Keto Diet for Migraine – How to Get Started

If you are reading this, then you are likely curious about whether or not the ketogenic diet can help you find migraine relief. As a registered dietitian schooled in the low-fat era, I thought “Eww, gross!” about low-carb and keto. I wish I had been more open-minded sooner. Keto is not at all what I thought it would be like. It helped reduce my attacks and improved my overall wellness while being delicious. There is scientific evidence to support the keto diet for migraine as well reports from neurologists and other practitioners.

You may be considering this significant change in the way you eat to help you find a new level of relief from migraine attacks. This article is focused on some basics. It is written with the assumption that you have done your own homework and have asked your doctor for input. I’m going to assume you have decided to dive in and commit to keto for a few months to see if it can help reduce attack frequency or lessen some symptoms. 

The focus will be on the ketogenic diet specific to migraine. For Phase 1 of the ketogenic diet, I recommend some migraine-specific tweaks discussed below.

**While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.

What is the ketogenic diet?

The ketogenic diet is a low carbohydrate diet that is high in fat and moderate in protein. The intended result of this way of eating is to generate nutritional ketosis. If you aren’t currently on a ketogenic diet, your metabolism is using glucose (blood sugar) as its primary fuel source. 

When you eat, your body digests your food and uses the carbohydrates from the meal for fuel. If there isn’t enough, your body takes the fuel it needs by using stored glycogen from your liver and muscles. When you haven’t eaten in a while the glycogen is converted for needed blood sugar. 

After prolonged periods without adequate food and/or extreme exercise, you may start using your body’s fat storage. When your body uses its fat, the fuel source is from ketones. Fat does not breakdown to blood sugar so your body switches fuel sources from blood sugar to ketones. 

What foods are on a well-formulated ketogenic diet?

The keto diet excludes all added sugars, grains and starchy vegetables.  Because of the natural sugars in fruit, small amounts of berries are the only suggested fruits. Although avocado is technically a fruit, it is allowed. 

Keto includes lots of fat and fatty foods. All meats, poultry and seafood are allowed as well as full-fat cheeses and cream. Low-carb veggies and leafy greens are allowed. Getting into consistent, sustained ketosis is what I consider as Phase 1 of keto. For most people this will take at least a few days and will depend on your own metabolism as well as how low your carbohydrate level has been.

The goal of maintaining the diet is to switch your metabolism so that you become a fat-burning machine instead of a carb-burning machine. Phase 2 of the ketogenic diet happens when your personal “hybrid engine” goes through a process referred to as “keto-adaption.” 

Based on the research and observation of Dr. Stephen Phinney, one of the most prominent doctors in the field of low-carb and therapeutic ketosis, this process can take several weeks but is usually complete by 8 weeks. 

During this second phase of the ketogenic diet, your brain and other organs and your biochemistry adapt to the different energy source. The body adjusts to have the appropriate amounts of enzymes for the different types of chemical interactions that keep us healthy and feeling good. For most people, the Phase 1 transition period is not notable but others may have some symptoms like lethargy and headaches.

While overblown and anxiety-provoking, “keto flu” happens in this early phase. It will be discussed later.

What is the keto and migraine connection?

These are some of theories as to why the ketogenic diet for migraine is effective for some people:

1- Elimination of migraine triggering foods

Some people are triggered by certain foods and food additives. Since the ketogenic meals may differ significantly from what a person typically eats each week, it’s possible the culprit isn’t being consumed. For example, the ketogenic diet eliminates grains and many fruits. If a person was unknowingly triggered by corn or wheat or apples, they may see a reduction in migraine attacks with keto.

2- The “magical” effect of ketones

Nobody truly knows why being in nutritional ketosis is helpful for so many. Perhaps ketones alter cell metabolism thereby bringing relief. It is thought that some people with migraine may have faulty or impaired mitochondrial function. If you recall from biology class, the mitochondria are critically important powerhouses of our cells. Certain preventive medications we take as well as some suggested nutritional supplements (i.e. riblofavin) effect these important organelles. Ketones have been shown to enhance mitochondrial function.

Additionally, the keto and migraine link may be due to neurotransmitter (chemical messenger) balance. Ketones may act protectively in the migraine brain by altering the brain chemistry in a favorable way.

Of course there is no real “magic,” but being unfazed by my usual migraine triggers while in ketosis felt truly miraculous. I could take joy in eating foods like raw onions and parmesan cheese again.

3- Carbs and migraines

Some of us have altered glucose metabolism. There is no denying that there is a relationship between simple carbs and migraines for a significant percentage of people.

Perhaps the keto diet for migraine works for some people as it addresses this flaw in their metabolism.

Dr. Alexander Mauskop, an authority on headache disorders, in his recent book, The End of Migraines- 150 Ways to Stop Your Pain, states:

Sugar is not always an obvious trigger. Many people develop migraine hours after a carbohydrate-rich food. Three-quarters of people with migraine have reactive hypoglycemia. This means that their blood sugar drops too low after a carbohydrate-rich meal.

In my blog about sugar and migraine, I expand on this interesting possibility.

4- Inflammation, keto and migraines

There is great controversy about what actually constitutes an anti-inflammatory diet. In general, the Mediterranean diet is often recommended to minimize inflammation. This is a very good diet recommendation for the general population. Because it’s a way of eating based on whole foods with limited sweets and highly processed foods, it would be expected that some people with migraine would improve.

However, for some people with frequent migraine attacks, the “magic” is in the ketones. Their metabolism, and possibly overall inflammation is improved with a well-formulated ketogenic diet.

Getting Started – Keto for migraine, Phase 1

This is the nitty gritty of what you need to know to get you through the earliest and trickiest phase of the keto diet for migraine. There are three steps to Phase 1.

1- Commit to keto for at least 3 months and print a list of allowed foods.    

Pay special attention to having enough quick, convenient foods. If you know you will be eating away from home, plan on having portable foods on hand. 

Keep things simple.  In this early phase, keep daily carbohydrate intake to 20-30 grams. I suggest keeping it simple and not trying to make some favorite carby foods into acceptable keto foods.  Save cauliflower crust pizza and keto desserts for another time. 

What about calculating macros?

One of the reasons trying the keto diet is intimidating is the math that is discussed in almost everything you read about keto. The way we eat should not be determined by numbers. There is no reason the calculate the percentage of calories you are getting from carbs, protein and fat. My suggestion is to just limit your carbs to 20-30 grams per day, have a moderate amount of foods high in protein. Choose fatty, satisfying foods but don’t feel like you have to add lots of extra fat to your foods unless that is what is helping you get over thoughts of eating carbs. I believe in the power of butter!

My favorite resource for practical information is DietDoctor.com. This beginner’s section is excellent. The visual guides are beautiful as well as helpful in understanding carb sources and making the best choices. This snack list will help you plan foods to always have at the ready.

Planning and setting up your environment is critically important in the beginning but will become second nature as you get into ketosis and think less and less about your next meal. Buy and prepare lots of simple favorites from the lists. 

This way of eating in Phase 1 is short-term

Plan on luxuriating in decadent, fatty foods.  This will keep you from obsessing about the carby foods that will not be on your plate. If you have a sweet tooth, you may want to make some simple “fat bombs” to keep on hand to help with cravings. 

Your current diet may be quite high in carbohydrate. I was addicted to sugar and carbs and I’m still shocked that I not only survived, but thrived.  Anticipating being without carbs was worse than the reality of what the diet was like.  The yummy, satisfying fat suppressed my appetite and surprisingly took most of my cravings away.

Embrace this change and know that the way you will be eating will change quite a bit.  DO NOT TRY TO HAVE A PERFECT, WELL-FORMULATED KETO DIET DURING PHASE 1. 

You will not be eating like this for long.  Your goal is setting up your first week or two to be as easy as possible and that might mean being repetitious and decadent. I ate an embarrassing amount of cream cheese but it was delicious! In Phase 2, more variety and balance is brought back into your day to day eating.

2- Get a bunch of cheap Ketostix

You can find them in the diabetes section of a pharmacy or online.  These urine dipsticks help determine if your body is making ketones. It is not a great way of measuring your degree of ketosis but will help you know when your body is shifting into ketosis. It can be quite motivating when you see your first positive signs of ketones!

Blood monitors are much better but that is an added, unnecessary expense. The results from ketostix merely provide some info that is likely helpful in the early stages of the diet. I admit to being obsessed with the ketostix and using them a few times a day.  I was very excited to see my efforts paying off and couldn’t wait to see my results. 

3- Keep hydrated and focus on your electrolytes

When starting the ketogenic diet, your body goes through many changes as it becomes a fat-burning machine. For many people, the keto foods they choose to eat are whole foods and much less processed than foods they used to eat. This often means that their sodium intake is lowered without them realizing it. 

In these early days, the lowered carb intake and burning-off of the body’s stored carbs signals the kidneys to make more urine. So, many people notice that they are needing to pee more as well as feeling the urge to drink more.

For overall health, as well as to avoid some of the common side effects of keto, it’s important to boost your fluid intake as well as your electrolytes (sodium, potassium and magnesium). DietDoctor.com recommends drinking 3 liters per day (~101 ounces) for the first week of keto.  As someone who struggles with drinking enough, that amount seems daunting but it’s just during the first week of keto. 

Paying attention to electrolytes is also very important for overall health and an easier transition to ketosis.  This link discusses amounts and sources of key electrolytes to make sure you are aware.  Personally, I do best when I drink homemade, salty broth along with salting my food well. Of course, I always take my usual magnesium supplements. 

What about keto headache?

Keto headache is usually from dehydration headache or shifts in electrolytes. Sometimes people feel lousy and have “keto flu.” Keto headache doesn’t last long.

As stated above, for some of us, there is a relationship between carbs and migraine. The headache may also be due to a “detox” effect combined with being a bit sad about not having some carby favorites. Treat yourself to a nice “fat bomb” to get yourself through. In Phase 2 you will be feeling better and will be making changes to your routine meals and snacks.

Keto for migraine – what’s different about it

Many of you have already noticed that quite a few keto mainstay foods like avocado, aged cheeses, nuts and bacon are considered common migraine triggers. I typically recommend going through a migraine-oriented elimination diet prior to trying keto to figure out your potential food triggers. 

If you have figured out your triggers, you should avoid them in Phase 1 of keto. Once you are in ketosis, the ketones seem to work their magic and provide a virtual force field and allow trigger foods to be safely eaten. Weird, right? 

I had a LOT of food triggers but was able to eat nearly all of them while in ketosis. It was fantastic. I felt more freedom at restaurants.  My experience with this force field phenomenon is not unique, fortunately. The keto diet may allow you to find relief as well as enjoy foods you have been avoiding due to migraine.

The downside of Phase 1

Combining Phase 1 of keto while eliminating common migraine triggers can be rather repetitive. But is certainly doable as it typically lasts for just a few days to a week.  You can find a pattern that will work for you.  However, you certainly do not have to do these tweaks especially if you are not convinced that the common triggers that I mentioned are YOUR triggers. You can simply jump into the unrestricted keto food list.

There is a lot more to the ketogenic diet than the above 3 steps, but the process outlined and the resources from DietDoctor.com will help you get on your way. 

Phases 2 and 3 of the the ketogenic diet for migraine will add much more variety and healthy, satisfying options for you.

What about the keto diet for vestibular migraines?

One of the most frustrating things about vestibular migraine (VM) is the lack of research. Even small studies can make a person with VM make important decisions that can shape quicken their improvement. The Migraine Strong Facebook and Instagram community is quite large but I have not seen many people discuss their adventures in keto. I am reluctant to recommend the keto diet for vestibular migraine without seeing research or more anecdotal reports. If you have VM and are considering it, don’t let me dissuade you. My personal and professional opinion is that the Heal Your Headache approach that is blessed by some prominent dizzy doctors may be a better first approach for managing VM. With that said, keto may be perfect for you.

If you have VM and have tried the keto diet, please leave us a comment or let us know in our social media channels.