Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations

Abstract

Headaches are among the most prevalent and disabling neurologic disorders and there are several unmet needs as current pharmacological options are inadequate in treating patients with chronic headache, and a growing interest focuses on nutritional approaches as non-pharmacological treatments. Among these, the largest body of evidence supports the use of the ketogenic diet (KD). Exactly 100 years ago, KD was first used to treat drug-resistant epilepsy, but subsequent applications of this diet also involved other neurological disorders. Evidence of KD effectiveness in migraine emerged in 1928, but in the last several year’s different groups of researchers and clinicians began utilizing this therapeutic option to treat patients with drug-resistant migraine, cluster headache, and/or headache comorbid with metabolic syndrome. Here we describe the existing evidence supporting the potential benefits of KDs in the management of headaches, explore the potential mechanisms of action involved in the efficacy in-depth, and synthesize results of working meetings of an Italian panel of experts on this topic. The aim of the working group was to create a clinical recommendation on indications and optimal clinical practice to treat patients with headaches using KDs. The results we present here are designed to advance the knowledge and application of KDs in the treatment of headaches.

Applying a biopsychosocial model to migraine: rationale and clinical implications

“…More important is the role of diet as a whole in individuals with migraine, given the relevance of glucose metabolism in migraineurs’ brains [ 130 , 131 ]. Diets shifting the brain metabolism to products different from glucose, such as the ketogenic diet, have shown to provide some benefits in migraine management [ 132 , 133 ] decrease of the hypermetabolic feature of migraineurs’ brain. However, even dietary measures that are less strict than ketogenic diet, including weight loss in obese individuals, low-calorie diets, or fatty acid supplementation, might be able to decrease the burden of migraine [ 134 ].…”

Management of Lipedema with Ketogenic Diet: 22-Month Follow-Up

“…The KD is a nutritional program that provides for a minimal daily intake of carbohydrates (<30 g or <10% of the total calories), and has been used for almost 100 years to manage drug-resistant forms of childhood epilepsy [17]. To date, it is proposed in support of cancer therapy by exploiting the Warburg effect [18,19], in the management of migraines [20,21], in polycystic ovary syndrome [22], and obviously for weight loss, in particular in obese subjects [23,24]. It is now well established that if operated under specialist supervision, it is safe, even if kept in the long term [24].…”

Ketogenic Diet for Cancer: Critical Assessment and Research Recommendations

“…The major variations include: (1) Very Low-Calorie Ketogenic Diet is time-limited (~12 weeks) calorically restrictive (600-800 kcal), characterized by a minimum protein content (≥75 g/day), limited carbohydrate content (30-50 g/day), and a fixed amount of fat (20 g/day, mainly from olive oil and omega-3 fatty acids); and (2) the Low Glycemic Index Diet characterized by intake of a higher quantity of carbohydrates (60-80 g/day) from low glycemic index sources (e.g., lentils, chickpeas, bran cereals, carrots). Although not, strictly speaking, a KD, the Low Glycemic Index Diet has been effective in treating some forms of epilepsy and headaches [24] (it is thought that this diet, with its less restrictive carbohydrate intake, is unlikely to have beneficial effects on cancer [25]).…”