If you live with migraine, you may have talked with your doctor about foods that can either help or worsen your migraine. Research indeed suggests that your eating patterns may help ease your migraine symptoms. One approach is a high-fat, low-carb diet approached called the ketogenic diet.
Migraine and diet
“There have been more and more studies that suggest the ketogenic diet may help treat various conditions, including migraine,” says Alexander Mauskop, MD, Director of the New York Headache Center in New York City and a professor of clinical neurology at SUNY Downstate Medical Center in Brooklyn, New York. “But it’s a very strict diet, and almost impossible to stay on long-term.”
Here’s why the ketogenic may help with migraine and how you can fit this type of eating pattern into your diet.
What Is the Ketogenic Diet?
A ketogenic diet is low in carbohydrates, moderate in protein, and high in fat. It’s similar to the Atkins diet from the 1970s, and it's been around since the 1920s. Here’s what your daily calories will look like:
- 55%-60% of your calories from fats such as olive oil, nuts, butter, and avocado
- 30%-35% of calories from proteins, such as lean meat, eggs, and cheese
- 5%-10% of your calories from carbohydrates, such as non-starchy vegetables and leafy greens. In general, you are not supposed to eat more than 50 grams of carbohydrate a day.
The ketogenic diet has been used since the 1920s to help treat patients, especially children, with epilepsy. Research also shows that it may help manage:
- Diabetes
- Heart disease
- Obesity
- Fatty liver disease
- Neurological conditions such as Alzheimer’s, Parkinson’s, and epilepsy
How Does the Ketogenic Diet Work?
Since you eat so few carbohydrates on this diet, your body enters a metabolic state called ketosis, where it burns fat for fuel instead. Here’s how the process works:
- When you eat carbohydrates, your body breaks them down into glucose and uses it for fuel.
- Once your glucose levels become low, your body will use fat instead of glucose.
- Your body breaks these fats down into molecules called ketones, which serve as another source of energy.
How Does the Ketogenic Diet Improve Migraine?
There have been several small studies that show a ketogenic diet may improve migraine. It’s not known for sure how the ketogenic diet helps with migraine, but there are several different theories:
It evens out blood sugar levels. “We know that many migraine sufferers have a condition called reactive hypoglycemia, where their blood sugar levels drop very low after they eat,” Mauskop says. “They consume carbohydrates, their blood sugar spikes, and then it crashes quickly. The ketogenic diet allows people to maintain stable blood sugars more easily than if they had a lot of carbs in their diet.”
It causes weight loss. Since the ketogenic diet puts your body into ketosis, it may help lower body fat.
“We know that people who are overweight or obese are more likely to experience migraine,” Mauskop says.
But research shows that if you lose weight, it can help. One study looked at over 470 patients with migraine and found that weight loss led to fewer, less intense headaches and shortened attack time.
It lowers inflammation. Brain inflammation worsens migraine, notes Vanessa Cooper, MD, a headache specialist at the Yale Medical Center in New Haven, Connecticut. Since a diet like the ketogenic diet lowers inflammation, it may lead to fewer, less severe migraines.
It gets rid of trigger foods. Alcohol and chocolate are both known to trigger migraine, and are usually avoided on a ketogenic diet. Other foods that you might eat on a keto diet, such as fatty fish, have been shown to lower migraine frequency.
What Is the Ketovore Diet?
The ketovore diet is a mix of two different eating patterns: the ketogenic diet and the carnivore diet, a zero-carbohydrate diet that’s limited to meat, fish, eggs, and full-fat dairy products.
The ketovore diet is less strict than a carnivore diet but shares the same low-carb principles. You’ll mainly eat meat, animal fats, and very small amounts of low-carb vegetables.
There’s no research to show that a ketovore diet helps you manage migraine, Cooper says. Also, the diet is so limiting that you won’t be able to get all the nutrients you need. It’s also high in saturated fat, which raises your risk of heart disease. High amounts of animal protein also put a lot of stress on your kidneys.
Who Should Try the Ketogenic Diet?
A ketogenic diet isn’t recommended for most people who live with migraine.
“There isn’t strong evidence to support it, since the studies have been very small, and it’s a very restrictive diet,” points out Cooper. “It also limits carbohydrates, so most people cut back on foods like fruits, certain vegetables, and whole grains, which are very good for you.”
Instead of a ketogenic diet, Cooper usually recommends that her patients follow a Mediterranean-style eating pattern. It’s rich in fruits, vegetables, whole grains, and healthy fats like extra virgin olive oil. Research shows this diet helps ease migraine symptoms, making them less severe.
Another possibility is a modified Mediterranean-ketogenic diet. You eat plenty of green leafy vegetables, healthy fats, like nuts and olive oil, and healthy protein like lean meat. You avoid processed or fried foods, red meat, full-fat dairy, sweets, as well as grain products and fruits.
In a small pilot study, 25 people with migraine followed a Mediterranean-ketogenic diet for 12 weeks and found that rates of migraine dramatically decreased, as did headache intensity.
How to Try It
If you do decide to try a ketogenic diet, or a Mediterranean-ketogenic diet, follow these guidelines to do it safely and to ensure you get as many nutrients as possible:
Focus on non-starchy vegetables. Aim to get at least two servings a day. Try to eat one serving raw, or as a salad. A serving of leafy greens is a cup. A serving of other vegetables is a half cup. Examples include:
- Leafy greens, such as kale, collards, arugula, or spinach
- Peppers
- Broccoli
- Celery
- Green beans
- Tomatoes
- Mushrooms
- Zucchini
- Eggplant
Eat healthy protein. Try to get some of this from plant-based sources, such as nuts like almonds, hazelnuts, walnuts, and pecans. A serving is 1/4 cup, or roughly a handful. Also, eat at least three servings of fish a week, ideally fatty fish like salmon, mackerel, herring, or tuna. A serving is 3-5 ounces, or about the size of your palm.
Cook with olive oil. You’ll want around four tablespoons each day. Eat less than a tablespoon of butter or margarine each day, too.
Drink plenty of fluid. You’ll want to have at least 8-12 cups of water each day to prevent dehydration. Make at least two of them, either chicken or vegetable broth, or a low-sugar sports drink, to help ensure you get needed electrolytes. This will help protect you against symptoms of “keto flu.”
Mediterranean Diet vs. Ketogenic Diet for Migraine
A Mediterranean-style diet is often much easier to follow and healthier than a ketogenic diet, Cooper says. “I recommend it to all of my patients, because it’s well-balanced and less restrictive than a ketogenic eating pattern,” she says. “Prioritize fruits and greens and minimize processed food, red meat, and anything that’s high in added sugar.”
In general, here’s what to eat on this plan:
- 2-3 servings of fruit daily
- At least four servings of vegetables daily
- At least three servings of fatty fish a week, such as tuna, salmon, sardines, mackerel, and herring. One serving is 3-5 ounces, about the size of a deck of cards.
- At least three servings of legumes such as lentils or peanuts, or beans like lima or kidney beans, a week. Both are high in fiber and protein, and low in fat. A serving size is a half-cup.
- Four servings of nuts a week. A serving equals 1/4 cup. Look for raw, unsalted options.
Other foods to add include whole grains, skinless chicken or turkey, extra virgin olive oil, and low-fat dairy. At each meal, half of your plate should be fruit or non-starchy vegetables, a quarter should be lean protein such as chicken, fish, nuts, lentils, or beans, and another quarter should be 100% whole grains.
Other Migraine-Friendly Diet Tips
When it comes to migraine, it’s not just what you eat, but when you eat — that matters, too. In general, you want to try to eat several small meals throughout the day, rather than three large meals spaced six to eight hours apart. “In general, we find it’s helpful to eat every three hours to help keep blood sugar levels steady,” Mauskop says. If you go much longer, you may trigger a headache.
Cooper also suggests that you limit caffeine to less than 200 milligrams a day (the equivalent of about two cups of coffee). More than that may cause a migraine, she says. When you consume fluids, stick to water, low-fat milk, or small amounts of juice.
“We know that artificial sweeteners, which are often found in diet soft drinks, can sometimes also trigger headaches,” Cooper says.
Remember, there’s no one-size-fits-all approach to diet either, Cooper adds. Focus on fresh, unprocessed foods that are high in fiber and protein, and avoid foods that are processed or have added sugar. “The healthier your diet, the better it is for migraine treatment and prevention,” Cooper says.
