Fasting and Headache.

Patrick T Ebbert, Lauren R Natbony
Author Information
  1. Patrick T Ebbert: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  2. Lauren R Natbony: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Lauren.Natbony@mountsinai.org.

Abstract

PURPOSE OF REVIEW: This review synthesizes the latest updates in the literature on the connection between fasting and migraine, examining both clinical outcomes and underlying pathophysiological mechanisms.
RECENT FINDINGS: Although no studies have specifically explored fasting as a therapeutic intervention for migraine, various retrospective analyses suggest that fasting might worsen migraine symptoms in the short term. On the other hand, recent investigations, including several randomized controlled trials, have shown that ketogenic diets significantly reduce the number of migraine days and decrease inflammation markers. Additional research has shown improvements in disability assessments, as indicated by VAS, MIDAS, and HIT-6 scores. These benefits are not replicated by merely administering ketone bodies. Furthermore, genetic studies have found a link between glycemic processing and the occurrence of migraine. There is accumulating evidence that ketogenesis can reduce both the frequency and disability associated with migraine, likely through the reduction of systemic inflammatory markers and diminished cortical excitability. However, the potential benefits of intermittent fasting on migraine prevention remain underexplored and warrant further investigation.

Keywords

References

An Experience with a Ketogenic Dietary in Migraine. Ann Intern Med. 1928;2(4):341–7. https://doi.org/10.7326/0003-4819-2-4-341 [DOI: 10.7326/0003-4819-2-4-341]
Gray Pa, Burtness Hi, Hypoglycemic Headache*. Endocrinology. 1935;19(5):549–60. https://doi.org/10.1210/endo-19-5-549 [DOI: 10.1210/endo-19-5-549]
Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The role of Diet and Nutrition in Migraine triggers and treatment: a systematic literature review. Headache. 2020;60(7):1300–16. https://doi.org/10.1111/head.13836 [DOI: 10.1111/head.13836]
Fischer-Schulte LH, Peng KP. Migraine prodromes and migraine triggers. Handb Clin Neurol. 2023;198:135–48. https://doi.org/10.1016/B978-0-12-823356-6.00014-7 [DOI: 10.1016/B978-0-12-823356-6.00014-7]
Gazerani P. Diet and migraine: what is proven? Curr Opin Neurol. 2023;36(6):615–21. https://doi.org/10.1097/WCO.0000000000001204 [DOI: 10.1097/WCO.0000000000001204]
de Cabo R, Mattson MP. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med. 2019;381(26):2541–51. https://doi.org/10.1056/NEJMra1905136 [DOI: 10.1056/NEJMra1905136]
Macri E, Azhar Y. Prevention of neurologic disease with fasting. Semin Neurol. 2022;42(5):549–57. https://doi.org/10.1055/a-1957-8449 [DOI: 10.1055/a-1957-8449]
Fung J, Moore J. The complete guide to fasting: heal your body through intermittent, alternate-day, and extended fasting. Las Vegas: Victory Belt Publishing; 2016.
Liu D, Huang Y, Huang C, Yang S, Wei X, Zhang P, et al. Calorie restriction with or without time-restricted eating in weight loss. N Engl J Med. 2022;386(16):1495–504. https://doi.org/10.1056/NEJMoa2114833 [DOI: 10.1056/NEJMoa2114833]
Lin S, Cienfuegos S, Ezpeleta M, Gabel K, Pavlou V, Mulas A, et al. Time-restricted eating without calorie counting for weight loss in a racially diverse Population: a Randomized Controlled Trial. Ann Intern Med. 2023;176(7):885–95. https://doi.org/10.7326/M23-0052 [DOI: 10.7326/M23-0052]
Höhn S, Dozières-Puyravel B, Auvin S. History of dietary treatment: Guelpa & Marie first report of intermittent fasting for epilepsy in 1911. Epilepsy Behav. 2019;94:277–80. https://doi.org/10.1016/j.yebeh.2019.03.018 [DOI: 10.1016/j.yebeh.2019.03.018]
Liu H, Yang Y, Wang Y, Tang H, Zhang F, Zhang Y, et al. Ketogenic diet for treatment of intractable epilepsy in adults: a meta-analysis of observational studies. Epilepsia Open. 2018;3(1):9–17. https://doi.org/10.1002/epi4.12098 [DOI: 10.1002/epi4.12098]
Lin X, Wang S, Gao Y. The effects of intermittent fasting for patients with multiple sclerosis (MS): a systematic review. Front Nutr. 2023;10:1328426. https://doi.org/10.3389/fnut.2023.1328426 [DOI: 10.3389/fnut.2023.1328426]
Al-Kuraishy HM, Jabir MS, Albuhadily AK, Al-Gareeb AI, Jawad SF, Swelum AA, et al. Role of ketogenic diet in neurodegenerative diseases focusing on Alzheimer diseases: the guardian angle. Ageing Res Rev. 2024;95:102233. https://doi.org/10.1016/j.arr.2024.102233 [DOI: 10.1016/j.arr.2024.102233]
Barborka CJ. Migraine: Results of Treatment by ketogenic diet in fifty cases. JAMA. 1930;95:1825–8.
Maggioni F, Margoni M, Zanchin G. Ketogenic diet in migraine treatment: a brief but ancient history. Cephalalgia. 2011;31(10):1150–1. https://doi.org/10.1177/0333102411412089 [DOI: 10.1177/0333102411412089]
Strahlman RS. Can ketosis help migraine sufferers? A case report. Headache. 2006;46(1):182. https://doi.org/10.1111/j.1526-4610.2006.00321_5.x [DOI: 10.1111/j.1526-4610.2006.00321_5.x]
Di Lorenzo C, Coppola G, Sirianni G, Di Lorenzo G, Bracaglia M, Di Lenola D, et al. Migraine improvement during short lasting ketogenesis: a proof-of-concept study. Eur J Neurol. 2015;22(1):170–7. https://doi.org/10.1111/ene.12550 [DOI: 10.1111/ene.12550]
Di Lorenzo C, Coppola G, Bracaglia M, Di Lenola D, Evangelista M, Sirianni G, et al. Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study. J Headache Pain. 2016;17:58. https://doi.org/10.1186/s10194-016-0650-9 [DOI: 10.1186/s10194-016-0650-9]
Di Lorenzo C, Pinto A, Ienca R, Coppola G, Sirianni G, Di Lorenzo G, et al. A Randomized Double-Blind, crossover trial of very low-calorie Diet in overweight migraine patients: a possible role for ketones? Nutrients. 2019;11(8). https://doi.org/10.3390/nu11081742
Haslam RL, Bezzina A, Herbert J, Spratt N, Rollo ME, Collins CE. Can ketogenic Diet Therapy improve migraine frequency, severity and duration? Healthcare. (Basel). 2021;9(9). https://doi.org/10.3390/healthcare9091105
Caprio M, Moriconi E, Camajani E, Feraco A, Marzolla V, Vitiello L, et al. Very-low-calorie ketogenic diet vs hypocaloric balanced diet in the prevention of high-frequency episodic migraine: the EMIKETO randomized, controlled trial. J Transl Med. 2023;21(1):692. https://doi.org/10.1186/s12967-023-04561-1 [DOI: 10.1186/s12967-023-04561-1]
Kossoff EH, Huffman J, Turner Z, Gladstein J. Use of the modified Atkins diet for adolescents with chronic daily headache. Cephalalgia. 2010;30(8):1014–6. https://doi.org/10.1111/j.1468-2982.2009.02016.x [DOI: 10.1111/j.1468-2982.2009.02016.x]
Finsterer J, Frank M. Low-glycemic-index Diet relieving migraine but inducing muscle cramps. J Neurosci Rural Pract. 2019;10(3):552–4. https://doi.org/10.1055/s-0039-1698034 [DOI: 10.1055/s-0039-1698034]
Evcili G, Utku U, Ogun MN, Ozdemir G. Early and long period follow-up results of low glycemic index diet for migraine prophylaxis. Agri. 2018;30(1):8–11. https://doi.org/10.5505/agri.2017.62443 [DOI: 10.5505/agri.2017.62443]
Lelleck VV, Schulz F, Witt O, Kuhn G, Klein D, Gendolla A, et al. A Digital Therapeutic allowing a Personalized Low-Glycemic Nutrition for the Prophylaxis of Migraine: Real World Data from two prospective studies. Nutrients. 2022;14(14). https://doi.org/10.3390/nu14142927
Putananickal N, Gross EC, Orsini AL, Schmidt S, Hafner P, Gocheva V, et al. Efficacy and safety of exogenous beta-hydroxybutyrate for preventive treatment in episodic migraine: a single-centred, randomised, placebo-controlled, double-blind crossover trial. Cephalalgia. 2022;42(4–5):302–11. https://doi.org/10.1177/03331024211043792 [DOI: 10.1177/03331024211043792]
Tereshko Y, Dal Bello S, Di Lorenzo C, Pez S, Pittino A, Sartor R, et al. 2:1 ketogenic diet and low-glycemic-index diet for the treatment of chronic and episodic migraine: a single-center real-life retrospective study. J Headache Pain. 2023;24(1):95. https://doi.org/10.1186/s10194-023-01635-9 [DOI: 10.1186/s10194-023-01635-9]
Tereshko Y, Dal Bello S, Di Lorenzo C, Pittino A, Filippi F, Belgrado E The Effect of Three Different Ketogenic Diet Protocols on Migraine and Fatigue in Chronic and High-Frequency Episodic Migraine: A Pilot Study. Nutrients. 2023;15(20). https://doi.org/10.3390/nu15204334 .
Neri LCL, Ferraris C, Catalano G, Guglielmetti M, Pasca L, Pezzotti E et al. Ketosis and migraine: a systematic review of the literature and meta-analysis. Front Nutr. 2023;10:1204700. https://doi.org/10.3389/fnut.2023.1204700
Yadav RK, Kalita J, Misra UK. A study of triggers of migraine in India. Pain Med. 2010;11(1):44–7. https://doi.org/10.1111/j.1526-4637.2009.00725.x [DOI: 10.1111/j.1526-4637.2009.00725.x]
Arca KN, Halker Singh RB. Dehydration and headache. Curr Pain Headache Rep. 2021;25(8):56. https://doi.org/10.1007/s11916-021-00966-z [DOI: 10.1007/s11916-021-00966-z]
Molarius A, Tegelberg A, Ohrvik J. Socio-economic factors, lifestyle, and headache disorders - a population-based study in Sweden. Headache. 2008;48(10):1426–37. https://doi.org/10.1111/j.1526-4610.2008.01178.x [DOI: 10.1111/j.1526-4610.2008.01178.x]
Andress-Rothrock D, King W, Rothrock J. An analysis of migraine triggers in a clinic-based population. Headache. 2010;50(8):1366–70. https://doi.org/10.1111/j.1526-4610.2010.01753.x [DOI: 10.1111/j.1526-4610.2010.01753.x]
Hauge AW, Kirchmann M, Olesen J. Trigger factors in migraine with aura. Cephalalgia. 2010;30(3):346–53. https://doi.org/10.1111/j.1468-2982.2009.01930.x [DOI: 10.1111/j.1468-2982.2009.01930.x]
Abu-Salameh I, Plakht Y, Ifergane G. Migraine exacerbation during Ramadan fasting. J Headache Pain., 2010;11(6):513-7. https://doi.org/10.1007/s10194-010-0242-z .
Al-Hashel JY, Abokalawa F, Toma R, Algubari A, Ahmed SF. Worsening of migraine headache with fasting Ramadan. Clin Neurol Neurosurg. 2021;209:106899. https://doi.org/10.1016/j.clineuro.2021.106899
Ragab AH, Kishk NA, Hassan A, Yacoub O, El Ghoneimy L, Elmazny A et al. Changes in migraine characteristics over 30 days of Ramadan fasting: a prospective study. Headache. 2021;61(10):1493–8. https://doi.org/10.1111/head.14231
Hussein M, Abdelghaffar M, Ali M, Yassein AM, Khalil DM, Magdy R. Impact of Ramadan fasting on vision and headache-related quality of life in women with idiopathic intracranial hypertension: a prospective observational study. Headache. 2024;64(4):352–60. https://doi.org/10.1111/head.14707 [DOI: 10.1111/head.14707]
de Almeida Rabello Oliveira M, da Rocha Ataide T, de Oliveira SL, de Melo Lucena AL, de Lira CE, Soares AA, et al. Effects of short-term and long-term treatment with medium- and long-chain triglycerides ketogenic diet on cortical spreading depression in young rats. Neurosci Lett. 2008;434(1):66–70. https://doi.org/10.1016/j.neulet.2008.01.032 [DOI: 10.1016/j.neulet.2008.01.032]
Hartman AL, Gasior M, Vining EP, Rogawski MA. The neuropharmacology of the ketogenic diet. Pediatr Neurol. 2007;36(5):281–92. https://doi.org/10.1016/j.pediatrneurol.2007.02.008 [DOI: 10.1016/j.pediatrneurol.2007.02.008]
Ma W, Berg J, Yellen G. Ketogenic diet metabolites reduce firing in central neurons by opening K(ATP) channels. J Neurosci. 2007;27(14):3618–25. https://doi.org/10.1523/JNEUROSCI.0132-07.2007 [DOI: 10.1523/JNEUROSCI.0132-07.2007]
Di Lorenzo C, Ballerini G, Barbanti P, Bernardini A, D’Arrigo G, Egeo G, et al. Applications of ketogenic diets in patients with headache: clinical recommendations. Nutrients. 2021;13(7):2307. [PMID: 34371817]
Gross EC, Klement RJ, Schoenen J, D’Agostino DP, Fischer D. Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention. Nutrients. 2019;11(4). https://doi.org/10.3390/nu11040811
Rivera-Mancilla E, Al-Hassany L, Villalon CM, MaassenVanDenBrink A. Metabolic aspects of Migraine: Association with obesity and diabetes Mellitus. Front Neurol. 2021;12:686398. https://doi.org/10.3389/fneur.2021.686398 [DOI: 10.3389/fneur.2021.686398]
Zelissen PM, Koppeschaar HP, Lips CJ, Hackeng WH. Calcitonin gene-related peptide in human obesity. Peptides. 1991;12(4):861–3. https://doi.org/10.1016/0196-9781(91)90147-h [DOI: 10.1016/0196-9781(91)90147-h]
Islam MR, International Headache Genetics C, Nyholt DR. Cross-trait analyses identify shared genetics between migraine, headache, and glycemic traits, and a causal relationship with fasting proinsulin. Hum Genet. 2023;142(8):1149–72. https://doi.org/10.1007/s00439-023-02532-6 [DOI: 10.1007/s00439-023-02532-6]
Li J, Ye X, Zhou Y, Peng S, Zheng P, Zhang X, et al. Energy metabolic disorder of astrocytes may be an inducer of Migraine Attack. Brain Sci. 2022;12(7). https://doi.org/10.3390/brainsci12070844
Yeh PK, An YC, Hung KS, Yang FC. Influences of genetic and environmental factors on chronic migraine: a narrative review. Curr Pain Headache Rep. 2024;28(4):169–80. https://doi.org/10.1007/s11916-024-01228-4 [DOI: 10.1007/s11916-024-01228-4]
Alstadhaug KB. Migraine and the hypothalamus. Cephalalgia. 2009;29(8):809–17. https://doi.org/10.1111/j.1468-2982.2008.01814.x [DOI: 10.1111/j.1468-2982.2008.01814.x]

MeSH Term

Humans
Fasting
Migraine Disorders
Diet, Ketogenic
Headache

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