Can a Controversial Diet Help Treat a Hidden Cause of Migraines?

In the spring of 2025, Natalie Mead made a last-chance attempt to treat her debilitating migraines, which had ended her career as a software engineer. She had spent the last six years cycling in and out of the hospital, trying one new medicine after another and cutting out various foods to identify potential triggers, yet was still averaging 28 migraine days a month. “I was spending most of my days in bed, wearing sunglasses or hats inside,” Mead says.

Mead finally decided to switch to a much more severe—and often controversial—diet: the ketogenic, or keto, diet, which drastically cuts out carbohydrates to encourage the body to shift away from using glucose as its primary source of fuel.

She had reached this point after coming across research suggesting that, for some people with chronic migraines, their condition is driven by metabolic dysfunction, or a breakdown in the body’s ability to turn food into energy. A keto diet had helped some of them find relief.

Although Mead didn’t have any known metabolic conditions, such as diabetes or prediabetes, she strapped on a continuous glucose monitor for 10 days to see if it might reveal any abnormalities.

(Why Do Women Get More Migraines Than Men?)

What Mead saw was eye-opening. Every time she ate, her blood sugar soared to diabetic levels, only to crash in an hour or two, to levels that are often considered to be a medical emergency.

This is a condition called reactive hypoglycemia, which isn’t detected by standard tests such as fasting glucose levels and hemoglobin A1C. These rapid changes in blood sugar levels had created a situation where Mead’s brain had to constantly adjust between extreme highs and lows, both of which result in pronounced symptoms.

The idea that there is a potential link between metabolism and migraine is an old one, dating back over a hundred years. Low blood sugar is a known migraine trigger, while there is also a known link between migraines and insulin resistance, which is when the body doesn’t respond efficiently to the release of insulin, resulting in elevated blood sugar levels and diabetes.

Yet in recent years, there has been an increased focus on the idea that for some people, their migraines are driven by specific differences in metabolism, such as rapid changes in blood sugar levels. In a study published earlier this year, for instance, researchers looked at 247 people with chronic migraine, which is defined as having 15 or more headache days a month. They found that people with chronic migraines had a higher level of glucose variability, meaning their blood sugars levels changed more often, and in greater numbers, compared to people without migraine.  

There is also an increasing recognition that there are differences between the body’s metabolism and the brain’s. Studies have shown metabolic abnormalities in the brain during migraine attacks, including an increased demand for glucose. 

The brain is especially vulnerable to fluctuations in blood sugar levels because it has a much more limited source of energy.

(Scientists Find New Clues to the Mysterious Rise of Migraines.)

“The brain is really metabolically demanding, relative to any other organ,” says Aaron Struck, a neurologist at Washington University in St. Louis, Missouri. “Most of the body can use fat, it can use protein, and it can use glucose [for energy], but the brain is kind of unique, in that it really only uses glucose.”

Managing your diet has always been a part of migraine treatment, whether it’s cutting out trigger foods, making sure not to skip meals, or drinking a Coke if your blood sugar is too low. The keto diet, however, has been seen as a last resort for people with migraines.

When you deprive the body of glucose, the body instead shifts to breaking down fat into something called ketones that it can use as fuel instead.

“When you develop ketones, you develop this extra source of energy for the brain,” Struck says, explaining that this can stabilize the brain’s energy supply. A keto diet also improves how well a person’s body responds to insulin, which can help stabilize blood sugar levels.

(Why Experts Worry About the Risks of a Keto Diet.)

But clinicians are very hesitant to suggest a ketogenic diet, given how hard the diet is on your body in the first few weeks —“You are intentionally tanking your blood sugar,” Mead says—and the potential risks. People on keto diets tend to see elevated blood cholesterol levels, which could have implications for heart health.

The results are also hit-or-miss. Scientists have always had a hard time predicting who would benefit, and who wouldn’t. “Migraine is not a unified disease,” says Hsiang-kuo Yuan, a neurologist at Thomas Jefferson Headache Center, in Philadelphia, Pennsylvania. For this reason, experts strongly recommend trying other medications first—the options for which have expanded in recent years—and that people with chronic migraine only attempt a keto diet while under the supervision of a medical professional.

But that uncertainty could change. Scientists are currently attempting to identify who among migraine sufferers would be best served by the keto diet. In the study published earlier this year, the researchers also found that people with chronic migraines could be divided into three separate clusters based on their metabolic profile. Now in follow-up work, those researchers are investigating which clusters respond well to this diet.

“We can personalize care for them in a way that helps,” says Kyle Bills, a researcher at Noorda College of Osteopathic Medicine, in Provo, Utah, and one of the authors of the study.   

For the patients who tend to do well on a keto diet, he has found that their insulin and blood sugar responses tend to straddle the line between pre-diabetes and hypoglycemia, or low blood sugar—like Mead. “In a fasting state, they’re pressing up towards what you traditionally think of as pre-diabetes,” Bills says, meaning that their blood sugar levels are somewhat high. “After they eat, or in this case, after they ingest the glucose, they’re the opposite of a pre-diabetic. They’re hypoglycemic.”

Mead spent her first three weeks on a keto diet existing in a misery that didn’t seem too different from life with chronic migraines. Then one day Mead woke up early, got out of bed, and went through her usual morning routine.

After going outside, she realized something.

The pain was gone.

“I remember taking my hat and sunglasses off, and just being like, ‘This is fine. I don’t feel I need them,’” Mead says. “After six years of wearing them everywhere, I was just in tears.”

Hours went by, where Mead kept expecting the pain to come back. She spent the afternoon sitting in the sun, enjoying the reprieve, and wondering when it would end.

“Every migraineur develops that deep fear of, ‘Oh, this is temporary,’” Mead says. And indeed, after three months, when she started transitioning out of the diet, some of the headaches started creeping back. Fortunately, this time, medicine was enough to make the migraine disappear, rather than just reducing its intensity.

Bills says that, in his experience, patients with chronic migraine can usually transition off of a keto diet after three months and still retain many of the benefits, which he suspects is probably due to having more a stable blood sugar response. That said, this doesn’t work for all patients.

This is why he and other experts are really focused on finding a more effective, comprehensive answer for their patients, that doesn’t rely on a restrictive diet.

“We’re moving away from the blame culture in migraine,” where we would blame patients for giving themselves a migraine, because they ate chocolate or skipped a meal, says Alexandra Sinclair, a neurologist at the University of Birmingham in the United Kingdom. “What we want to do is actually treat the underlying migraine pathways rather than making people feel guilty about their condition.” 

More than a year after transitioning back to a normal diet, Mead is still largely migraine-free. She still gets a few headache days a month, but unlike before, these respond well to medication.

After years of being advised against starting a family due to the severity of her migraines, Mead got pregnant earlier this year. Her due date is in December.  

“That, to me, was the most unexpected ending to this story,” Mead says.