Chronic Migraine,  Diet,  Keto,  Migraine

Keto for Migraine – Phases 2 & 3

The goal of Phase 1 of the ketogenic diet is to get your body into consistent ketosis by limiting your carbohydrate intake to ~25g/day while having adequate protein and getting most of your calories from fat. Read our Starting Keto From Scratch blog to get a jump on this way of eating. This eating pattern allows your body to burn-off a significant portion of your stored glucose (glycogen) and eventually get to the point where it’s using fat for fuel – nutritional ketosis. As promised, this will help explain the goals and tips beyond the first phase of keto for migraine.


Phase 2
of The Ketogenic Diet for Migraine – Keto Adaption

In this phase, the practical things to focus on are fine-tuning what you buy at the grocery store, prepare at home and order at restaurants. You probably learned a great deal about carbs in Phase 1 so Phase 2 should be a little less time-consuming and easier. In order for the ketogenic diet to be a healthy and sustainable way of eating, it must be well-formulated and varied. Keep the idea of variety and healthier choices in mind but do not put too much pressure on yourself at this point. Your goal for Phase 2 of keto for migraine relief is to continue eating foods that keep you in ketosis while keeping satisfied and not longing for goodies. Establishing the metabolic shift to keto-adaption is the main focus of the second phase of keto for migraine.

What is keto-adaption?

Keto-adaption refers to the time in which your body has successfully made the switch to becoming an efficient fat-burning machine. It is beyond just being in consistent nutritional ketosis. For decades, most of the living cells in your body have been using carbs for fuel. In the process of the sustained ketogenic diet, they are adapting and making enough enzymes to properly digest and metabolize fat for energy. This means that when there is an increased need for energy, as in physical exertion, your body is able to access and burn fat rather than mobilizing stored carbs. So, improved exercise tolerance during ketosis is a sign of improving keto-adaption.

There are other signs, too. Some of them are decreased appetite and cravings for carbs. Many people report an overall sense of improved energy and better sleep. Many also report improved ability to think clearly. For those of us with migraine-associated brain fog, this is BIG. Since the GI tract has been tasked with handling a boost in fat and a decrease in carbohydrate, people often notice significant difference in their stools. Some people may have constipation and some may have diarrhea and some may have a little of both. Usually, people adapt to it over the course of a few weeks. Personally, I didn’t realize how much brain fog I had until it lifted while in ketosis.

When does the keto-adaption phase happen?

Sorry, but this is another question with the nebulous answer of “it depends, everyone is different.” Most experts think it takes at least a month. This blog written by Dr. Phinney, a pioneer and expert in the ketogenic diet gives more scientific info about markers for this phase and why it is so variable from person to person. In my personal experience, I had been doing keto for about 6 weeks before I felt noticeably better and more energetic than I had in years. After 6 months, I felt like I was hitting my stride and on keto cruise-control.

Keto for migraine is much more enjoyable in Phase 2!

It’s best to keep carbs low but some people can stay in consistent ketosis while eating 50-75 grams of carbs some days. There is a vast difference in food diversity and palatability when you double the upper limit of carbs.  At this point, having a blood ketone monitor is very helpful so you can measure your upper limit of carbs. And, since we are all doing this for migraine, this is the phase where the ketones strengthen our virtual force field and allow us to enjoy many foods that were previously triggers. Hello, avocado! Hello gruyere cheese!

The metabolic flexibility that develops is what makes this phase so much more enjoyable. I think of this phase as one in which our body seems to favor staying in ketosis and can adjust to slight increases in carbohydrate amounts. This is also the stage where you have learned so much about carb content of foods that you don’t feel the need to diligently track carb amounts. I encourage people to continue to track occasionally to just help them stay in solid ketosis and avoid “carb creep.”  This is the time to add some more variety to your diet.  Instead of only having green leafies veggies, asparagus and cruciferous veggies, have some onions and peppers.  Sprinkle some chopped pecans on your salad. Perhaps you want to try making a cauliflower crust or keto granola.

Phase 3 – The well-formulated ketogenic diet for migraine

You got things rolling in Phase 1 and keto-adapted in Phase 2.  The objective of Phase 3 is to continue to control your symptoms while adding a variety of yummy, wholesome foods to your plate.  This way of eating should allow you to maintain your health and ability to participate fully in your community. 

So, how is a well-formulated ketogenic diet for migraine described? 

  • It keeps you in ketosis. You can experiment with your upper-limit of carbs with more certainty if you have a blood ketone monitor. I strongly encourage only increasing carbs with foods considered allowable on the keto diet. Experimenting with grains and sugars of any type is STRONGLY discouraged as cravings will return. I promise!
  • Continue to focus on whole foods with minimal processing. If you have trouble finding or affording fresh foods, try frozen foods without added sugars and sauces. 
  • Eat enough food. You may not be hungry but you must eat enough calories and protein to maintain a healthy metabolism and lean body mass. This advice is especially important for people who do not wish to lose weight. Dr. Phinney recommends not going below 1000 calories per day even for those who wish to lose weight. 
  • Keep your diet varied so you get different nutrients and you keep things interesting. It can be easy to get stuck in repetitive eating patterns, so challenge yourself with finding new recipes. Try different grocery stores to see what is new. Experiment with different nut oils, infused oils, herbs and spices. Perhaps you can experiment with more recipes. Choose green leafies and veggies that are high fiber. Maybe your family misses your Bolognese sauce. Make pasta Bolognese for them while you have broccoli Bolognese.

Time for a check up?

If your head is feeling better but you have new symptoms that are not resolving quickly, seek help from a doctor. The information here is not medical advice. A doctor who is keto-friendly would be best, but many in the medical community are not knowledgeable about keto. This list of keto friendly doctors from www.dietdoctor.com can be a starting point for finding a doctor to help you navigate your new way of eating. New or worsening symptoms need professional, in-person attention.

Phase 3 is also the time to schedule an appointment with your doctor to get your blood work checked if you haven’t already done so. Experts say that blood lipids can fluctuate quite a bit in the first months of keto and tend to stabilize at the 6-month mark. I am NOT an expert in this is an area. You must do your own research including a consultation with your doctor.


What is after Phase 3?

Ketosis can and does help many people with migraine who commit to giving it a try. Some do very well with limiting carbs from sugars (including sugary fruits), grains and starchy veggies (i.e. potatoes) without being in nutritional ketosis. You may or may not need to stay in ketosis to get migraine attacks in better control. Personally, I was such a carb addict that I could not have curbed those cravings without the help of ketones. I failed miserably with previous attempts to cut out sugar. The ketones were also helpful in allowing me to eat many foods that were triggers.

I liked being in ketosis and enjoyed the reduction in migraine symptoms, especially the reduction in brain fog. You may find that you feel relief with ketosis as well as low-carb/high fat eating without the goal of staying in ketosis. Finding a way of eating that helps you get debilitating migraine under control may take a while and keto may be an excellent tool for you.

My degree is in clinical nutrition and I’m a registered dietitian. I changed my career to focus only on helping people with migraine find relief and became a certified health and wellness coach to help me help my clients beyond just my expertise in food and nutrition. My fascination with diet, nutrition and migraine began when I made my condition worse by eating “clean and healthy.” This was mainly due to both rebound/medication-overuse headache and a diet high is beautiful, nutritious, wholesome food triggers. Implementing a comprehensive migraine elimination diet helped me dramatically. Continuing my research into diet, I transitioned to the Ketogenic diet which further improved my brain fog. My work with the Ketogenic diet for migraine relief has led me to working with one of the pioneers in reversing diabetes and obesity with Keto, Dr. Eric Westman. I love helping people take control of their wellness and get their lives back. For relaxation and enjoyment, I like to go on adventures with my family, spend time in the garden and cook for friends and family.

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