taking specific medications should talk to their doctor first. This is not a replacement for medical care but a potential complementary approach to discuss with healthcare providers.
If someone tries a ketogenic diet for migraines, they might notice changes within 2-4 weeks, though some people may take longer. The diet requires commitment and proper planning to be done safely. Benefits may continue to improve over several months. It’s important to track migraine patterns before and after starting to see if it’s actually helping.
Want to Apply This Research?
- Track daily: number of migraine hours, pain intensity (0-10 scale), medications used, and carbohydrate intake. Record this in a simple daily log to see patterns over 4-8 weeks
- Start by learning which foods are allowed on a ketogenic diet (fats, proteins, non-starchy vegetables) and which to avoid (grains, sugars, most fruits). Use the app to log meals and track macronutrients (fat, protein, carbs) to stay in ketosis. Set reminders to drink water and take supplements as recommended by your doctor
- Create a weekly summary showing migraine frequency, average pain level, and medication use. Compare month-to-month trends to see if the diet is helping. Share reports with your doctor every 4-8 weeks to adjust the plan if needed. Track any side effects or challenges to discuss with your healthcare provider
This review summarizes current research but is not medical advice. Ketogenic diets are not proven treatments for migraines and may not work for everyone. Before starting a ketogenic diet, especially if you have other health conditions, take medications, are pregnant, or are breastfeeding, consult with your doctor or healthcare provider. Do not stop taking migraine medications without medical guidance. This information is for educational purposes and should not replace professional medical care.