Breaking new IHC 2017

Ketone supplements prevent migraine headaches

Breaking new IHC 2017

Supplementation with BHB salts can decrease migraine frequency by 51%

That was the conclusion of a pilot study presented at the 18th Congress of the International Headache Society. The study looked migraine frequency after a month of supplementation with the ketone body, beta –hydroxybutyrate (BHB).   The participants consisted of four females and one male who had refractory migraines, defined as having an average pretreatment migraine frequency between 6-24 migraines a month.

The BHB supplement, in salt form, was given at a dose of 10 mg twice a day on top of a normal diet. During the one month on the supplement, there was an average reduction of 51% in migraine days compared to baseline. The migraine days per month went from a pretreatment an average of 16.25 day down to 8 migraine days during the month.

Granted this was a small study with only five participants, but the 51% reduction in only one month is impressive. Especially since Topiramate, probably the most prescribed medication for migraine prevention, also showed about a 50% reduction in migraine frequency.

The good news is that there is a BHB salt supplement that is commercially available without a physician’s prescription. Click here to find out more about the ketone supplement.*  For more information on why ketones may be beneficial in patients with migraines please see prior blogs.


Gross, E. (2017). Preliminary Data on Exogenous Ketone Bodies in Migraine Prevention. 18th Congress of the Internation Headache Society, (PO-01-069).

Silberstein SD, (2004). Topiramate in migraine prevention, results of a large controlled trial. Arch Neurol. 61:490–5.


*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to are not intended to diagnose prevent treat or cure any disease. If you are under medical supervision for any allergy, disease, taking prescription medications or you are breastfeeding contact your medical provider before adding any new supplements to your daily regimen



Hello from Dr. Deb


An alternative approach to Neurology

Hello Dr. Deb here. I just wanted to say thanks for liking my Facebook page @ I also wanted to introduce myself to those who do not know me. I am currently 48 years old. I am a wife and a mom of wonderful 2 young girls. I have been practicing neurology for over 18 years. I specialize in headache medicine but still manage all types of neurological diseases including Alzheimer’s dementia, seizures, strokes, multiple sclerosis and Parkinson’s disease. However pain and migraines are the conditions I see the most.

I started this website and my Facebook page because over the years my approach to the practice of medicine and specifically neurology has changed. I previously believed that my job was just to find the right pill for your symptoms. I since have come to the conclusion that sometimes the best medicine is not a pill that I can give, but a healthy life style that you choose for yourself. I have discovered this both thru my patients but also with my personal experience. I too suffer from migraines and depression but since making some changes with exercise and changes my diet to include ketosis I have had significant improvement in my symptoms.

Over the last couple of years I have been doing more and more research on the powers of exercise, nutrition and most recently the benefits of ketones. I will be making a series of videos over the next several of weeks so that I can share with some of what I have learned.  I hope that you will find some value in these videos.


Dr. Deb


Can changing what you cook with prevent migraine headaches?


  A Low Omega 6 and High Omega 3 diet has been shown help to prevent migraines




As a headache specialist, I am often asked, “Are there specific foods that I should be eating to prevent migraines?”  Until recently, I would just recommend avoiding specific foods, such as MSG and red wines, that can trigger migraines, but not a specific type of diet.  Recently, the evidence is mounting that the foods that you eat not only can trigger a migraine but also can alter the metabolic pathway of pain and increase systemic inflammation.  This results in elevating your risk of having a migraine even after the food is out of your system.  A likely culprit of doing this is Omega 6 fatty acids (N-6).  Unfortunately, N-6 is a bigger part of our diet then one may realize.

The Omega 6 fatty acids (N-6) include Linoleic acid (LA) and Arachidonic acid (AA).  Linoleic acid is the predominant polyunsaturated fatty acid (PUFA) in US western diet.  High LA oils include soybean, corn, cottonseed, safflower, and sunflower.  It is also found in salad dressing, margarine, mayonnaise and cooking oils.  LA oils are also added to a lot of packaged foods including bread, cereals, cookies, and chips.  Since the early 1960s, intake of LA has increased threefold due to the dietary advice to substitute vegetable oil instead of animal fats.

It has been hypothesized that the overabundance of N-6 in the nervous system is a fundamental metabolic basis for central pain sensitization.  Dietary patterns of high N-6 are felt to promote pain by increasing the amount of Arachidonic acid (AA), the breakdown product of LA, in the nervous system.  High AA is believed to increase pain by inducing inflammation and by directly stimulating pain triggering N-methyl-d-aspartate (NMDA) receptors.

Omega 3 acids (N-3) are the “good” omega fatty acids, which have been shown to have anti-inflammatory and anti-pain properties.  Alpha linolenic acid (ALA) is the vegetable sources of Omega 3, found mainly in flaxseed.  Docosahexaemoic acid (DHA) and 3-eicosapentaenic acid (EPA) is the Omega 3 fatty acid that is found in fatty fish.

N-6 and N-3 fatty acids compete for enzymatic conversion, tissue incorporation, and metabolism to bioactive derivatives.  So, if there is too much of N-6 in your diet or not enough N-3, N-6 will win.  Your body will be more in a pro-inflammatory, pro-nociceptive (pro-pain) state.  This state potentially would then cause headaches in a headache susceptible people.

A recent study published in the journal Pain was a12 week study looking to see if a dietary intervention would improve headaches.  Patients with chronic headaches were randomized into 2 groups.  The first group reduced N-6 intake while eating ‘normal’ levels of N-3.  The second group were to reduced the N-6 intake but were to also eat high levels of N-3.  The rest of the diet was to remain the same. To decrease N-6 levels, both groups were to use only low LA oils and fat sources such as macadamia nut oil, coconut oil, low LA olive oil, butter and fat-free mayonnaise.  The participants in the second group, who were to also increase the N-3, were also encouraged to eat flaxseed and 4 oz servings of fatty fish a day.

This randomized trial found that both groups showed improvements in clinical outcomes compared to the pre-intervention phase.  The high N-3 + low N-6 group, however, produced significantly greater improvement in all clinical measures.  The HIT-6 disability scores decreased from 61 at baseline down to 53.5 at follow up.   The number of headache days per month was also significantly improved in the high N-3 + low N-6 group, from 23.3 at baseline down to 14.5 at follow up.  The headache hours per day decreased from 10.2 at baseline down to 5.6.   The probability of experiencing a severe headache day was also improved.   The amount of medication that was used to treat a headache compared to baseline was also significantly reduced by 43% in the N-3 + low N-6 group.

Thus, the study showed that the combination of increasing dietary N-3 with a concurrent lowering of N-6 fatty acids produced a clinically relevant and significant improvement in headache days, hours per day, severe headache days, and headache-related quality of life compared to baseline and compared to just lowering N-6.

A prior study looking at the effects of just supplementing N-3 without lower N-6 levels showed no clinical benefit.  A possible explanation to why just adding more N-3 did not improve migraines is when there is too much N-6 around.  This is secondary to their competing for enzymatic conversion and metabolism.  The high level of N-6 does not allow the N-3 to be active despite taking in extra N-3.

Currently, the average American eats N-6 to N-3 omega fatty acids at a ratio of 16:1 where the ratio should be closer to 1:1.  To get your ratio closer to those recommended in this diet, there are 3 steps you can do to improve your diet.



The first step is to limit the amount of N-6 omega fatty acids.  Unfortunately, it is almost impossible t avoid N-6 entirely.  Thus, focus on avoiding as many vegetable oils such as safflower, corn, sunflower, cottonseed, and soybean as possible.  Also, avoid the processed fat-based foods that utilize these oils including mayonnaise and bottled salad dressings.

The second step is to replace those oils with the oils that have better ratios of N-6 to N-3 including olive oil, avocado oil, coconut oil and organic butter.

The third step to improve your ratio of N-6 to N-3 fatty acids is to increase the amount of N-3 in your diet.  Foods that are rich in omega-3 fatty acids include fatty fish (salmon, mackerel, tuna, sardines, and anchovies) and some grass feed animal products.  Vegetarian sources include flax seed, chia seed, sachi inchi, walnuts, quinoa, brussels sprouts, kale, and spinach.

I realize changing your diet is difficult, but so is living with chronic migraines.  Isn’t having fewer headaches worth giving it a try?

Works Cited

Finkel, A. G. (2013). Dietary Considerations in Migraine Management: Does a consistent Diet Improve Migraine? Current Pain Headache Report,17 (373), 1-8.
Ramsden, C. E. (2011). Low omega-6 vs low omega-6 plus high omega-3 dietary intervention for Chronic Daily Headache: Protocol for a randomized clinical trial. Trials, 12 (97), 1-11.
Ramsden, C. E. (2013). Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: A randomized trial. Pain (154), 2442-2451.
brain small

Exercise to prevent your migraines


Exercise can prevent your migraines!

Did you know that exercise can prevent migraines?  Well, it is true, and there is a recent study that proves it.  As a headache specialist, I always try to encourage my migraine patients to start a regular exercise program as a conservative way to decrease their migraine headaches, but up until now, we did not much scientific evidence to show that it actually helped.

Individuals with migraines and other headaches have been shown to be less physically active than those without headaches.  One of the reasons is that individual with migraines, that their headaches often worsen during physical activity. This is actually one of the major criteria on which migraines are diagnosed.  However, it is unclear if the lack of exercise in individuals with migraines is the cause or effect of having migraines.

The reason why exercise may decrease the frequency of migraine headaches is unclear.  Some of the things that we do know are that exercise can increase the natural endorphins (feel-good chemicals) in our brain.  Exercise can also decrease migraine triggers such as anxiety and stress.  Additionally, your sleep pattern is improved with regular exercise, which may then result in less frequent migraines.  Other risk factors for migraine headaches such as obstructive sleep apnea, hypertension, and obesity are also improved with regular exercise.

In a randomized, controlled trial of adults with migraines where patients were randomized into three groups; an exercise group, a relaxation training group, or a group that received the preventive medication topiramate (Topamax).  The exercise group exercised three times a week for 40 minutes.  The study looked at how frequent migraines occurred compared to their baseline migraine frequency. The study lasted three months.  What was found was that there were no significant differences between the groups, all decreased the frequency of migraines compared with the baseline. No adverse effects were reported in the exercise or relaxation groups.  Adverse effects were reported in 33% of the participants in the topiramate group. Restated, participants in this randomized controlled study who exercised regularly (3 times a week) experienced an improvement in the frequency of their migraine attack that was not significantly different from the participants who received drug preventive medication topiramate.1

Now I am not saying that routine exercise will prevent all migraines.  However, neither does medications.  So wouldn’t you rather try something that is good for you anyway either in addition to or instead of medications?

For more information on the causes and ways to prevent migraines see my Migraine Headache post.

As always please discuss with your physician before starting any strenuous physical activity. Also, please do not suddenly stop any of your medications without discussing with your physician first.  

Sites Referenced:

1Emma Varkey, A. C. (2011). Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalagia, 1428-1438.


Migraine Headaches

 What are migraines and how can I prevent them?

As a Neurologist with a specialty in Headache Medicine;  This is what I tell patients with migraine headaches

What are migraines?  Migraines are a primary headache disorder of recurrent attacks of moderate to severe pain.  The pain is often described as a throbbing or a pulsing pain which is typically located on one side of the head.  This can be accompanied by light and noise sensitivity, upset stomach, and visual changes (aura).  Migraines may present in different ways and maybe misdiagnosed by as tension headaches or sinus headaches.

What causes migraines? For many years it was believed that migraine attacks were due to changes in the blood vessels in the brain.  It is now believed that migraines are probably genetically induced hypersensitivity of the neurons in the central nervous system. This results in the brain neurons being more sensitive to their environment and thus has a lower threshold for developing a headache. Hormones, foods, noises, smells, lights, and stress all play a part in causing headaches.

How are migraines diagnosed? Migraines are diagnosed clinically by talking with your doctor. There are no x-rays or blood tests that will diagnose migraines. Generally, no tests are needed when migraine is suspected.

Who gets Migraines? Migraines affect 12 % of the U.S. population. Men and women of any age can get migraine headaches. However, migraines are most common in women in their teens to menopause.  Migraines often run in families.

Why did I get migraines? Every person has a headache threshold.  For a lucky few, it may take a sledgehammer to give them even a mild headache.  However for those with frequent headaches, something as simple as a missed meal may lower their headache threshold enough to start a disabling migraine.  Everyone has different migraine triggers to increase their headache threshold. The way I like to describe migraine is to think of it like a cup; once the cup is full = migraine.  Some people start with a cup that is already almost full and only one other trigger such as hormonal issue can make the cup full and thus trigger a migraine.  Other people have very little in the cup to begin with so it takes multiple triggers before the cup is full, and thus harder to trigger a migraine.

What are some common migraine triggers?

  1.     Sleep pattern changes, either too much or too little
  2.     Increased stress in everyday life
  3.     Menstrual cycles or hormonal changes (for women)
  4.     Weather changes/fronts
  5.     Foods; There a lot of foods that has been reported to trigger migraines in some people.  Some of the most commonly reported causes include
    1. Caffeine
    2.  Aspartame
    3.  MSG from Chinese food
    4.   Nitrates and nitrites
    5.   Red wines and alcohol
  6.  Dehydration

For more information on migraine triggers see recent blog post on triggers.

Conservative ways to prevent/decrease migraines:

  1. Get good restorative sleep; try to wake up and go to sleep at about the same time every day.  If you snore please seek medical evaluation and treatment for this, it may be sign of obstructive sleep apnea which can cause headaches, and also other medical problems such as high blood pressure, heart attack, and strokes.
  2. Stress reduction; obviously it is hard to get rid of all the stress in your life, but you need to find ways to better deal with the stress.  Such as: talking about problems, relaxation, messages, and exercise.
  3. Make exercise a routine part of your life.  Migraine may worsen when you exercise with a headache.  Recent studies however show that participants who routinely exercise had a decrease in the frequency and severity of their migraines.  I recommend exercising 5-6 times a week.  Exercise also help to decrease other migraine triggers such as anxiety and stress. It can improve sleep, decrease weight, increases natural pain reducing chemicals, and increases natural endorphins (feel good chemicals) in the brain.  For more information see “Exercise to prevent your migraines” post.
  4. Practice relaxation exercises on a daily basis. Whether it is through biofeedback, deep breathing, mediation, guided relaxation, cognitive-behavioral treatment, yoga, or Tai Chi, these practices can help decrease the hyperexcitation of the brain, thus decreasing likelihood of getting a migraine, help you deal with the migraine better, and help you deal with other outside stressors.
  5. Weight loss: Obesity is associated with an increase in frequency of migraines in people with migraines.  It is unclear why, some feel it is due to the higher levels of inflammation in the body.
  6. Hydration:  Drink at least eight 8 ounces of water daily, this may need to be increased in the summer months, if exercise regularly, or drink dehydrating fluids such as caffeine or alcohol.
  7. Limit or stop drinking caffeine: If suddenly stop drinking caffeine may get caffeine withdraw headache.  If must drink caffeine try to drink less than two servings a day.
  8. Eat regularly: do not skip meals, especially breakfast. I also recommend eating smaller more frequent meals.  (See addition information in “Migraine Diet” blog)
  9.  Maintain a headache diary: this helps you keep track of any possible triggers (lack of sleep, food, hormones, stress) that might have trigger but also shows if migraine frequency is improving or worsening.

Medical treatment for migrainesThere are medications that can decrease the frequency of your migraines and also medication to take when you have a migraine.  For more information please discuss with your Neurologist.

This site is purely informative and should not be considered medical advice. It is not intended to be used to diagnosis or treat any disease.  Please consult your physician before starting any fitness program or new supplement.