Category Archives: Migraines / Headaches

A Cure for Migraines?:

Posted by on March 29, 2011 104 comments

The weekend was happy for us, because a number of readers left word of health improvements.

Raynaud’s Syndrome, Constipation, and Other Problems Relieved

Becky reported that her Raynaud’s was better:

Hat tip and thank you: After I started reading your blog, and adding in “safe starches”, my Reynaud’s largely cleared up with temperatures over 20F. This wasn’t the intention, but a wonderful side-effect. Last month, when the sun came out and the temps got over 25, I enjoyed a successful 2-mile snow hike for the first time in three years. =)

Kate reported the same:

I too have had Raynaud’s all my life … In the past two months, I have modified my diet in line with Paul’s suggestions for Migraine. I now eat 200 calories worth of safe starch, all the recommended supplements, and as much coconut oil as I can stomach. I am also doing the 16/8 fast. My Raynaud’s has further improved, as measured by the fact I sometimes forget to turn the heat up in the morning, and cold extremities don’t always alert me to my forgetfulness!

Bill, who last October reported a variety of health complaints which persisted after he adopted a Primal Diet in May 2009, has experienced a big improvement:

I definitely feel 100% better with a more appropriate caloric intake and some starch.

Betty reported her constipation was gone:

You have blessed my life. I had one final symptom that was chronic all my life. Constipation. I e-mailed you last week and you offered up some suggestions. PRAISE THE LORD! I have had NO IBS, or constipation since following your advice. I am, and will be forever grateful.

I’ll discuss my constipation advice in Thursday’s post. Today I want to discuss migraines.

Migraines

You may recall that reader Rob Sacks cured his migraines through ketogenic dieting. I asked Kate if her migraines had responded. Here was her reply:

Thanks for asking about the Migraines. They are in fact vastly improved, which I attribute solely to your recommendations. I can say that, because I have tried virtually everything else in the past.

Kate sent me a full account of her experiences by email. It is fascinating and she has given me permission to share it. The next section was written entirely by Kate.

Kate’s Story

Thanks for asking about the migraines.  They are in fact vastly improved!  Since they have been so intractable in the past, I guess I was waiting to make sure the effect was stable before I reported my results. But clearly something remarkable is happening, thanks to your recommendations!

A little history.  I started getting these headaches in my late 30s.  (I am now 52).  In the beginning I thought I had the stomach flu, because in addition to the headache I would always throw up or have dry heaves.  The worst headaches would keep me immobilized in bed for up to two days.  My brother-in-law, a neurologist, convinced me they were migraines. I finally consulted a doctor, who put me on midrin, which did not help, and a few months later I started on imitrex, which did help, at least at first.  Eventually, my headache pattern evolved, and I had at least a mild headache every day, punctuated by the occasional doozy.  Apparently, this is a pretty common progression, especially with women my age.  I always suspected there was something wrong with my lifestyle or diet, and over the years I have tried numerous experiments, but nothing ever worked.  Here is a summary of what I have tried, more or less in order. Unless noted, these were all for three months.

What I tried The inspiration The results
Chelated Magnesium and riboflavin Mauskop’s book What Your Doctor May Not Tell Your about Migraines nada
Expensive German butterbur preparation Magnum website (www.migraine.org) nada
Forever Well Gut Brain Therapy (a mix of probiotics, peptides, and a state of the art supplement to support the organs of elimination) Magnum website I think I slept a little better.  No help with headaches.  Was surprised that the president of the company called me to see if the supplements were helping
Amitriptyline, a tricyclic anti depressant—my first foray into pharmaceutical prophylactics My doctor insisted I consult a neurologist Tried for 4 months. Slept like a zombie, and acted like one.  No help with headaches.
45 minutes of low intensity aerobics 6 days a week Inspired by Crowley and Lodge’s Younger Next Year—Never mind I had been exercising regularly all my life. Got a heart rate monitor and got after it.  No help for headaches.
No caffeine, alcohol, triptans, or over the counter analgesics Buchholz  Heal Your Headache. I love my coffee, so this was a big step for me. Did this for four months.  Very sleepy for first few days.  Did NOT help with headaches.  However, I felt I could rule out medicine overuse headaches.
Cerapamil—A calcium channel blocker My primary care manager thought it would be worth a try. Tried for four months, and upped dose after a few weeks.  Extreme constipation and painful cramps.  No help with headaches.
Low carb diet Found a reference to a german website of someone who had cured his headaches with a low carb diet.  I had always though low carb diets were ridiculous, but decided to give it a try Immediate improvement within a few days!  Also cured insomnia and acid stomach within a week. Headaches were less severe by about 50%.  Frequency was unchanged however.  Remained on low carb diet and manipulated the variables, but did not find further headache improvement.
Vitex Always felt there was a hormonal connection nada
Natural progesterone cream Same Didn’t help my headaches, but did weird things to my period
Nortriptyline–another tricyclic antidepressant My brother-in-law, a neurologist thought I should try it. Did seem to help a little.  Had to stop in less than a month because it gave me high blood pressure.
Birth Control-Yaz PCM sent me to gynecologist for heavy menstrual bleeding.  Benign fibroids found.  Doc was sure Yaz (without placebo pills) would help heavy bleeding and headaches.  I didn’t care about the bleeding, but I rose to the headache relief bait. Tried for five months. Spotted every day, but got no headache relief.
Inderal-a beta blocker Neurologist Seemed to help, but my blood pressure went too low.
Fish oil, vitamin D, coenzyme Q10, and various other supplements Grasping at straws Tried these at various times. No noticeable effects
Acupuncture same No noticeable effects, but I didn’t really believe
Self analysis, meditation Sarno The Mind Body Prescription I think there is something to this, but no headache relief for me.  Do feel more at peace with myself.
Topamax-epilepsy drug Neurologist Low dose did not help.  Worked up to 100mg over four months. Did not help headaches.  Gave me extreme anxiety about driving on limited access roads.  I didn’t notice the connection, but my college age daughter did.  I immediately tapered off.

Got off the Topamax last summer, and forswore further pharmaceutical prophylactics at that point.  In the meantime I stumbled upon the profusion of “primal” material that is now out.  I had not read any low carb stuff for a couple years, and I enjoyed reading Sisson, Wolf, Cordain, et al.  I started eating more saturated fat. I also read Fallon’s Nourishing Traditions, and started eating liver again, which I had loved as a child.  Her book inspired me to order some kelp tablets for iodine, and I took one here and there when I thought of it.  In January, in my blog travels, I stumbled on your site.  I ordered the book and was intrigued by your and Shou-Ching’s ideas about disease and chronic conditions.  I was already familiar with the idea of a ketogenic diet for epilepsy, so I was immediately interested in trying a more ketogenic diet for myself.

I ordered all your basic supplements, and immediately upped my kelp to two capsules.  I had been using coconut oil for curries, so I started using it habitually.  Started eating 200 calories of starches that you recommended—this was a little scary, after studiously avoiding them for four years!  I was afraid I they might keep me awake at night, but I am sleeping like a log. Started fasting 16/8, which was easy once you absolved me for having cream in my morning coffee!

Within a week of starting this regimen my chronic headache started to disappear! Some days I would only have a headache for part of the day, and occasionally I would have no headache at all!  I read somewhere on your site that NAC is good on a ketogenic diet, so I ordered it too.  I had never heard of this supplement before.  It seems to have made a further positive difference.  I have started taking it twice a day.  Once before bed, and once in the late afternoon, when the headache sometimes starts coming back.  Since I added NAC, I have been nearly headache free.

Another amazing development concerns anxiety.  Over the years I have become somewhat anxious when I drive on highways. I grip the steering wheel tightly, sit forward in the seat, and am generally hyper vigilant. I always chided myself for my lack of nerves, but that didn’t help.  As mentioned above, this was magnified by the Topomax.  I never had this issue when I was younger; indeed I used to fly helicopters in the army.  Two weeks ago I drove up to New Jersey to pick up my daughter, a 3.5 hour trip from where I live in Northern Virginia.  I stopped two hours into the trip to make a pit stop, and I suddenly realized I was totally relaxed, and had been for the entire trip!  The PHD is strong brain medicine indeed!

Thanks for all your research, insights, and ideas.  I think the Perfect Health Diet is going to be a game changer for many people.  Hopefully it is the start of a sea change at how we approach the chronic maladies of our times.

Mechanisms

Thank you, Kate! That’s a fantastic chronicle of your history.

This is already a long blog post, so I won’t go into an analysis of why and how the ketogenic variant of the Perfect Health Diet can cure migraines, reduce anxiety, and improve sleep. I’ll only add a few things.

First, there is a case report in the literature of a ketogenic diet helping migraines. [1]

Second, the diet helps in part by getting around mitochondrial dysfunction. Some other nutritional supplements that support mitochondrial function have a chance to help:

  • carnitine [2]
  • riboflavin [3,5]
  • CoQ10 [4,5]
  • alpha lipoic acid [4]
  • magnesium [4, 5]

I realize that you’ve already tried those, Kate, and didn’t notice an effect, but you may notice a benefit now that your diet is better. If in the past they reduced headache severity from 100% to 99%, you wouldn’t have noticed a change. If now they reduce severity from 2% to 1%, or 1% to 0%, the improvement might be obvious. So you might re-consider them now.

Finally, in the interests of full disclosure I should note that some doctors expect improvements from diet and nutrition to be short-lived: “high-dose vitamin and cofactor treatment and, where applicable, high-fat diet, are well tolerated and possibly effective in the short term, but ineffective in the longer term” against mitochondrial disorders. [6]

I believe that fading benefits are likely a result of eating the wrong diet, and that on the ketogenic version of the Perfect Health Diet the good effects will prove permanent. But time will tell.

Conclusion

We believe that diseases are generally caused by food toxins, malnutrition, and pathogens. The Four Steps of the Perfect Health Diet eliminate food toxins, optimize nutrition, and enhance immunity; therefore they remove most of the causes of disease and should render most diseases curable.

But we had no idea, last October when our book was released, which cures would appear first.

It’s interesting that migraines are appearing so early as a curable disease. I think this says a lot about the discipline, and eagerness for a cure, of Rob and Kate. Rob was willing to fast for 30 days (!); Kate read the book in January and was able immediately to make substantial diet, lifestyle, and supplement changes.

It seems that a painful but non-debilitating disease will create the most dedicated, venturesome patients.

I’m very grateful to Kate for trying the diet and sharing her story. Hopefully we can bring the good news to others, and gather more evidence to prove that diet is the best therapy – for migraines, and for many other diseases as well.

References

[1] Strahlman RS. Can ketosis help migraine sufferers? A case report. Headache. 2006 Jan;46(1):182. http://pmid.us/16412174.

[2] Kabbouche MA et al. Carnitine palmityltransferase II (CPT2) deficiency and migraine headache: two case reports. Headache. 2003 May;43(5):490-5. http://pmid.us/12752755.

[3] Triggs WJ et al. Neuropsychiatric manifestations of defect in mitochondrial beta oxidation response to riboflavin. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):209-11. http://pmid.us/1564483.

[4] Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. http://pmid.us/19454881.

[5] Taylor FR. Nutraceuticals and headache: the biological basis. Headache. 2011 Mar;51(3):484-501. http://pmid.us/21352223.

[6] Panetta J et al. Effect of high-dose vitamins, coenzyme Q and high-fat diet in paediatric patients with mitochondrial diseases. J Inherit Metab Dis. 2004;27(4):487-98. http://pmid.us/15303006.

Fasting and the Ketogenic Diet for Migraines

Posted by on December 21, 2010 82 comments

We’ve previously argued that people with migraines should try a ketogenic diet. There are two reasons: (1) ketones can evade certain mitochondrial defects which might cause migraines, and (2) ketones reduce glutamate levels, and glutamate toxicity is implicated in migraines.

Reader Rob Sacks has had lifelong migraine headaches. As an experiment he turned to desperate measures – a long fast. Here’s his story:

I fasted for 30 days.   When I say “fast” I mean that I stopped eating all food.   I consumed only water and occasionally sea salt and potassium tablets.

As part of the fast I stopped taking Imitrex which I had been using almost daily to control my migraines.   I did this because I thought Imitrex was increasing the number of migraines due to a rebound effect.   I also stopped consuming caffeine to which I was addicted.

As the fast went on, my migraines lasted for shorter periods of time, and they became less painful. 

By day 23 I became free of headaches.  There was still some sort of migraine activity — I could often feel the sensations that in all my previous life, had always been followed by a headache — but no headache resulted.   Judging from what I could feel, there is a cascade of events that leads to a migraine, and the metabolic changes induced by the fast were interrupting the cascade at a certain point.

I was quite happy with this result and continued the fast as long as I could in the hopes that this would increase the chances that the change would be permanent.

Unfortunately, after the fast ended, the headaches gradually came back. I think this happened because after the first few post-fast meals, I made no effort to keep my diet ketogenic. An intense craving for fruit developed and once the danger of refeeding syndrome seemed to be over, I gave in. This was interesting because before the fast I had been on low carb diets since 2007 and hadn’t craved carbs in years.

When I saw the gains slipping away, I fasted again for two days to get back into ketosis as quickly as possible. Then I started following a diet similar to those used by neurologists at Johns Hopkins to treat children with epilepsy, with calorie restriction, frequent meals, and a ratio of fat to protein (by weight) of four to one. After two days of this diet, my headaches stopped again. That was only 48 hours ago but I’m sure the diet is working because I challenged myself last night with a sure-fire migraine trigger by staying up past my bedtime to watch the eclipse. Normally this would create a debilitating headache, but the only result was a slight migrainy feeling that was easily controlled with two aspirin. Before the fast, aspirin had no apparent effect on my migraines.

The next step will be to try more moderate diets and find the least extreme one that controls the headaches.

The fast proved that migraine headaches can be stopped by the metabolic changes induced by fasting.  Hopefully I can find a way to make that same metabolic state occur permanently.

Incidentally, the fast had some unexpected beneficial effects.  A bad varicose vein is dramatically improved, and a teary eye problem (which I think was caused by a clogged tear duct, and which I previously controlled with large amounts of vitamin C) has resolved almost completely.

I think this kind of experimentation is extremely important. Through experiments like Rob’s we can learn more about the causes of these seemingly incurable health conditions and find dietary and nutritional methods for healing or mitigating them. Experiments in lab mice are important, but the mice don’t tell us what they’re experiencing!

Rob lost 22 pounds during his 30-day fast, equivalent to 2200 calories per day if taken equally from protein and fat. Such an extended loss of lean tissue can be quite dangerous. If he had taken coconut oil or medium chain triglycerides during his fast, he would have conserved lean tissue mass and might have actually increasing ketone availability.

Fortunately it looks like ketogenic dieting is the key to Rob’s migraine relief, so extreme fasting should not be necessary.

Fasting does have therapeutic actions apart from its elevation of ketones. For instance, it promotes autophagy. It is possible that the fasting, not the ketones, was responsible for Rob’s cure of his varicose vein and teary eyes.

Rob might wish to experiment with protein restriction and other techniques for autophagy promotion, in order to see if they might also be beneficial in addition to ketosis.

Also, experimenting with micronutrients is important. Magnesium and riboflavin are often helpful for migraines.

Good luck Rob! Keep us posted.

Migraine Sufferers Should Try a Ketogenic Diet

Posted by on September 2, 2010 113 comments

Anyone with an impairment of brain or neurological function – whether mental illness, depression, seizures, brain cancer, headaches, neuropathy, brain infections, or any other neurological condition – should try a ketogenic diet to see if it improves the condition.

 “Ketogenic” means that the diet causes the liver to manufacture ketones. Ketones are small water-soluble compounds that are metabolized like fats. Unlike fats, they do not need carnitine transport to reach mitochondria. They can be used for energy by every mitochondria-containing human cell type. This makes them one of the most disease-resistant sources of dietary energy. There are few things that can go wrong with ketone metabolism.

Ketogenic diets have several major benefits for neurological conditions:

  • They relieve neuronal starvation from cognitive hypoglycemia of any cause.
  • They stimulate the innate immune response against intracellular pathogens, helping to heal brain infections.

Recent work has identified a third benefit from ketogenic diets: They eliminate an excess of glutamate. In a carbon isotope study, feeding the ketone beta-hydroxybutyrate in place of glucose caused less glutamate to be formed in the brain:

The amount of (13)C incorporation and cellular content was lower for glutamate and higher for aspartate in the presence of [2,4-(13)C]beta-hydroxybutyrate as opposed to [1,6-(13)C]glucose. [1]

This is important because excessive brain glutamate is “excitotoxic” and kills neurons. Glutamate excitotoxicity causes damage in a host of conditions including

spinal cord injury, stroke, traumatic brain injury and neurodegenerative diseases of the central nervous system (CNS) such as multiple sclerosis, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), Parkinson’s disease, alcoholism or alcohol withdrawal and Huntington’s disease. [2]

Other diseases in which damage from glutamate excitotoxicity is important include epilepsy, schizophrenia and various mood and anxiety disorders.

Migraines and Glutamate

My sister’s husband gets frequent migraines, so I keep an eye out for papers about migraines. A new paper in Nature Genetics finds that people with common migraine tend to have a mutation in a regulatory sequence for genes that control glutamate abundance. [3]

People with the mutation are prone to glutamate excitotoxicity:

[A] DNA variation found between the PGCP and MTDH/AEG-1 genes on chromosome 8 appears to be associated with increased susceptibility to common migraine. The variant appears to alter the activity of MTDH/AEG-1 in cells, which regulates the activity of the EAAT2 gene: the EAAT2 protein is responsible for clearing glutamate from brain synapses in the brain….

“Although we knew that the EAAT2 gene has a crucial role to play in neurological processes in human and potentially in the development of migraine, until now, no genetic link has been identified to suggest that glutamate accumulation in the brain could play a role in common migraine,” says co-senior author of the study Professor Christian Kubisch of University of Ulm, Germany (previously at the University of Cologne where he conducted his research for this study.) “This research opens the door for new studies to look in depth at the biology of the disease and how this alteration in particular may exert its effect.” [4]

If glutamate excitotoxicity causes migraines, then it’s likely that migraine sufferers would benefit from a ketogenic diet.

How Do You Eat a Ketogenic Diet?

The safest and healthiest way to eat a ketogenic diet is by:

  • Restricting carbohydrate consumption to 200 calories per day from “safe starches” like rice, taro, and sweet potatoes.  70 grams of cooked white rice, 150 grams of taro, and 300 grams of sweet potato are an appropriate daily ration.
  • Eating massive amounts of coconut oil. The short-chain fats in coconut oil are the most “ketogenic” of foods, i.e. the most readily turned into ketone bodies. 6 to 8 fluid ounces (12 to 14 tablespoons) per day of coconut oil is an appropriate daily ration.

Supplements with vitamin C and selenium should also be increased on a ketogenic diet.

Conclusion

Research on ketogenic diets as a therapy has focused on epilepsy for decades, with some recent interest in using these diets as a therapy for brain cancer. But really, they are likely to be helpful against nearly all brain and neurological conditions, and probably all solid tumor cancers and many infectious diseases as well.

Rather than waiting for the glacial progress of modern biomedical research, which needs decades to assemble sufficient evidence to get an application for funding for a clinical trial past skeptical reviewers, anyone with a brain or neurological condition should simply experiment with a ketogenic diet themselves to see if it helps. Odds are it will.

References

[1] Lund TM et al. Availability of neurotransmitter glutamate is diminished when beta-hydroxybutyrate replaces glucose in cultured neurons. J Neurochem. 2009 Jul;110(1):80-91. http://pmid.us/19457063.

[2] Wikipedia, “Excitotoxicity,” http://en.wikipedia.org/wiki/Excitotoxicity.

[3] International Headache Genetics Consortium et al. Genome-wide association study of migraine implicates a common susceptibility variant on 8q22.1. Nat Genet. 2010 Aug 29. [Epub ahead of print] http://pmid.us/20802479.

[4] “First Genetic Link to Common Migraine Exposed,” Physorg.com, Aug. 29, 2010, http://www.physorg.com/news202139760.html.