Ketone bodies, particularly beta-hydroxybutyrate (BHB), have gained attention as a potential treatment or supportive therapy for migraine, largely based on emerging scientific evidence rather than long-standing tradition. The interest stems from the observation that ketogenic diets—high-fat, low-carbohydrate nutritional approaches that induce ketosis—can reduce the frequency and severity of migraine attacks in some patients. The exact mechanism is not fully understood, but several hypotheses exist. Ketones may provide a more efficient energy substrate for neurons, improve mitochondrial function, and reduce neuronal excitability, all of which are implicated in migraine pathophysiology. Additionally, ketone bodies may have anti-inflammatory and neuroprotective effects.

Clinical evidence is still limited but growing. Small pilot studies and case reports have shown that both ketogenic diets and exogenous ketone supplementation may help reduce migraine attacks. A 2018 pilot study found a significant decrease in migraine frequency in patients following a ketogenic diet. However, larger randomized controlled trials are needed for definitive conclusions. Exogenous ketones (supplements that provide ketone bodies directly) are being investigated, but as of now, most evidence relates to dietary ketosis, not isolated ketone administration. Therefore, while there is promising scientific rationale and preliminary human data, more robust clinical trials are necessary to fully establish efficacy and safety for migraine management.