title: Migraine improvement during short lasting ketogenesis: a proof-of-concept study.
abstract: OBJECTIVE
  Ketogenesis is a physiological phenomenon due to starvation or a ketogenic diet (KD), a drastic restricted carbohydrate dietary regimen that induces lipid metabolism and ketone body synthesis. Two patients whose migraines disappeared only during, and not outside, cycles of very-low-calorie KD performed to reduce their weight were recently observed. To confirm our observation, in a dietitian clinical setting two parallel groups of migraineurs, one receiving a 1-month very-low-calorie KD prescription followed by a 5-month standard low-calorie diet (SD) and the other a 6-month SD, were followed.
  
  
  METHODS
  Ninety-six overweight female migraineurs were enrolled in a diet clinic and blindly received a KD (n = 45) or an SD (n = 51) prescription. Mean monthly attack frequency, number of days with headaches and tablet intake were assessed before and 1, 2, 3 and 6 months after diet initiation.
  
  
  RESULTS
  In the KD group, the baseline attack frequency (2.9 attacks per month), number of days with headaches (5.11 days per month) and tablet intake (4.91 doses per month) were significantly reduced after the first month of diet (respectively 0.71, 0.91, 0.51; overall, KD versus baseline, P < 0.0001). During the transition period (first versus second month), the KD group showed a transient worsening of each clinical headache variable (respectively 2.60, 3.60, 3.07), despite being improved compared with baseline, with continuous improvement up to month 6 (respectively 2.16, 2.78, 3.71). In the SD group, significant decreases in the number of days with headaches and tablet intake were observed only from month 3 (P < 0.0001), and in attack frequency at month 6 (P < 0.0001).
  
  
  CONCLUSIONS
  The underlying mechanisms of KD efficacy could be related to its ability to enhance mitochondrial energy metabolism and counteract neural inflammation.
authors.affiliation: Don Carlo Gnocchi Onlus Foundation, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: G
authors.initials: G
authors.lastname: Coppola
authors.forename: G
authors.initials: G
authors.lastname: Sirianni
authors.forename: G
authors.initials: G
authors.lastname: Di Lorenzo
authors.forename: M
authors.initials: M
authors.lastname: Bracaglia
authors.forename: D
authors.initials: D
authors.lastname: Di Lenola
authors.forename: A
authors.initials: A
authors.lastname: Siracusano
authors.forename: P
authors.initials: P
authors.lastname: Rossi
authors.forename: F
authors.initials: F
authors.lastname: Pierelli
mesh_terms: D000328:Adult; D055423:Diet, Ketogenic / Q000379:methods*; D005260:Female; D006801:Humans; D007657:Ketone Bodies / Q000096:biosynthesis*; D008875:Middle Aged; D008881:Migraine Disorders / Q000178:diet therapy* / Q000503:physiopathology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007657:Ketone Bodies
keywords: ketogenesis; ketogenic diet; ketone bodies; migraine; very-low-calorie diet