Migraine Sufferers Should Try a Ketogenic Diet

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.


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.


[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.

Leave a comment ?


  1. Hello, I was just wondering what increased VitC and Selenium was recommended?

    • Hi woly – Vitamin C, 1 g per day. Selenium, 200 mcg per day. Our selenium recommendation is not actually higher, but there is greater damage from a deficiency, so it becomes more important not to fall short of this intake level.

  2. Paul, some may also benefit from supplementing with magnesium early on as leg cramps are common enough with this diet (which is VLC). They should also be aware that there’s an adaption period where they may feel “uncomfortable.” For example, I developed foggy brain (lasted over 8 weeks, which I think is fairly lengthy compared to others–I think 1-2 weeks is much closer to the mean). I feel great now.

    Or maybe these symptoms don’t happen with so much coconut oil, which I only use in cooking. Speaking of coconut oil, your suggestion accounts for between 1406 and 1641 daily calories coming from coconut oil alone. Every single day. Is that correct?

  3. Hi poisonguy,

    Yes, supplements are very important on a ketogenic diet. Nutritional deficiencies are the main problem experienced by epileptic children on prescribed ketogenic diets.

    Potassium deficiency is common as plant foods are largely given up and this may be behind the leg cramps.

    Magnesium supplementation is very important and this should be part of the supplement regimen for everyone, whether on or off the ketogenic diet.

    Some of the “foggy brain” may be toxicity effects from the die-off of pathogens. If so, the duration of foggy brain may be an indicator of disease severity.

    I wouldn’t be so precise as that, but yes, around 1500 calories coconut oil is desirable for maximal ketone generation, whether that is desired because of a long fast or for neuroprotection. Fortunately coconut oil has strong effects that inhibit fat gain, so the extra calories aren’t likely to cause weight gain.

  4. You may also find Kaisu Viikari’s work interesting. According to her, a spasm in ciliary muscle is also a major cause of migraine. And that could be relieved by adding some plus lenses to the front of the eyes.

  5. You say

    “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.”

    Since carbs have 4cal/gm, the numbers don’t seem to add up. Could you clarify?

    • Hi Dan,

      I’m glad you asked, this is a very important point.

      Glucose has 4 calories per gram. Starch, which is a chain of glucose molecules, has 4 calories per gram. But plant foods are not pure glucose or pure starch. They have large amounts of indigestible matter and fiber.

      In the book, we have a table with calorie counts per pound of various foods. Rice has about 1300 calories per pound, as it is starch-rich; potatoes have only 300 calories per pound, as they are largely indigestible matter. Pure glucose is 1800 calories per pound.

      Best, Paul

  6. Perfect Health Diet » Fasting and the Ketogenic Diet for Migraines - pingback on December 21, 2010 at 3:28 pm
  7. Paul,

    Do you think a dietary treatment for epilepsy should be similar to your migraine dito?

    “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.”

    Also, from this, and your protein + carb rule, I guess that protein should be around 400 calories?

    Best, Patrik.

  8. Hi patrik,

    Yes, that’s right, I would recommend that epileptics start the same way: 200 starch calories, no fructose, 400 protein calories, lots of MCTs. That is the safest, healthiest form of ketogenic diet.

    Similar diets (modified Atkins diets, etc.) seem to suppress seizures entirely in about half of epileptics and substantially in most of the other half. This is less seizure suppression than diets which create more extreme ketosis, but the more extreme diets can have serious side effects.

    Best, Paul

  9. Hi Paul,

    How about using a small amount of this: http://edwardandsons.com/ldo_shop_coconut.itml while doing a ketogenic fast? When I do a 16 hr. fast, I sometimes need a little something more than coconut milk in my coffee, especially since I get up very early and it is typically 5 hours before I eat breakfast. I also do about 90 minutes of exercise before breakfast. There is a tiny amount of protein in it (2 grams per Tbsp.), but mixing it with about a Tbsp. of coconut oil is pretty tasty and filling.

    I included the link above so you and others could see the nutrition breakdown, but this product is available on Amazon and it is a fairly good deal, especially on subscription.

  10. Hi Cathryn,

    Yes, coconut is excellent during a ketogenic fast, fiber rich and the fats are ketogenic.

  11. Paul, someone asked about your daily ration of carbs on paleohacks. Despite your answer to Dan, I’m not sure how “70 grams of cooked white rice” winds up being 50 g of carbs. When cooked, white rice has a lot of water in it, so to get 50g of carbs you typically need to eat more like 150g (depending on the type of rice).

    Could you have meant 70g of dry rice, cooked?

  12. Hi Beth,

    Yes, thanks for leaving that correction here.

    I wrote that having mistakenly used dry rice when it should have been cooked rice, which absorbs a lot of water and has far fewer calories per gram. It’s 70 g of dry rice, not cooked rice, that produces 50 g / 200 calories glucose; the equivalent in cooked rice would be more like 150 to 200 g.

  13. Hi Paul,

    I have a relative who suffers from migraines and I suggested she try the ketogenic diet you describe here. She’s having problems consuming that much coconut oil though. She starts feeling sick in the stomach before even getting close to the 12-14 tablespoons you recommend. Are there ways of taking in that much of the oil without this side effect? Are there other sources of the ketogenic fats she could try? Thanks.

  14. Hi Audrey,

    I’ve been reducing my recommendation for how much coconut oil to take on a therapeutic ketogenic diet. Most of the people trying ketogenic diets have reported they do well on substantially smaller amounts of coconut oil.

    Taking MCT oil instead of coconut oil also reduces the amount needed, and most people tolerate that better. So I would suggest she try 4-6 tbsp per day MCT oil, and see how that goes. Use coconut oil just for cooking.

  15. Hi Paul,

    Ok, I’ll have her try it that way. What are some guidelines as far as how long to stay on a therapeutic ketogenic diet? Also, I’m curious, how much coconut oil would it take to have the equivalent of 4-6 tbspn of MCT oil? Thanks.

  16. Hi Andrey,

    4-6 tbsp MCT oil is probably equivalent to 6-9 tbsp coconut oil. Even that amount is probably more than is necessary. If she notices an effect she can experiment with how much works for her.

  17. Hi Paul,

    Almost done reading the book, but still having trouble figuring out where to start with my diet. Would this type of keto diet be appropriate for dealing with dysbiosis/leaky gut/acne?

  18. Hi Brian,

    Maybe but it’s far from certain. I would start with the normal diet for a while and then experiment with ketogenic fasts. Be sure to eat bone broth, organ meats, and vitamin C for skin health and gut barrier integrity.

    If you the dysbiosis / leaky gut is severe, then I would ask your doctor to do a Metametrix GI Effects stool test to see what pathogens you may have. If it is mild I would give diet a chance first.

    Let me know how things go.

    Best, Paul

  19. I truly appreciate the feedback. It’s amazing (and inspiring) that you take the time to respond to so many individual comments. I have been practicing the diet for a couple weeks now, slowly phasing things in (supplements, intermittent fasts, etc). I will definitely post my experience once I have given the diet some more time.

    I have been working with a GI doctor, so far we have eliminated a lot of possible causes to my symptoms. A stool analysis was definitely next on my agenda. I was going to request the Genova Comprehensive Digestive Stool Analysis 2.0. I have never heard of the Metametrix test. Would you consider the Merametrix to be superior and more thorough?

    Thanks Again!

  20. Hi Brian,

    The Genova stool analysis provides a lot of information about digestive tract function that is absent from the Metametrix test. The Metametrix test only looks at pathogens.

    The advantage of the Metametrix test would be that it uses PCR to look for pathogen DNA, whereas the Genova test uses ELISA (aka EIA) to look for pathogen proteins. PCR is more sensitive and precise. It looks like Metametrix looks for more pathogens as well.

    So if money is no object, it would be valuable to have both; much of the information they provide is disjoint.

    If only one is to be had, then it would be a question of what you think is causing your problems. If it’s an infection, I would go with Metametrix. If it might be some dysfunction of human tissue, eg cancer, autoimmune disease, digestive issues due to pancreatic or bile dysfunction, etc., then the Genova test would be more helpful.

  21. Hello, I’m sorry to post on an old topic, but how would one get enough Omega-3 oils on a ketogenic diet with such servings of coconut oil (isn’t it advised to have a 4:1 ratio for Omega-6 to Omega-3 oils maximum)?


  22. Hi Caleb,

    Coconut oil has very little of either omega-6 or omega-3, so it doesn’t affect the ratio much. That’s good, you want low polyunsaturated fat levels.

  23. Thanks for the info, Paul. Newbie betraying his ignorance here 😉

  24. I was wondering if you could recommend a daily diet for a person with TBI as i am from Ireland and have had a brain injury since 2006 the irish health system is ignorant to TBI unfortunatly infact i can say with confidence that i have a better knowledge of TBI than many doctors ive dealt with.

  25. Hi Eddie,

    Try a well nourishing but mildly ketogenic diet (200 calories from starches, 400 calories protein, lots of coconut oil or MCT oil, lots of vegetables, micronutrient supplements, shellfish and seafood). Include B12 and B6 supplements, magnesium and selenium and a bit of iodine, vitamins D and K2 also. And do intermittent fasting. Story today on this: http://www.guardian.co.uk/society/2012/feb/18/fasting-protect-brain-diseases-scientists

  26. Thanks very much for the info very intresting reading, also do you have any views on the Paelo diet vs the ketogenic diet in my case?

  27. Hi Eddie,

    There are many variants of Paleo. Ours is a Paleo diet, and the ketogenic variant of our diet is Paleo. Paleo is good, yes, your diet should be Paleo, but that designation is not specific enough. See our book, Step Two, for what “Paleo” means and why it is good.

  28. Cheers for the help Paul

  29. Hello Paul,
    My Wife suffers from migraines,the nausea is worse than the pain. We have eaten paleo w/dairy for almost 2 years. Recently started your recommended supplements, enjoy your blog posts and book very much,thank you. Have been IFing for most of those 2 years as well, if she were to try a ketogenic approach how soon would you expect to see improvements? She has been bad lately & neurologist just prescribed new drugs, very scary sides
    to me anyway, she has not taken yet.
    Thank You for your time.

  30. Hi Mike,

    If a ketogenic approach were going to work I would expect it to work quickly – within a few weeks. If she’s IFing and fairly low carb, then just adding some coconut oil may be enough.

    Magnesium is also extremely important, I would do at least 400 mg/day and test higher doses.

    Other things people with migraines have reported benefiting from include aspirin and stress reducers (yoga, meditation, relaxing music).

    An intriguing idea for symptomatic relief during a migraine is hot baths but with an ice pack / cold pack around the neck and head. The idea is that the hot bath is relaxing and expands blood vessels elsewhere, diverting blood from the head, but you want to constrict the blood vessels in the head with cold since vasodilation in the head contributes to migraines.

    I agree with trying every natural method possible before trying drugs with dangerous side effects.

    Best, Paul

  31. Paul,
    Thanks a Million for your comments, they are greatly appreciated. I should have noted Tracey was diagnosed Hypothyroid last year, its been a rough couple years for her, I didn’t like the idea of Levothyroxine either but 75mcg has her TSH at 1.15 & compared to the migraine meds this stuff seems not so bad.

    If you have time to comment, have you seen a link between the two?
    This was my main reason for the PHD supplements as well as the recent addition of some ‘ Safe Starches “.

    Thanks Again,

  32. Hi Mike,

    Hypothyroidism can cause headaches. See, eg, http://www.ncbi.nlm.nih.gov/pubmed/18625107.

    Best, Paul

  33. I always was concerned in this topic and stock still am, thanks for posting .

  34. Thanks, Nigel. It’s great to see that tested. Leucine and MCTs are alternative ways of inducing ketosis and it’s never been tested what proportion is best.

  35. I have particularly severe, chronic, complicated, and often silent migraines. I have had these since childhood all day everyday. Because they were often silent (no pain) they would manifest in various other ways, thus leading to misdiagnoses of mood disorders and schizophrenia for many years. At one point I was also misdiagnosed with epilepsy as well. After one particularly smart neurologist saw and tested me, I was placed on blood pressure medications for migraines. This worked.

    The problem is that my body constantly fights to readjust to the medications. After a few months at one dose, it seems I start to get migraines again. So it would go up and the same thing would repeat again. I was looking for a different solution and I stumbled across this article.

    I’ve been on the keto diet for nearly a month and it is the best thing that has happened to me. I’m migraine free and medication free. My mood is incredibly stable, I fall asleep quickly and stay asleep all night, I have lots of energy, I can concentrate for hours on end, etc. I’ve lost weight also, a much loved side effect. Thank you for writing this!

  36. Congratulations Karin! Thanks for sharing your story!

    Best, Paul

  37. Unfortunately my Wife is still suffering,
    not just the migraines but her overall health is
    not good,has not tried keto diet. Recently had cat scan, told she has fatty liver????? Of course according to webmd.com there is no treatment.
    I hesitate to suggest full blown Keto as she feels quite restricted in her diet already, any link NAFL & Migraines??

    Thank You

  38. Sunfood Nutrition has an unprocessed cocoa powder that can be added to anything. All the good benefits without sugar or alkali processing. They’re a good source for raw, exotic foods, berries, etc.

  39. Just my opinion, but I think Scribner’s doesn’t know what Paul and Shou-Ching do about titles. ‘Perfect Health Diet’ is short, succinct and powerful. The new, longer title is just going to tend to help this outstanding book blend into the mass of other stuff out there.
    Sure, people want to lose weight, but what overweight person can argue with the concept of perfect health? How could a perfectly healthy person be overweight?

  40. The word ‘lose’ as in ‘lose weight’ is a negative quality for many people. It’ll keep lots of people who like to eat from buying the book.
    I’d change the cover picture too. The fancy cocktail glass is going to drive off some big macho chowhounds who need this information.

  41. Sorry for the multiple posts, but just one more comment if I may on the new book. I think any subtitle is a mistake. Anyone who won’t investigate a book called Perfect Health Diet without an expanded explanation on the cover isn’t a potential reader anyway.
    No other nutrition book can compete with your 3 word title, and that will make people try to see what it’s about. When they do, it’ll be more interesting to them than any subtitle.

  42. Thank You Again for the response Paul!
    It is just so strange to me that we finally
    decide to improve our health and Tracey has
    had so many issues,when we ate crap all the time she felt fine, sadly she is a great example
    of the shortcomings of modern medicine. I am so frustrated that no one cares to find out ” why “.

    Again Thanks for your comments

  43. For anyone still suffering with this issue, we may be close to having some answers. My wife had an endoscopy today, esophagus & stomach are inflamed
    We don’t know why yet possibly H.Pylori???? With or without that I am wondering if Gastritis itself could contribute to migraine & hypothyroid symtoms? Really looking forward to Lab results.

    • Hi Mike,

      Yes, GI issues are often associated with migraines. Food sensitivities and endotoxemia may both contribute.

      Let’s hope the labs get to the bottom of it all!

  44. Hello Paul,
    Thanks very much for your comment, in spite of the issues Tracey has been suffering with I am certain your book and blog have improved both our short and long term health. Your work is really appreciated!

  45. Hi, I appreciate your sharing so much helpful information. I wonder if you would mind helping me clear up some confusion about short-chain vs. medium-chain fatty acids? I have read elsewhere that coconut oil is rich in medium-chain fats, is that what you mean or is it also rich in short-chain fats also? I read elsewhere that the short-chain fats were I think cypric and butyric acids, and it looked like these were, aside from being formed in the gut, mostly in butterfat?? is it that the shorter, the better? would butter be even better than coconut oil for this purpose then? or is really only the medium chain fats that are ketogenic and so butter would not work? anyway, you see my confusion! I’ve tried looking it up and figuring it out for myself but I am hampered by my lack of good science education! Thanks again for the article …

    • Hi Nyx,

      You’re correct about the naming convention for these fats.

      Butter does have more of the 4- and 6-carbon fats, but its total short- and medium-chain fats are less than 10% of its fats. In coconut oil they’re 58%, mostly 12-carbon. MCT oil, which you can buy at Amazon, is 100% these fats, mostly 8-carbon.

      So if you want to promote ketosis, MCT oil is best, coconut oil next best, and butter third.

      But butter is more nutritious than either coconut oil or MCT oil.

  46. oh, now I get it!! 💡 thanks so much, that really clears things up. I wish I’d asked you sooner now! 😀

  47. Hi Paul,

    I’m dependent on starch and low-fodmap foods (which are still mostly starch and leafy-greens) to keep my digestive system happy. I’ve recently associated my migraine “clear days” with my large indulgences of coconut milk whilst I was on the Paleo diet upon just reading articles such as this.

    How do I go about satisfying these dependencies whilst still eating a large amount of coconut oil/milk? If there isn’t any way, is my only option antibiotics? Or will I have to sustain the weight gain from the amounts of starch and coconut oil I’ll need till my migraines clear, which how long do you think it would take?

    Thanks in advance.

    • Hi Faisal,

      It’s a little tricky, but it is certainly worthwhile gaining a few pounds to clear your migraines. It shouldn’t be much weight, you won’t keep getting fatter – your body will compensate.

      You have to experiment to see how much coconut oil or milk you need to stop the migraines. The amount of starch you need for good health isn’t huge – 600 calories/day – so that shouldn’t make you fat.

      Also, as noted above, if you use MCT oil instead of coconut oil you’ll need fewer calories to stop the migraines.

      Best, Paul

  48. “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.”

    Did you hear about http://www.miginfo.de (the site is in German). This is possibly one of the largest and most frequented migraine websites worldwide. Their recommendation (since 2004) is to treat migraine with low carb/ketogenic diets.

    The success rates are very impressive: Almost one third of the forum participants claim to be nearly cured after 2 years, within another third the migraine has improved so much, that they keep with the diet.

    In their forum you will find hundreds of people, who try to get rid of migraine by low carb/ketogenic diets. BTW: The rationale of the site for such diets is slightly different to your one.

    The site is operated by Peter Mersch, who suffered from chronic migraine until 40. Now he is a quite successful author:


    Best regards

  49. Paul:
    I’ve read everything you’ve said (that I can find) on ketogenic dieting for migraine-type problems…
    The actual food intake is my question…Is it the PHD with 200 g of safe starches and addition MCT and coconut oil and some supplements???
    Is there anything more to the diet that makes it ketogenic???
    The high fat emphasis isn’t saturated fat, it’s the coconut oil and MCT’s…
    What makes it lower protein….It isn’t really lower carb due to the safe starch
    requirement, is it???
    I hope my questions are clear…

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