Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Beta-hydroxybutyrate (BHB) is a ketone body produced during states of low carbohydrate intake, fasting, or ketogenic diets. Its use in migraine management has emerged from scientific investigation rather than traditional medicine. The rationale is based on the observation that migraines are associated with altered brain energy metabolism and mitochondrial dysfunction. BHB serves as an alternative energy substrate for the brain, potentially bypassing these metabolic deficits.

Several small studies and case reports have explored exogenous ketone supplements, such as BHB salts or esters, for migraine prevention. A few pilot trials and open-label studies have suggested a reduction in migraine frequency and severity with ketogenic diets or exogenous BHB, but the sample sizes have been small, and studies are often uncontrolled or preliminary. For example, a 2021 open-label study (Di Lorenzo et al.) indicated that a ketogenic diet, which increases endogenous BHB, reduced migraine days in chronic migraine patients. However, direct evidence from randomized controlled trials using exogenous BHB for migraine is limited.

Thus, while the scientific rationale is plausible and supported by preliminary findings, robust clinical evidence is lacking. The current level of evidence for BHB’s use in migraine is weak to moderate (rated 2/5), and more high-quality, controlled studies are needed to confirm efficacy and safety.

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