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Ketosis and migraine: a systematic review of the literature and meta-analysis

INTRODUCTION: Headaches are a prevalent disorder worldwide, and there is compelling evidence that certain dietary interventions could provide relief from attacks. One promising approach is ketogenic therapy, which replaces the brain's glucose fuel source with ketone bodies, potentially reducing...

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Autores principales: Neri, Lenycia de Cassya Lopes, Ferraris, Cinzia, Catalano, Guido, Guglielmetti, Monica, Pasca, Ludovica, Pezzotti, Elena, Carpani, Adriana, Tagliabue, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292926/
https://www.ncbi.nlm.nih.gov/pubmed/37377485
http://dx.doi.org/10.3389/fnut.2023.1204700
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author Neri, Lenycia de Cassya Lopes
Ferraris, Cinzia
Catalano, Guido
Guglielmetti, Monica
Pasca, Ludovica
Pezzotti, Elena
Carpani, Adriana
Tagliabue, Anna
author_facet Neri, Lenycia de Cassya Lopes
Ferraris, Cinzia
Catalano, Guido
Guglielmetti, Monica
Pasca, Ludovica
Pezzotti, Elena
Carpani, Adriana
Tagliabue, Anna
author_sort Neri, Lenycia de Cassya Lopes
collection PubMed
description INTRODUCTION: Headaches are a prevalent disorder worldwide, and there is compelling evidence that certain dietary interventions could provide relief from attacks. One promising approach is ketogenic therapy, which replaces the brain's glucose fuel source with ketone bodies, potentially reducing the frequency or severity of headaches. AIM: This study aims to conduct a systematic review of the scientific literature on the impact of ketosis on migraine, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS: After a careful selection process and bias evaluation, 10 articles were included in the review, primarily from Italy. The bias assessment indicated that 50% of the selected articles had a low risk of bias in all domains, with the randomization process being the most problematic domain. Unfortunately, the evaluation of ketosis was inconsistent between articles, with some assessing ketonuria, some assessing ketonemia, and some not assessing ketosis levels at all. Therefore, no association could be made between the level of ketosis and the prevention or reduction of migraine attacks. The ketogenic therapies tested in migraine treatments included the very low-calorie ketogenic diet (VLCKD, n = 4), modified Atkins diet (MAD, n = 3), classic ketogenic diet (cKDT, n = 2), and the administration of an exogenous source of beta-hydroxybutyrate (BHB). The meta-analysis, despite reporting high heterogeneity, found that all interventions had an overall significant effect (Z = 9.07, p < 0.00001; subgroup differences, Chi2 = 9.19, dif = 3, p = 0.03; I(2), 67.4%), regardless of the type of endogenous or exogenous induction of ketosis. CONCLUSION: The initial findings of this study suggest that metabolic ketogenic therapy may provide some benefit in treating migraines and encourage further studies, especially randomized clinical trials with appropriate and standardized methodologies. The review strongly recommends the use of the adequate measurement of ketone levels during ketogenic therapy to monitor adherence to the treatment and improve knowledge of the relationship between ketone bodies and efficacy. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022330626.
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spelling pubmed-102929262023-06-27 Ketosis and migraine: a systematic review of the literature and meta-analysis Neri, Lenycia de Cassya Lopes Ferraris, Cinzia Catalano, Guido Guglielmetti, Monica Pasca, Ludovica Pezzotti, Elena Carpani, Adriana Tagliabue, Anna Front Nutr Nutrition INTRODUCTION: Headaches are a prevalent disorder worldwide, and there is compelling evidence that certain dietary interventions could provide relief from attacks. One promising approach is ketogenic therapy, which replaces the brain's glucose fuel source with ketone bodies, potentially reducing the frequency or severity of headaches. AIM: This study aims to conduct a systematic review of the scientific literature on the impact of ketosis on migraine, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS: After a careful selection process and bias evaluation, 10 articles were included in the review, primarily from Italy. The bias assessment indicated that 50% of the selected articles had a low risk of bias in all domains, with the randomization process being the most problematic domain. Unfortunately, the evaluation of ketosis was inconsistent between articles, with some assessing ketonuria, some assessing ketonemia, and some not assessing ketosis levels at all. Therefore, no association could be made between the level of ketosis and the prevention or reduction of migraine attacks. The ketogenic therapies tested in migraine treatments included the very low-calorie ketogenic diet (VLCKD, n = 4), modified Atkins diet (MAD, n = 3), classic ketogenic diet (cKDT, n = 2), and the administration of an exogenous source of beta-hydroxybutyrate (BHB). The meta-analysis, despite reporting high heterogeneity, found that all interventions had an overall significant effect (Z = 9.07, p < 0.00001; subgroup differences, Chi2 = 9.19, dif = 3, p = 0.03; I(2), 67.4%), regardless of the type of endogenous or exogenous induction of ketosis. CONCLUSION: The initial findings of this study suggest that metabolic ketogenic therapy may provide some benefit in treating migraines and encourage further studies, especially randomized clinical trials with appropriate and standardized methodologies. The review strongly recommends the use of the adequate measurement of ketone levels during ketogenic therapy to monitor adherence to the treatment and improve knowledge of the relationship between ketone bodies and efficacy. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022330626. Frontiers Media S.A. 2023-06-12 /pmc/articles/PMC10292926/ /pubmed/37377485 http://dx.doi.org/10.3389/fnut.2023.1204700 Text en Copyright © 2023 Neri, Ferraris, Catalano, Guglielmetti, Pasca, Pezzotti, Carpani and Tagliabue. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Nutrition
Neri, Lenycia de Cassya Lopes
Ferraris, Cinzia
Catalano, Guido
Guglielmetti, Monica
Pasca, Ludovica
Pezzotti, Elena
Carpani, Adriana
Tagliabue, Anna
Ketosis and migraine: a systematic review of the literature and meta-analysis
title Ketosis and migraine: a systematic review of the literature and meta-analysis
title_full Ketosis and migraine: a systematic review of the literature and meta-analysis
title_fullStr Ketosis and migraine: a systematic review of the literature and meta-analysis
title_full_unstemmed Ketosis and migraine: a systematic review of the literature and meta-analysis
title_short Ketosis and migraine: a systematic review of the literature and meta-analysis
title_sort ketosis and migraine: a systematic review of the literature and meta-analysis
topic Nutrition
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292926/
https://www.ncbi.nlm.nih.gov/pubmed/37377485
http://dx.doi.org/10.3389/fnut.2023.1204700
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