Are Migraines Partially a Metabolic Condition?

Migraines are a complex and often misunderstood ailment that tortures many people. Finding effective ways to combat symptoms is a daunting task for those who suffer from debilitating attacks.

“[Migraine] is the second most disabling disease in the world, [and] the first among women,” Elena Gross, a neuroscientist with a doctorate in clinical research, told The Epoch Times.

Despite the large swath of the population afflicted by migraines, treatment options are limited. Simply prescribing current medications for those with chronic migraines leaves the root cause unaddressed. To this day, migraine remains under-researched, said Gross.

“Migraine is the unwanted child of neurology. Migraine affects a billion people, and still, there’s very limited research out there [and] there are very [few] drugs in development,” she added.

Thankfully, Gross highlighted an area we have some autonomy over when it comes to managing migraines: what we eat. Data in support of addressing migraines through nutrition have begun to accumulate.

Metabolic Health

Improving metabolic health may hold the key to reducing the frequency and severity of episodes.

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“The metabolic has always been there, and then it was vascular, and then it was genetic, and then it was neurogenetic,“ said Gross. ”I think now it’s going to be neurometabolic.”

Gross highlighted that a significant portion of migraine sufferers may have a metabolic root cause where dietary interventions could prove beneficial.

“Between 30 and 70 percent of migraineurs might fall into this metabolic migraine category,“ said Gross, ”which means that some of their damaged metabolism is leading to the brain’s warning signal being turned on.”

She believes that migraines serve as a warning signal from the body, indicating energy deficiencies or hormonal imbalances.

“[A] migraine is your friend because it’s trying to protect you and it’s trying to warn you,“ Gross said. ”Pain is always a warning signal. We have to figure out what it’s warning us from.”

Viewing the pain as a protective mechanism, she urges individuals to address underlying issues rather than merely masking symptoms with medication. Gross believes that the pain also communicates a need for rest and stillness until balance has been restored in the brain. For most people, the intuitive response to managing a migraine is resting in a dark room, which strengthens this hypothesis.

During the initial consultation, participants underwent a dietary assessment using a self-administered questionnaire. It included a selection of commonly consumed foods, categorized into groups: fish, red meat, white meat, pasta/rice, pizza, vegetables, legumes, cheese, eggs, sweets, bread, fruit, coffee, extra-virgin olive oil, and frying.

Data were collected and reassessed after four weeks and eight weeks of the participants following personalized dietary plans based on the Mediterranean-ketogenic diet, a hybrid of the two approaches combining low-carb intake with Mediterranean diet-friendly foods.

Adequate ketone levels and improvements in migraine symptoms and body measurements confirmed their adherence to the diet. Those who did not complete all visits were excluded from the study analysis.

The researchers evaluated migraine intensity and frequency through a headache diary maintained for at least one month prior to starting the diet. Participants completed diaries documenting their migraines throughout the study, providing data on the frequency of attacks per month and the severity of their pain.

The study noted a significant reduction in both the frequency of attacks and the intensity levels after four weeks of the Mediterranean-ketogenic diet.

According to the researchers, one of the key limitations of the study was the small number of participants (sample size). They highlighted the need to conduct trials with a larger sample size over an extended period. Additionally, they noted the fact that some participants had not received a recent diagnosis of migraine.

However, overall, the researchers found that the Mediterranean-ketogenic diet appears to be a promising intervention for migraines and benefits body weight and fat mass.

This is believed to be the first study demonstrating that such a diet can lead to changes in body composition and reduce the frequency and intensity of pain in individuals struggling with chronic migraine.

What Is a Mediterranean-Keto Diet?

All participants in the study received a tailored diet plan based on their criteria for a Mediterranean-ketogenic diet. Carbohydrates were limited to less than 25 grams a day, while protein needs were determined at 2 grams per kilogram of fat-free mass. Fat-free mass refers to all parts of your body that are not fat tissue, including muscles and bones. Additionally, common headache triggers like caffeine, monosodium glutamate (MSG), sulfites, histamines, and amines were minimized or eliminated from the diet.

The researchers developed a new ketogenic diet incorporating Mediterranean foods. A ketogenic diet focuses on keeping the body in a metabolic state of ketosis. This is achieved by consuming low-carbs, generally between 20 and 50 grams daily, while increasing fats and protein. A Mediterranean diet is primarily plant-based and consists of whole foods and healthy fats like olive oil.

Until more personalized therapies are available, increasing ketone bodies is a relatively safe option for sufferers, though the exact mechanisms behind its effectiveness remain unclear. The authors question whether avoiding carbohydrates, having ketones, or both contribute most to the protective effects observed with ketogenic diets. Increased fatty acids and amino acids, supplementation with medium-chain fatty acids (found in milk, yogurt, and butter), and changes to the gut microbiome may also play a role. The review concluded that further research is needed as most of the existing data has only been conducted on animals.

“Dietary changes aren’t simple; they’re drastic, multipathway, and multifactorial. [But] they are very powerful tools, especially if they involve ketosis and anti-inflammatory factors,” she continued.

With the plethora of packaged and processed foods at our fingertips, a nutrition-based approach to managing migraines is challenging, and Gross stressed that there are no shortcuts.

“You have to eat food that is food. If something comes out of a packet with 50 ingredients, it’s not food. Food is supposed to fuel and nourish your body, [and] this is not fueling or nourishing your body; it’s just empty calories. The thing I would like to get people to do is to eat real food,” she said.

If opting for anything in a package, such as a keto treat or snack, scanning ingredient lists and seeking out whole foods is paramount.

“There’s no place for highly processed, sugary foods,“ said Gross. ”As a staple food, that’s something that has to go. It’s toxic to your body [and] that’s the non-negotiable.”

Gut health is another consideration when making dietary changes to combat migraine symptoms.

“If you’re switching from high-carb to a ketogenic [diet] overnight, basically all your gut bacteria will be starving, and you will not have any that can metabolize what you’re currently eating. So then these are dying off, and they’re probably releasing some toxins, and it’s just more shock to the system,” explained Gross.

Listening to your body remains the gold standard for figuring out what diet works best for tackling your migraines. Gross stressed that no matter what diet you follow, if you know something is a trigger for you, definitely avoid it.

“Listen to your body. That’s what the migraine is doing; we’re not listening [to] the subtle signals [that] you probably should slow down. And if you don’t, then the full-blown migraine comes because we haven’t listened,” she concluded.