Dr Deborah Lee, from Dr Fox Online Pharmacy

For Migraine Awareness Week, we hear from Dr Deborah Lee, from Dr Fox Online Pharmacy, who reveals how your overall diet and weight could be causing your migraines, plus how the keto diet could be the key to migraine relief…

Click here to read our guide on the signs, symptoms and causes of migraines!

Do you suffer from headaches or migraines? Although some migraines are triggered by certain foods, you may not realise that your overall diet could be a causative factor.

Obese people are three times more likely than those of normal weight to suffer from migraine. Read on and find out how a keto diet may help improve your migraines.

What causes migraines?

Migraine is common, affecting approximately 14.4% of the population. Migraine is said to be the greatest cause of disability in people aged under 50, in the world.

In a migraine attack, abnormal electrical activity in the brain, known as cortical spreading depolarisation (CSD), spreads across the cortex and the occipital regions. Acute migraine may be triggered when this process activates the trigeminal nerve. This is the largest cranial nerve which supplies sensation to the skin of the face.

CSD also results in the release of the neurotransmitters glutamate and nitric oxide (NO). Calcitonin gene-related peptide (CGRP), substance P, and neurokinin A are other substances that are also released, and this results in vasodilatation and brain inflammation. The throbbing pain of migraine is thought to be due to the effects of inflammation, stimulating pain-sensitive, blood vessels.

The neurotransmitters serotonin, dopamine, and noradrenaline also transmit the pain response in the midbrain and hypothalamus. Nausea, vomiting, and photophobia occur because affect autonomic (involuntary) nerve pathways are also stimulated.

How are migraines and obesity related?

There are various similarities between obesity and migraine. In both conditions:

  • CGRP levels are elevated.
  • Numbers of inflammatory cytokines including interleukin 6, and tumour necrosis factor-alpha, are increased.
  • C-reactive protein (CRP) levels are raised.

In addition:

  • Levels of Substance P, which mediates pain in migraine, are raised in obese people with type-2 diabetes, and obese children.
  • The increase in chronic inflammation found in people who are obese is thought to exacerbate the inflammatory response that occurs in migraine, resulting in headaches that are more frequent and more severe.

What else is known about migraine and obesity?

Migraine sufferers often have low levels of serotonin, apart from during an acute attack.

They also tend to have lower levels of a key neuropeptide called orexin-A, which has an important role in arousal, reward, satiety, and helps control blood glucose levels. Orexin -A deficiency has been linked to inflammation of the trigeminal nerve.

In obesity, low levels of the hormones adiponectin and leptin may also underlie the increase in inflammation and proved a trigger for migraines.

Migraine sufferers tend to have a poorly performing sympathetic nervous system. Obesity sufferers are thought to have a higher resting sympathetic tone. Hence obese migraineurs may be increasingly susceptible to migraine attacks.

Could keto be the cure for migraines?

In ketosis, the brain has switched to using ketones for fuel, especially D-β-hydroxybutyrate. Ketones are cell-signalling molecules that have the potential to influence many of the pathways in migraine pathophysiology. This includes cerebral excitability, inflammation, oxidative stress, and mitochondrial functioning.

Research into the keto diet and migraines:

  • The first case of a woman with migraine being treated with a keto diet was reported in 1928.  She consumed 3-4 high-protein, low-carbohydrate shakes (200 kcal) per day. Once in ketosis, her headaches stopped completely. Moreover, this effect was seen for 7-months after discontinuing the diet.
  • In another 1928 study, 18 migraineurs followed a keto diet, of whom around half achieved a marked reduction in their symptoms.
  • More recently, in 2016, 18 migraineurs were asked to follow a keto diet, and most reported a significant reduction in the frequency and severity of their migraine episodes.
  • In 2013, the keto diet was found to have a better effect on migraines than a standard low-calorie diet. 90% of those on the keto diet had a positive response to their migraine. In contrast, none of the low-calorie diet group responded at all.
  • In a subsequent study, the same investigators reported that during the first month of the keto diet, migraine sufferers noted a significant reduction in the frequency and severity of their headaches and a marked reduction in the need to take medication.

How does the keto diet reduce migraines?

The exact mechanism is unknown. However, it is thought that ketosis improves serotoninergic function, calms down neuronal excitability, reduces CGRP production and release, reduces CSD, and improves brain mitochondrial function. In the mouse, ketosis has been shown to directly reduce brain inflammation.

Recent studies of obese people who have lost a large amount of weight after bariatric surgery have also reported a reduction in headaches and migraines.

Is the keto diet the key to migraine relief?

Dietary strategies, such as a keto diet for migraine relief, are promising. There are common factors in both obesity and migraine, and the metabolic state of ketosis. The high level of ketone bodies, seems to play a role in neuroprotection, reducing brain inflammation, and improving mitochondrial function.

If you suffer from migraines, why not try a keto diet and see for yourself if your symptoms improve?

Click here for our guide on the keto diet!