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Ketogenic diet in refractory migraine: possible efficacy and role of ketone bodies—a pilot experience

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Abstract

Introduction

Refractory migraine is a particularly disabling form of chronic migraine, unresponsive to multiple prophylactic strategies. Ketogenic diet (KD) is useful to treat migraine but poorly tested for refractory migraine.

Objective

We started exploring the efficacy and safety of KD, as compared to a non-ketogenic dietary regimen similar in reduction of carbohydrate intake (low-carb diet, LCD), in refractory migraine. Secondary objective was to explore whether ketones have a role in the prophylaxis induced by KD on migraine.

Results

In a first trial, 22 patients with refractory migraine were included and completed the study. Thirteen (mean age 36.8 ± 12.9 years, 11 females, 2 males) were assigned to the KD arm and eight (mean age 50.9 ± 10.8 years; all females), not eligible for KD, to LCD. Patients treated with KD showed a significant reduction in the frequency of migraine attacks, intensity of headache, and amount of drug intake. No significant benefit was seen in the LCD group. A relationship between ketone production and effect on headache was observed among patients with a good response to KD. In a second study, additional 31 refractory migraineurs were treated with these two dietary regimens, 26 with the same KD scheme and 5 with a LCD. Results were comparable with those of the first study.

Conclusions

KD might be a useful option in refractory migraine. Ketones seem to have a role in migraine modulation and their regular measurement might be useful to monitor KD in migraineurs. Larger, randomized, and controlled trials are needed to confirm these data.

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References

  1. Headache Classification Committee of the International Headache Society (IHS) (2018) The international classification of headache disorder, 3rd edition (ICDH3). Cephalalgia 38:1–211. https://doi.org/10.1177/0333102417738202

  2. Martelletti P, Katsarava Z, Lampl C, Magis D, Bendtsen L, Negro A, Russell MB, Mitsikostas DD, Jensen RH (2014) Refractory chronic migraine: a consensus statement on clinical definition from the European Headache Federation. J Headache Pain 28(15):47. https://doi.org/10.1186/1129-2377-15-47

    Article  Google Scholar 

  3. Jahromi SR, Ghorbani Z, Martelletti P, Lampl C, Togha M (2019) On behalf of the school of advanced studies of the European headache federation (EHF-SAS) association of diet and headache. J Headache Pain 20:106–111. https://doi.org/10.1186/s10194-019-1057-1

    Article  Google Scholar 

  4. Bongiovanni D, Benedetto C, Corvisieri S, Del Favero C, Orlandi F, Allais G, Sinigaglia S, Fadda M (2021) Effectiveness of ketogenic diet in treatment of patients with refractory chronic migraine. Neurol Sci. https://doi.org/10.1007/s10072-021-05078-5

    Article  PubMed  Google Scholar 

  5. Maggioni F, Margoni M, Zanchin G (2011) Ketogenic diet in migraine treatment: a brief but ancient history. Cephalalgia 31(10):1150–1151. https://doi.org/10.1177/0333102411412089

    Article  PubMed  Google Scholar 

  6. Barbanti P et al (2017) Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci 38(Suppl 1):111–115. https://doi.org/10.1007/s10072-017-2889-6.Review

    Article  PubMed  Google Scholar 

  7. Di Lorenzo C et al (2019) A ketogenic diet normalizes interictal cortical but not subcortical responsivity in migraineurs. BMC Neurol 19(1):136. https://doi.org/10.1186/s12883-019-1351-1

    Article  PubMed  PubMed Central  Google Scholar 

  8. Altamura C et al (2018) Promoting healthy eating can help preventing migraine: a real-life preliminary study. Neurol Sci 39(Suppl 1):155–156. https://doi.org/10.1007/s10072-018-3381-7.Noabstractavailable

    Article  PubMed  Google Scholar 

  9. Di Lorenzo C et al (2019) A randomized double-blind, cross-over trial of very low-calorie diet in overweight migraine patients: a possible role for ketones? Clinical Trial Nutrients 11(8):1742. https://doi.org/10.3390/nu11081742

    Article  CAS  Google Scholar 

  10. Lovati C et al (2017) Sleep, headaches and cerebral energy control: a synoptic view. Expert Rev Neurother 17(3):239–250. https://doi.org/10.1080/14737175.2016.1226133

    Article  CAS  PubMed  Google Scholar 

  11. Gross EC et al (2019) Potential protective mechanisms of ketone bodies in migraine prevention. Nutrients 11(4):811. https://doi.org/10.3390/nu11040811

    Article  CAS  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Headache Center, Neurology Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20156, Milan, Italy

    Carlo Lovati & Caterina Mariotti d’Alessandro

  2. Endocrinology Unit, Humanitas Clinical and Research Institute - IRCCS, Rozzano, MI, Italy

    Stefania Della Ventura

  3. Clinical Nutrition and Dietetics Unit, L, Sacco University Hospital, Milan, Italy

    Fulvio Muzio

  4. Luigi Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

    Leonardo Pantoni

Authors
  1. Carlo Lovati
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  2. Caterina Mariotti d’Alessandro
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  3. Stefania Della Ventura
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  4. Fulvio Muzio
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  5. Leonardo Pantoni
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Corresponding author

Correspondence to Carlo Lovati.

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Ethical approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Patients gave their consent to the dietary protocol and for an anonymous use of data collected.

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The authors declare no competing interests.

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Lovati, C., d’Alessandro, C.M., Ventura, S.D. et al. Ketogenic diet in refractory migraine: possible efficacy and role of ketone bodies—a pilot experience. Neurol Sci 43, 6479–6485 (2022). https://doi.org/10.1007/s10072-022-06311-5

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  • DOI: https://doi.org/10.1007/s10072-022-06311-5

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