Ketogenic diet (KD) is an established treatment for refractory pediatric epilepsy and a promising therapy for diverse neurological diseases. Clinical data on KD in migraine—obtained from 150 patients investigated in case reports and prospective studies—suggest that KD may be a rapid onset effective prophylaxis for episodic and chronic migraine. KD would contribute to restore brain excitability and metabolism and to counteract neuroinflammation in migraine, although its precise mechanism is still unclear. Randomized controlled studies are needed to confirm the usefulness of KD in migraine and to investigate its optimal duration, repeatability, feasibility in normal weight subjects, efficacy in pediatric population and association to conventional migraine prophylaxis.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Martin VT, Vij B (2016) Diet and headache: part 2. Headache 56(9):1553–1562
Paoli A, Rubini A, Volek JS, Grimaldi KA (2013) Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr 67(8):789–796
Goadsby PJ, Lipton RB, Ferrari MD (2002) Migraine–current understanding and treatment. N Engl J Med 346(4):257–270
Guelpa G, Marie A (1911) La lutte contre l’epilepsie par la disintoxication et par la reeducation alimentaire. Rev Ther Med Chir 78:8–13
Stafstrom CE, Rho JM (2012) The ketogenic diet as a treatment paradigm for diverse neurological disorders. Front Pharmacol 3(59):1–8
Martin K, Jackson CF, Levy RG, Cooper PN (2016) Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev 2:CD001903. doi:10.1002/14651858
Vanitallie TB, Nonas C, Di Rocco A et al (2005) Treatment of Parkinson disease with diet-induced hyperketonemia: a feasibility study. Neurology 64(4):728–730
Henderson ST, Vogel JL, Barr LJ et al (2009) Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer’s disease: a randomized, double-blind, placebo-controlled, multicenter trial. Nutr Metab 6:31. doi:10.1186/1743-7075-6-31
Woolf EC, Syed N, Scheck AC (2016) Tumor metabolism, the ketogenic diet and β-hydroxybutyrate: novel approaches to adjuvant brain tumor therapy. Front Mol Neurosci 9(122):1–11
Evangeliou A, Vlachonikolis I, Mihailidou H et al (2003) Application of a ketogenic diet in children with autistic behavior: pilot study. J Child Neurol 18:113–118
Vecchia D, Pietrobon D (2008) Migraine: a disorder of brain excitatory–inhibitory balance? Trends Neurosci 8:507–520
Montagna P, Cortelli P, Monari L et al (2004) 31P-magnetic resonance spectroscopy in migraine without aura. Neurology 44(4):666–669
de Almeida Rabello Oliveira M, da Rocha Ataìde T, de Oliveira S et al (2008) Effects of short-term and long-term treatment with medium- and long-chain triglycerides ketogenic diet on cortical spreading depression in young rats. Neurosci Lett 434:66–70
Yudkoff M, Daikhin Y, Horyn O, Nissim I (2008) Ketosis and brain handling of glutamate, glutamine, and GABA. Epilepsia 8:73–75
Waeber C, Moskowitz MA (2005) Migraine as an inflammatory disorder. Neurology 64:S9–S15
Jeong EA, Jeon BT, Shin HJ et al (2011) Ketogenic diet-induced peroxisome proliferator-activated receptor-γ activation decreases neuroinflammation in the mouse hippocampus after kainic acid-induced seizures. Exp Neurol 232(2):195–202
Borkum JM (2016) Migraine triggers and oxidative stress: a narrative review and synthesis. Headache 56(1):12–35
Kim D, Davis L, Sullivan P et al (2007) Ketone bodies are protective against oxidative stress in neocortical neurons. J Neurochem 101:1316–1326
Maalouf M, Sullivan P, Davis L et al (2007) Ketones inhibit mitochondrial production of reactive oxygen species production following glutamate excitotoxicity by increasing NADH oxidation. Neuroscience 145:256–264
Bough K, Wetherington J, Hassel B et al (2006) Mitochondrial biogenesis in the anticonvulsant mechanism of the ketogenic diet. Ann Neurol 60:223–235
Schnabel TG (1928) An experience with a ketogenic dietary in migraine. Ann Intern Med 2:341–347
Strahlman RS (2006) Can ketosis help migraine sufferers? Headache 46:182
Urbizu A, Cuenca-León E, Raspall-Chaure M et al (2010) Paroxysmal exercise-induced dyskinesia, writer’s cramp, migraine with aura and absence epilepsy in twin brothers with a novel SLC2A1 missense mutation. J Neurol Sci 295(1–2):110–113
Di Lorenzo C, Currà A, Sirianni G et al (2013) Diet transiently improves migraine in twin sisters: possible role of ketogenesis? Funct Neurol 28(4):305–308
Kossoff EH, Huffman J, Turner Z, Gladstein J (2010) Use of the modified Atkins diet for adolescents with chronic daily headache. Cephalalgia 30(8):1014–1016
Di Lorenzo C, Coppola G, Sirianni G et al (2015) Migraine improvement during short lasting ketogenesis: a proof-of-concept study. Eur J Neurol 22(1):170–177
Di Lorenzo C, Coppola G, Bracaglia M et al (2016) Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study. J Headache Pain 17:58. doi:10.1186/s10194-016-0650-9
Conflict of interest
I certify that there is no actual or potential conflict of interest in relation to this article.
About this article
Cite this article
Barbanti, P., Fofi, L., Aurilia, C. et al. Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci 38, 111–115 (2017). https://doi.org/10.1007/s10072-017-2889-6
- Ketogenic diet