# Dietary Modulation of Migraine: Metabolic, Neuroinflammatory and Microbiota-Mediated Mechanisms

## TL;DR

This review explores how diet can influence migraine through metabolic, inflammatory, and gut microbiota pathways, suggesting diet may help reduce migraine frequency and severity.

## Contribution

The paper provides a comprehensive overview of how diet modulates migraine through metabolic and microbiota mechanisms, highlighting gaps in current research.

## Key findings

- Dietary interventions like ketogenic and DASH diets may reduce migraine frequency by modulating metabolic and inflammatory pathways.
- The gut microbiota influences migraine through the gut–brain axis, affecting inflammation and neuronal excitability.
- Current evidence is limited by small sample sizes and lack of standardized protocols, necessitating more robust studies.

## Abstract

Migraine is a common neurological condition characterized by recurrent headache attacks, frequently associated with prodromal, aura, and postdrome phases. Increasing evidence suggests that metabolic and mitochondrial dysfunction play a central role in migraine pathophysiology, contributing to cortical hyperexcitability and increased oxidative stress. Additionally, the gut microbiota has emerged as an important modulator of migraine susceptibility via the gut–brain axis, influencing inflammation, neurotransmitter production, and neuronal excitability. Specific dietary interventions, including ketogenic diets, low-carbohydrate diets, DASH, omega-3 supplementation, and elimination diets, may modulate these metabolic and inflammatory pathways, as well as the microbiota composition, ultimately reducing the frequency and severity of migraine attacks. This review provides an overview of current evidence on the interplay between metabolism, microbiota, and diet in migraine pathophysiology and management. Overall, the available data support a biologically plausible role for diet as an adjunctive strategy in migraine prevention; however, the current evidence remains highly heterogeneous and is often limited by small sample sizes in sample size, a lack of protocol standardization, suboptimal adherence assessment, and insufficient long-term follow-up. Future studies should focus on adequately powered trials with standardized outcome measures, objective biomarkers and precision medicine approaches.