Keto for Chronic Migraines FAQ

A living resource for patients and medical providers

Photo by Michelle @Shelly Captures It on Unsplash

I’ve been debating whether or not to share the specifics of how I used the keto diet to recover from chronic migraine disorder because I did keto under the supervision of a doctor and I very much recommend anyone interested in reproducing the below process do the same. With that said, I’ve decided to share everything I can think of about my recovery process—pitfalls and all—as a resource for anyone stuck in the hell of chronic migraine, or any medical providers interested in exploring this treatment option. Nothing in this post should be considered medical advice.

If you’re a regular subscriber who has no use for this information, feel free to skip this post. We’ll be back to our regular programming next month!

What do you mean by recovered? Can you eat anything you want and be pain-free?

This is the question I get asked the very most, and reasonably so. After all, why bother with any of this if the payoff isn’t worth it?

Today, I eat a maximum of 100-150g of net carbohydrates per day (I think—after getting an idea of my limit, I stopped counting on a daily basis). For those unfamiliar with the world of carb counting and net carbs, you can read more about that here, but the main thing you need to know is that the net carbs in a food is its total carb content minus its fiber content. Meat has zero net carbs (it’s all protein and fat), cheeses and dairy products have a little, veggies have some, fruits have more, and breads, grains, and sweets have the most. A cup of broccoli has 3.5 g, a burger bun, 25 g, and a can of Coke, 39 g. (From here forward, when I say “carbs,” I’m referring to net carbs unless if otherwise specified.)

Carbs are the only thing I limit, though I will say that (1) I don’t ever eat high fructose corn syrup and (2) the majority of my carbohydrates are not in the form of refined sugar. I do eat unrefined sugars such as honey and maple syrup. Oh also, two cups of coffee in the morning gives me a headache while one does not, so I limit my coffee intake, too.

A diet of 100-150g of carbohydrates per day that’s low in refined sugar is what I consider a flexible “healthy” diet. My usual breakfast is greek yogurt with muesli, fruit, and a bit of honey. Sometimes, eggs with sprouted grain toast. And coffee, of course! Lunch varies from a salad to Dave’s Hot Chicken (the best chicken place in the world) with coleslaw and some (not all) of an order of fries. A simple dinner at home is a meat, a veggie, and potatoes or chili with cornbread. I do eat dessert sometimes, but not every night, and never a second helping of it.

With this diet, I have a headache anywhere from 5-10 days per month, though generally closer to five, and none of them severe or long-lasting. Things that push me toward the upper end of the monthly range include weather/pressure changes, getting sick, or messing with my sleep schedule.

Is this pain-free? Technically, no. But compared to before, when I averaged 28 migraine days per month, it might as well be.

So you’re not still doing keto, right?

That’s correct! I did keto for three months only, as this was the length of time my doctor recommended. More on that below.

Why did he recommend keto? How does it help migraines?

The doctor who treated me (Dr. Bills at the Migraine and Neuro Rehab Center) recommended keto because when he gave me a continuous glucose monitor, the data showed that I was experiencing glucose dysregulation.

Glucose/sugar is your body’s primary source of energy, and your metabolic system is what turns the carbs you eat into that energy. Glucose dysregulation is like having diabetes and hypoglycemia at the same time—your blood sugar changes wildly and in unexpected ways. Dr. Bills just published a research study on this, which observed glucose dysegulation in all 247 chronic migraine participants.

Keto helps with glucose dysregulation by switching your body to use fat instead of carbs for energy. In doing so, the metabolic system is bypassed and, effectively, turned “off.” As the metabolic system continues to go unused, your body clears out a lot of its machinery (like receptors on your liver) and rebuilds it from the ground up. So when you start eating carbs again, the system is recalibrated and no longer prone to glucose dysregulation.

This helps migraines because the great orchestrator of metabolism is the brain. The hypothalamus, specifically. In a glucose dysregulation situation, the hypothalamus has trouble keeping up with the blood sugar swings and frequently overloads—an overload which can cascade to the rest of the brain and trigger a migraine. Repairing the body’s metabolism keeps the hypothalamus from getting so frequently into this overloaded state.

What did the keto diet look like, specifically?

For the first two weeks, my diet was minimum 60% fat and no more than 15 g of TOTAL carbs per day (not net). For the remaining 10 weeks, it was 60% fat and 15 g NET carbs per day. I was advised to avoid sugar alcohols (erythritol etc) during the three months as well, though I do eat sugar alcohols now.

You can read more about the keto diet here.

Please note that fifteen grams of carbs per day is WAY stricter than keto for weight loss, and it’s hard on the body. For me, I dealt with a severe “keto flu” and had a lot of trouble staying hydrated. This is one of the many reasons to not try this without continuous glucose monitoring data that indicates glucose dysregulation, or without the help of a doctor. Just sayin’.

How long did it take you to feel better?

Week three of keto was the best week I’d had in six years of having chronic migraines. For some, it takes a month or more.

It can’t have been that simple?

Actually, it was. The process wasn’t all roses—more on that below—but follow-up CGM readings have confirmed that my glucose dysregulation went away and hasn’t come back.

How did you STOP keto?

Dr. Bills advised adding 10-20 g of carbs back into my diet every 1-2 weeks. That’s what I did for the first two months post-keto, both of which were more difficult than the months I was on keto. I was wearing a CGM at the time and noticed a few issues:

1. Post-keto insulin sensitivity, wherein my blood sugar would drop too quickly after eating and give me a migraine. This improved with time, but I had to stick it out and keep eating carbs in order for my body to adjust. Eating carbs with a lower glycemic index seemed to help.

2. Generally low blood sugar which resulted in lack of energy and, sometimes, migraines. After troubleshooting with a few different healthcare providers, I stopped one of my medications and started to introduce carbs more quickly. That helped a lot! In hindsight, I wish I would have kept using ketosis test strips to understand when exactly by body switched back into using carbs for energy, and increasing my carb count accordingly.

Another issue was gut problems, which came about from eating carbs after not eating them for so long. I added a fiber supplement to help with this.

It wasn’t until four or five months after stopping keto that I had fully reintroduced carbs (up to 100-150 g per day). Though at that point, I was still getting more migraines than I get right now. It took a couple months more for my doctor to figure out that coffee was the lingering culprit, and a few weeks for me to slowly decrease my caffeine intake to one cup per day.

All in all, it was about nine months from the day I started keto to the day I felt consistently, predictably good.

Also note that using a CGM for this part is not “required” and in some ways, not helpful. Metabolism can be altered by any number of factors including anxiety about your metabolism! So as my body was adjusting and being a little unpredictable, I tried my best to use the CGM data only in hindsight, never in real time.

Wow, that’s a long time. Was it worth it?

Are you kidding me?! Even as I struggled to reintroduce carbs, it was a night-and-day difference from how I felt before. Case in point: In the middle of that time, my husband and I traveled to Europe, and migraines didn’t slow me down for even a single day of the three-week trip. And now, my worst days are better than even my best days before, to the point that it’s a silly comparison.

I got my life back, full stop.

More info...

• Here’s another link to Dr. Bills’s study.

• My friend Rachel Weaver (who had chronic vestibular migraine) was a participant in study. She wrote about her recovery experience on Reddit and in her recent memoir, Dizzy.

• Here’s an article I wrote about the research and the link between migraine and metabolism.

• Some things I found helpful in doing the keto diet were the MyFitnessPal app, the Keto Life cookbook, and ProMix electrolytes.

• This version of the keto diet mirrors similar diets used for treating epilepsy. So if you want to learn more, try googling “keto for epilepsy” or similar.

Ask me (almost) anything!

I hope I can address your questions in the comments below. I’ll keep track of them and update this post from time to time to incorporate whatever new information comes up.

However, this entire post and the discussion of it is intended to stick closely to the protocol described above. Not because this protocol is the only way out of chronic migraine, but because it’s being actively researched and it’s something I can share about in depth. So, if you have done the exact keto protocol for chronic migraines that I’ve described above—I know there are a few of you who started keto with Dr. Bills after hearing about it from me—please feel free to share anything from your experience that you think would help others! I’ll likewise compile your thoughts into updates on this post.

This post is not paywalled and never will be. Please share with anyone who may benefit.

Love,
Natalie