Carlo Lovati1, Caterina Mariotti d'Alessandro2, Stefania Della Ventura3, Fulvio Muzio4, Leonardo Pantoni5. 1. Headache Center, Neurology Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20156, Milan, Italy. carlo.lovati@asst-fbf-sacco.it. 2. Headache Center, Neurology Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20156, Milan, Italy. 3. Endocrinology Unit, Humanitas Clinical and Research Institute - IRCCS, Rozzano, MI, Italy. 4. Clinical Nutrition and Dietetics Unit, L, Sacco University Hospital, Milan, Italy. 5. Luigi Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
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.
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.
Authors: Cherubino Di Lorenzo; Gianluca Coppola; Martina Bracaglia; Davide Di Lenola; Giulio Sirianni; Paolo Rossi; Giorgio Di Lorenzo; Vincenzo Parisi; Mariano Serrao; Mackenzie C Cervenka; Francesco Pierelli Journal: BMC Neurol Date: 2019-06-22 Impact factor: 2.474