In a recent study published in Frontiers in Nutrition, researchers investigate the potential protective effects of ketosis-inducing diets on migraines.

Study: Ketosis and migraine: a scientific review of the literature and meta-analysis. Image Credit: Chatham172 / Shutterstock.com

Background

Headaches are widespread and a big source of impairment globally. Current therapies for migraine prophylaxis lack specificity, have poor tolerability and limited efficacy, and have potential opposed effects, thus resulting in poor results.

In response to recent studies, certain dietary treatments may provide symptomatic relief from migraine episodes. The ketogenic eating regimen, which substitutes glucose, the brain’s primary source of energy, with ketone bodies, is a promising approach that will reduce the number or intensity of headaches.

Concerning the study

In the current meta-analysis, researchers evaluate the efficacy of ketogenic dietary treatment (KDT) in migraine prevention and attenuation.

The ketogenic therapies tested in migraine treatments included the very-low-calorie ketogenic eating regimen (VLCKD, 4 studies), modified Atkins eating regimen (MAD, three studies), classic ketogenic eating regimen (cKDT, two studies), and β-hydroxybutyrate administration (BHB). Ketogenic diets were characterised by high-fat, moderate-protein, and low-carbohydrate intake.

Data on the tolerability and efficacy of various ketogenic diets as in comparison with other control diets or placebos, in addition to the degrees of ketosis in migraine management amongst children, adolescents, and adults, were searched through the Cochrane Library, PubMed/Medline, Web of Science, Scopus, Science Direct, and LILACS databases.

Additional references from recent studies or those present in previous review articles were also included. Only observational studies and clinical trials published throughout the previous ten years in Italian, English, Spanish, or Portuguese were included.

Studies including individuals without migraine, assessing ketoses unrelated to ketogenic diets or exogenous ketone body administration, equivalent to ketosis in diabetes, and outcomes unrelated to migraine episodes, were excluded from the evaluation. Non-human studies with unavailable full text, opinion articles, reviews, letters, guidelines, comments, editorials, news, case reports, case series, abstracts, dissertations, theses, and animal or in vitro studies were also excluded.

Two researchers independently screened the information, with a 3rd researcher resolving any disagreements between these two researchers. The Cochrane RoB version 2.0 tool was used to evaluate bias risks, whereas the Mixed Methods Appraisal Tool (MMAT) system evaluated evidence quality.

Study findings

Initially, 2,582 studies were identified, from which 169 duplicates were removed, and a pair of,413 were screened. Thereafter, 1,042 studies were excluded on account of the fallacious sample population, and 725 studies were removed on account of out-of-data period.

Moreover, 215 studies were excluded on account of the inclusion of other outcomes, 195 studies differed in publication type, 39 studies were excluded on account of study design, 100 studies were conducted in animals, and 59 studies were published in a distinct language.

This led to 41 remaining studies, 12 of which were assessed for eligibility. A complete of ten studies were ultimately considered for the ultimate evaluation after excluding three studies on account of their publication type and one study on account of the end result evaluated.

Half of the studies had low bias risks, with most issues concerning randomization. All studies included only adult individuals.

Ketosis evaluation was inconsistent between the included studies, with a couple of studies evaluating ketonuria, some evaluating ketonemia, and others with no ketosis level evaluation. Thus, no relationships between ketosis levels and migraine prevention or reduced migraine episodes could possibly be inferred.

Despite high levels of heterogeneity within the included studies, all ketogenic interventions showed significant effects, no matter exogenous or endogenous ketosis induction. A mean dropout rate of 21% was documented within the included studies and was higher amongst patients undergoing the classic ketogenic eating regimen and lower for the modified Atkins eating regimen at 34% and 13%, respectively.

Conclusions

The study findings indicate that ketogenic treatment may improve migraine treatment and ought to be studied further through randomized clinical trials with appropriate and standardized methodologies. Proper measurement of ketone levels during ketogenic therapy is crucial to observe adherence and improve understanding of the connection between ketone bodies and efficacy.

Some necessary considerations include the correlation between migraine improvement and weight reduction in obese subjects, an absence of a well-defined association between blood and urine ketones, and potential mechanisms of motion for ketogenic therapy. Future studies should evaluate compliance rates based on migraine type and diverse ketogenic dietary interventions, in addition to their optimal duration, repeatability, feasibility in normal-weight individuals, and association with conventional migraine prophylaxis.