Treatment of Chronic Cluster Headaches with Ketogenic Diet

Cluster Headaches

Cluster headaches, also known as ‘suicide headaches’ are considered to be one of the worse headache that a person can experience. The pain is a very severe pain located around the eye. The pain can last between 15- 180 minutes but can recur up to eight times a day. The name cluster headaches come from the fact that the headache episodes tend to cluster together for several weeks to months at a time. Typically these clusters of headaches break or resolve after several weeks only to return months or years later. In 10-15% of people who have cluster headaches, however, can have their headache cluster last for over a year without relief. These unfortunate people have what is called chronic cluster headaches. (Hoffmann, 2018)

People who have chronic cluster headaches not only have more frequent headaches but they often are unable to find pain relief. Chronic cluster headaches are often not responsive to typical medical available treatments. The fact that the pain is so severe, along with the intractability has lead patients and physicians to look for alternative ways to treat chronic cluster headaches.

One such alternative treatment option is the ketogenic diet. A recently published study, by Di Lorenzo looked at treatment of drug-resistant chronic cluster headaches with the ketogenic diet. Eighteen patients who had drug-resistant chronic cluster headaches went on the ketogenic diet for 12 weeks to see if dietary changes could decrease the frequency of their headaches. The ketogenic diet consisted of low carbohydrates, normal levels of protein (0.7-1.2 g/kg/day) and high-fat diet. The amount of carbohydrates that were allowed for the first month was 10g/day. The amount of carbohydrates than maybe increased during next month to a maximum of 30 g/day. The calories intake varied according to patients needs. Patients were encouraged to drink between 2-2.5 liters of water a day. Daily urine stick testing was done to confirm the presence of ketosis.

The eighteen participants in the study had all failed at least three different medication treatment trials for their cluster headaches. The mean number of headache attacks for the month before starting the ketogenic diet was 108 compared to 31 at the end of the study. Out of the 18 patients on the ketogenic diet, 15 were considered to have a positive response. Eleven experience a complete resolution of their headaches. The other four had at least a 50% reduction of mean monthly headache attacks.

Out of the 15 participants that responded to the ketogenic diet. Cluster headaches returned in three of the participants who stopped eating ketogenic after the study was over. The twelve other who remained on the ketogenic diet after the study had no recurrence of their cluster headaches over the following 12 weeks.

An advantage of dietary changes compared to medications is minimal side effects. The only side effect reported from the ketogenic diet was hair loss in one person and abdominal bloating in another. Both of these side effects improved with the use of supplements.

Bibliography

Di Lorenzo, C. (2018). Efficacy of Modified Atkins Ketogenic Diet in Chronic Cluster Headache: An Open-Label, Single-arm, Clinical Trial. Frontiers in Neurology, 9, 1-5.
Hoffmann, J. (2018). Diagnosis, pathophysiology, and management of cluster headache. The Lancet Neurology, 17, 75-83.

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