Diet transiently improves migraine in two twin sisters: possible role of ketogenesis?

Abstract

The ketogenic diet is a high-fat, low-carbohydrate diet long used to treat refractory epilepsy; ketogenesis (ketone body formation) is a physiological phenomenon also observed in patients following lowcarbohydrate, low-calorie diets prescribed for rapid weight loss. We report the case of a pair of twin sisters, whose high-frequency migraine improved during a ketogenic diet they followed in order to lose weight. The observed time-lock between ketogenesis and migraine improvement provides some insight into how ketones act to improve migraine.

Figures

Figure 1

Diary chart. The columns show the months, the rows the days. Patients recorded their degree of migraine disability daily on a 3-point scale: 1 = mild; 2 = moderate; 3 = severe. In the “Weight” row, the patient’s weight, in kg, on the last day of the month is reported. The last row in each chart gives, month by month, the monthly migraine frequency (number of attacks), number of days with migraine in the month, and a monthly mean migraine disability index (sum of day-to-day disability divided the number of days with migraine in the month). Neither patient experienced migraine attacks during the ketogenic diet, except for a non-migraine headache during menses and influenza in Patient 1 (*). The number of attacks, days with migraine, and the disability index all diminished during and after the ketogenic diet.