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Clinical Trial
. 2022 Nov;43(11):6479-6485.
doi: 10.1007/s10072-022-06311-5. Epub 2022 Aug 11.

Ketogenic diet in refractory migraine: possible efficacy and role of ketone bodies-a pilot experience

Carlo Lovati  1 , Caterina Mariotti d'Alessandro  2 , Stefania Della Ventura  3 , Fulvio Muzio  4 , Leonardo Pantoni  5
Affiliations
Clinical Trial

Ketogenic diet in refractory migraine: possible efficacy and role of ketone bodies-a pilot experience

Carlo Lovati et al. Neurol Sci. 2022 Nov.

Abstract

Introduction: Refractory migraine is a particularly disabling form of chronic migraine, unresponsive to multiple prophylactic strategies. Ketogenic diet (KD) is useful to treat migraine but poorly tested for refractory migraine.

Objective: We started exploring the efficacy and safety of KD, as compared to a non-ketogenic dietary regimen similar in reduction of carbohydrate intake (low-carb diet, LCD), in refractory migraine. Secondary objective was to explore whether ketones have a role in the prophylaxis induced by KD on migraine.

Results: In a first trial, 22 patients with refractory migraine were included and completed the study. Thirteen (mean age 36.8 ± 12.9 years, 11 females, 2 males) were assigned to the KD arm and eight (mean age 50.9 ± 10.8 years; all females), not eligible for KD, to LCD. Patients treated with KD showed a significant reduction in the frequency of migraine attacks, intensity of headache, and amount of drug intake. No significant benefit was seen in the LCD group. A relationship between ketone production and effect on headache was observed among patients with a good response to KD. In a second study, additional 31 refractory migraineurs were treated with these two dietary regimens, 26 with the same KD scheme and 5 with a LCD. Results were comparable with those of the first study.

Conclusions: KD might be a useful option in refractory migraine. Ketones seem to have a role in migraine modulation and their regular measurement might be useful to monitor KD in migraineurs. Larger, randomized, and controlled trials are needed to confirm these data.

Keywords: Diet; Ketone; Migraine; Prophylaxis; Refractory migraine; Treatment.

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