Written Chrystal Moulton, Science Writer. At 6 months, patients showed a significant decrease in the frequency (P<0.001), intensity (P<0.001), and length of migraines (P<0.005).
Migraines can be attributed to environmental, behavioral, and genetic causes1. Treatment is predominantly dependent on NSAIDs and triptans, both of which play an anti-inflammatory role in ameliorating the pain experienced by migraine sufferers2. The main energy source for the brain is glucose followed by ketone bodies and lactate3. Some researchers have found that individuals who suffer from migraines who have insulin resistance are particularly prone to migraine attacks4. Considering prolong use of NSAIDs and triptans creates complications and the possible link sugar may play in exacerbating migraines, researchers have also considered a dietary approach to preventing migraines. Since the brain can also acquire energy through ketone bodies, researcher has explored ketogenic diets as possible treatment for migraines. Poor compliance to ketogenic diets has made it difficult to observe its effect on migraine prevention5. The modified Atkins ketogenic diet [MAD] was created as an alternative to regular ketogenic diet6. Given that few studies have observed the effect of the modified Atkins Ketogenic diet [MAD] for more than 3months, researchers in this study investigated the long-term effect of the modified Atkins Ketogenic diet [MAD] in the treatment of drug-resistant episodic and chronic migraine5.
The study was designed as a non-randomized, retrospective trial. Fifty-two patients who were previously treated in a neurological clinic were included in this study. Patients were categorized as chronic if they experienced headaches ≥15days/month for 3months. Individuals categorized as episodic experienced headaches <15days/month. All patients were offered treatment with MAD which had a fat to protein plus carbohydrate ratio of 1:2:1. MAD restricts carbohydrate consumption to 30g/day maximum with no restriction on protein intake. Blood pressure, migraine assessment/therapy, and labs were collected at baseline, 1, 3, 6, 9, and 12 months after the start of MAD. However, data was reported at baseline, 6months, and 12 months. Patients kept a headache diary to record frequency and intensity of migraine attacks as well as the amount of pain meds consumed. Insulin resistance was defined as HOMA-IR≥ 2.5. Ketonuria was self-monitored daily with a urinary stick.
At baseline, the average age of the 52 patients was 44.3 ±10.5 years old. There were 45 females and 7 males, 28 patients categorized as chronic and 24 as episodic. The average frequency of migraine attacks was 14.3 ±8.1 days/month. Average medication intake was 20.7 ±15.1 doses/month and average migraine related disability [MIDAS] score was 94.4 ±53.1 points. Medication overuse was roughly 40%. At 6 months, 11 patients dropped out of the study. Data on the 41 remaining patients showed a significant decrease in the frequency (P<0.001), intensity (P<0.001), and length of migraines (P<0.005). Researchers also observed a significant decrease in hs-CRP (P<0.001), HOMA-IR (P<0.05), diastolic blood pressure (P<0.001), BMI (P<0.001), migraine related disability [MIDAS] (P<0.001), and pain medicine intake (P<0.001). HDL-C increased significantly during this time (P<0.05) and no patients were classified with medication overuse. At 12 months, 33 patients remained in the trial. Data from these patients showed no further improvements when compared to data at 6months. Furthermore, none of the 33 patients were classified with medication overuse. When assessing the effect of a change in BMI from baseline to 6months on migraine occurrence, researchers found no significant results. All patients had ketonuria after 6 and 12 months.
Results from this study showed that adherence to the modified Atkins ketogenic diet [MAD] for 6 months significantly lowered the frequency, length, and disability associated with migraines. These improvements were maintained until the end trial at 12months in patients who adhered to the modified Atkins ketogenic diet [MAD]. Additional studies will be needed to verify these results.
Source: Francini-Pesenti, Francesco, Silvia Favaretto, Matteo D’Angelo, Martina Cacciapuoti, and Lorenzo A. Calò. “The Long-Term Treatment of Drug-Resistant Migraine with the Modified Atkins Ketogenic Diet: A Single-Center, Retrospective Study.” Nutrients 16, no. 24 (2024): 4324.
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/
4.0/).
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Posted February 18, 2025.
Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.
References:
- Ruschel MAP, De Jesus O. Migraine headache. StatPearls [Internet]. StatPearls Publishing; 2024.
- Harirforoosh S, Asghar W, Jamali F. Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci. 2013;16(5):821-47. doi:10.18433/j3vw2f
- Del Moro L, Rota E, Pirovano E, Rainero I. Migraine, Brain Glucose Metabolism and the “Neuroenergetic” Hypothesis: A Scoping Review. J Pain. Aug 2022;23(8):1294-1317. doi:10.1016/j.jpain.2022.02.006
- Ali M, Hussein M, Magdy R, et al. The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics. BMC Neurol. Nov 12 2022;22(1):422. doi:10.1186/s12883-022-02966-x
- Francini-Pesenti F, Favaretto S, D’Angelo M, Cacciapuoti M, Calò LA. The Long-Term Treatment of Drug-Resistant Migraine with the Modified Atkins Ketogenic Diet: A Single-Center, Retrospective Study. Nutrients. Dec 15 2024;16(24)doi:10.3390/nu16244324
- Kossoff EH, Rowley H, Sinha SR, Vining EP. A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia. Feb 2008;49(2):316-9. doi:10.1111/j.1528-1167.2007.01256.x
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