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.

Metabolic health refers to how efficiently your metabolism works, or how well your body converts food into energy for your cells to use. More conscious food choices can lead to improved metabolic health that, in turn, may help mitigate migraines.

This promising avenue of dietary intervention offers a glimmer of respite for those seeking relief. A powerful solution to your debilitating headaches may be sitting on your plate.

Metabolic Migraine

The connection between migraines and metabolic health is a decades-old concept. Migraines were coined “hypoglycemic headaches“ as far back as 1935. Hypoglycemia is characterized by abnormally low blood sugar levels, suggesting a tie between the body’s blood sugar management—a key metabolic marker—and migraines.

“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.”

The vascular hypothesis refers to changes in the blood vessels of the brain. The blood vessels dilate and then constrict, which can lead to the typical migraine symptoms. The term neurogenetic refers to the study of how genetic factors may affect the development and function of the nervous system.

The neurometabolic angle Gross refers to is the relationship between the nervous system and metabolic processes in the body. It involves how metabolism affects brain function and overall neurological health.

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 review that Gross authored and published in 2019 in Nature Reviews Neurology found that migraines can be viewed as an adaptive response in genetically susceptible individuals, resulting from a mismatch between the brain’s energy reserves and its demands.

Imbalances in energy metabolism and oxidative stress often trigger migraine attacks. Oxidative stress occurs when free radicals and antioxidants are out of balance in the body. Free radicals are compounds that can harm our cells and disrupt our normal bodily functions. Contrastingly, antioxidants help stabilize free radicals, reducing their reactivity.

“[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.

Common medications for migraines include over-the-counter pain relievers like ibuprofen and aspirin, and prescription drugs include beta-blockers and anti-epileptics.

Evidence Is Stacking Up

Research continues to add evidence to the neurometabolic aspect of migraines, showing the link between what we eat and the condition.

A study published in Clinical Nutrition in August 2024 looked at 25 people, ranging in age from 18 to 60, who had been diagnosed with chronic migraine by a neurologist. Participants were required to stop any preventive migraine treatment at least three months prior to the screening.

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.

A sample diet plan combining the two diets that was given to patients looked like this:

• Breakfast: rye bread topped with dark chocolate and hazelnuts
• Snacks: pine nuts or walnuts accompanied by black or green olives
• Lunch: a combination of tuna, chicory, juniper berries, raw fennel, green pepper, and anise seeds
• Dinner: scrambled eggs with a splash of lemon juice, served alongside escarole, tomatoes, oregano, and basil

This way of eating helped participants maintain healthy levels of ketones while keeping inflammatory factors low, ultimately improving the conditions of patients with chronic migraine.

What Else We Know

A 2019 review published in Nutrients determined that finding one singular treatment is difficult because migraines are complex. Gross, the study’s lead author, emphasized that migraines involve various pathways and environmental factors rather than being attributed to a single cause.

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.

Some believe that the weight loss that often accompanies a ketogenic diet is the driving factor in its effective treatment of migraines. However, an article published in 2022 in the Journal of Clinical Medicine examined the role of the ketogenic diet in migraine relief beyond weight loss. The authors concluded that other mechanisms are at play, other than just a loss of fat mass.

More recently, a review published in Nutrients in 2024 concluded that while some studies suggest that certain foods and diets may trigger migraine attacks while others may help reduce the frequency, duration, and severity of symptoms and decrease the need for medication, the overall evidence supporting specific diets to treat migraines must be strengthened. This underscores an urge for more extensive clinical trials to confirm whether particular diets can be reliably used as part of migraine treatment.

Dietary Interventions

As the research continues to build, dietary interventions seem to be a viable approach worth exploring to relieve symptoms in those dealing with migraines.

“There’s huge success in going on a low-carb diet or a low-GI [glycemic index], real food [diet],” said Gross. The glycemic index is a scale that ranks foods based on how quickly they raise blood sugar levels.

“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.”

She proposes the following four-pillar model for managing metabolic migraines:

1. Blood Sugar Management: Emphasizing whole foods and cutting out processed sugars is first and foremost.
2. Micronutrient Intake: Ensure adequate intake of vitamins and minerals through a well-rounded, whole-food diet and possibly supplementation.
3. Reducing Oxidative Stress: Manage lifestyle factors contributing to oxidative stress, including stress management and reducing toxins.
4. Alternative Energy Sources: Explore using ketone bodies as alternative energy sources for the brain.

Dietary approaches to migraines should be individualized, as not everyone responds the same way to food. Gross pointed out dairy as an example of a food some people do well with while others do not. She also recommends a gradual transition when switching to a new diet and referred to her personal experience with drastic changes eliciting migraines.

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.