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A paper published recently in Frontiers in Nutrition makes a case for why ketogenic diets with a specific emphasis on sodium supplementation may be an effective prophylactic for migraine.
Research is expanding in this area (as was covered in a past blog article) with an increasing number of case reports being published. It’s not certain why a ketogenic diet is effective for helping prevent migraine (or reducing frequency and severity), but this paper covers several possible mechanisms, mostly centered around stabilizing neuronal membrane potential and preventing rapid changes in sodium dynamics that appear to be a main trigger for migraine.
Hypo- and hyperglycemia cause alterations in electrolyte status – particularly sodium – in the sensory neuron extracellular space, which affects the capacity of these neurons to generate proper action potentials. By keeping total carbohydrate intake low, ketogenic diets typically prevent large fluctuations in blood glucose and insulin, which in turn may help to prevent rapid shifts in sodium balance. Additionally, the presence of ketones in the brain may have a stabilizing effect as well as providing an energy substrate.
The paper also presents an interesting hypothesis on why migraine is so common. It’s believed that the brain of a migraineur is anatomically different from that of a non-migraineur, including having more sensory neuronal connections, potentially leading to a “hypersensitivity” to stimuli such as odors, sights, and sounds. This may have provided an evolutionary survival advantage but has become a liability in the modern world, where we are surrounded by powerful sensory stimuli. The author also outlines an interesting hypothesis as to why women and children are at greater risk for migraine compared to men, stemming from this evolutionary perspective.
Regarding the importance of sodium, migraineurs may need significantly more of this mineral compared to people without migraines, as renal sodium wasting is a common feature of migraine, with migraineurs excreting up to 50 percent more sodium than non-migraineurs.
Considering the lackluster efficacy of most migraine drugs, it may be that the fundamental etiology of migraine has been misunderstood. Ketogenic diets and sodium supplementation have the potential to address the underlying root cause(s) to prevent migraine rather than targeting individual symptoms after one has already occurred.
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