{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:31:17Z","timestamp":1791725477989,"version":"4.3.4"},"reference-count":111,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2013brain 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.<\/jats:p>","DOI":"10.3390\/jcm15041476","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:52:21Z","timestamp":1770979941000},"page":"1476","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Dietary Modulation of Migraine: Metabolic, Neuroinflammatory and Microbiota-Mediated Mechanisms"],"prefix":"10.3390","volume":"15","author":[{"given":"Domenico","family":"Santangelo","sequence":"first","affiliation":[{"name":"Unit of Neurology, Sant\u2019Elia Hospital, 93100 Caltanissetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concetta","family":"Lobianco","sequence":"additional","affiliation":[{"name":"Unit of Neurology, Sant\u2019Elia Hospital, 93100 Caltanissetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalia Eugenia","family":"Burrafato","sequence":"additional","affiliation":[{"name":"Istituto Tolman, 90139 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Tosto","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, \u201cGiovanni Paolo II\u201d Hospital, 88046 Lamezia Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8187-8354","authenticated-orcid":false,"given":"Giuseppe","family":"Magro","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, \u201cGiovanni Paolo II\u201d Hospital, 88046 Lamezia Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0085-9494","authenticated-orcid":false,"given":"Angelo","family":"Pascarella","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy"},{"name":"Regional Epilepsy Centre, Great Metropolitan \u201cBianchi-Melacrino-Morelli Hospital\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","unstructured":"(2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38, 1\u2013211."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S1474-4422(25)00402-8","article-title":"Global, regional, and national burden of headache disorders, 1990\u20132023: A systematic analysis for the Global Burden of Disease Study 2023","volume":"24","author":"Xu","year":"2025","journal-title":"Lancet Neurol."},{"key":"ref_3","first-page":"709","article-title":"Common pathophysiologic mechanisms in migraine and epilepsy","volume":"65","author":"Rogawski","year":"2008","journal-title":"Arch. Neurol."},{"key":"ref_4","first-page":"S16","article-title":"Neurogenic inflammation in the pathophysiology and treatment of migraine","volume":"43","author":"Moskowitz","year":"1993","journal-title":"Neurology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1744806918767697","DOI":"10.1177\/1744806918767697","article-title":"Chronic migraine: A process of dysmodulation and sensitization","volume":"14","author":"Su","year":"2018","journal-title":"Mol. Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1038\/s41582-019-0255-4","article-title":"The metabolic face of migraine\u2014From pathophysiology to treatment","volume":"15","author":"Gross","year":"2019","journal-title":"Nat. Rev. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hill, A., Amendolara, A.B., Small, C., Guzman, S.C., Pfister, D., McFarland, K., Settelmayer, M., Baker, S., Donnelly, S., and Payne, A. (2024). Metabolic Pathophysiology of Cortical Spreading Depression: A Review. Brain Sci., 14.","DOI":"10.3390\/brainsci14101026"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e70652","DOI":"10.1002\/brb3.70652","article-title":"Impact of Dietary Patterns on Migraine Management: Mechanisms of Action and Recent Literature Insights","volume":"15","author":"Behrouz","year":"2025","journal-title":"Brain Behav."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S1474-4422(19)30356-4","article-title":"The gut microbiome in neurological disorders","volume":"19","author":"Cryan","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s10194-020-1078-9","article-title":"Gut-brain Axis and migraine headache: A comprehensive review","volume":"21","author":"Arzani","year":"2020","journal-title":"J. Headache Pain"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1111\/head.13836","article-title":"The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review","volume":"60","author":"Hindiyeh","year":"2020","journal-title":"Headache"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1212\/WNL.44.4.666","article-title":"31P-magnetic resonance spectroscopy in migraine without aura","volume":"44","author":"Montagna","year":"1994","journal-title":"Neurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1177\/0333102410394675","article-title":"31P-MRS demonstrates a reduction in high-energy phosphates in the occipital lobe of migraine without aura patients","volume":"31","author":"Reyngoudt","year":"2011","journal-title":"Cephalalgia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100102","DOI":"10.1016\/j.ynpai.2022.100102","article-title":"Magnetic resonance spectroscopy studies in migraine","volume":"12","author":"Nikolova","year":"2022","journal-title":"Neurobiol. Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1097\/j.pain.0000000000001307","article-title":"Dynamic sodium imaging at ultra-high field reveals progression in a preclinical migraine model","volume":"159","author":"Abad","year":"2018","journal-title":"Pain"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.pain.2014.04.001","article-title":"Sensitization and ongoing activation in the trigeminal nucleus caudalis","volume":"155","author":"Oshinsky","year":"2014","journal-title":"Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.1093\/brain\/awaf015","article-title":"Spreading depolarization triggers pro- and anti-inflammatory signalling: A potential link to headache","volume":"148","author":"Kaya","year":"2025","journal-title":"Brain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1097\/00004647-200206000-00006","article-title":"Nitric oxide formation during cortical spreading depression is critical for rapid subsequent recovery of ionic homeostasis","volume":"22","author":"Obrenovitch","year":"2002","journal-title":"J. Cereb. Blood Flow. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1038\/nn1902","article-title":"Cortical spreading depression causes and coincides with tissue hypoxia","volume":"10","author":"Takano","year":"2007","journal-title":"Nat. Neurosci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1038\/nrneurol.2013.192","article-title":"Cortical spreading depression and migraine","volume":"9","author":"Charles","year":"2013","journal-title":"Nat. Rev. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s10194-019-0978-z","article-title":"ROS\/TRPA1\/CGRP signaling mediates cortical spreading depression","volume":"20","author":"Jiang","year":"2019","journal-title":"J. Headache Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.neuron.2012.01.001","article-title":"Understanding migraine through the lens of maladaptive stress responses: A model disease of allostatic load","volume":"73","author":"Borsook","year":"2012","journal-title":"Neuron"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wang, Y., Wang, Y., Yue, G., and Zhao, Y. (2023). Energy metabolism disturbance in migraine: From a mitochondrial point of view. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1133528"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cavestro, C. (2025). Metabolic Dysfunction and Dietary Interventions in Migraine Management: The Role of Insulin Resistance and Neuroinflammation\u2014A Narrative and Scoping Review. Brain Sci., 15.","DOI":"10.3390\/brainsci15050474"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Fila, M., Chojnacki, C., Chojnacki, J., and Blasiak, J. (2021). Nutrients to Improve Mitochondrial Function to Reduce Brain Energy Deficit and Oxidative Stress in Migraine. Nutrients, 13.","DOI":"10.3390\/nu13124433"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/jnc.12267","article-title":"Insulin-like growth factor-1 abrogates microglial oxidative stress and TNF-\u03b1 responses to spreading depression","volume":"126","author":"Grinberg","year":"2013","journal-title":"J. Neurochem."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.2174\/1381612825666190709204107","article-title":"Novelty in Inflammation and Immunomodulation in Migraine","volume":"25","author":"Cavestro","year":"2019","journal-title":"Curr. Pharm. Des."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1111\/j.1526-4610.2006.00483.x","article-title":"Calcitonin gene-related peptide (CGRP) and migraine","volume":"46","author":"Durham","year":"2006","journal-title":"Headache"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.npep.2010.12.002","article-title":"Calcitonin gene-related peptide (CGRP) and its role in hypertension","volume":"45","author":"Smillie","year":"2011","journal-title":"Neuropeptides"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1126\/science.1231897","article-title":"Spreading depression triggers headache by activating neuronal Panx1 channels","volume":"339","author":"Karatas","year":"2013","journal-title":"Science"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1038\/nm0202-110","article-title":"From CSD to headache: A long and winding road","volume":"8","author":"Iadecola","year":"2002","journal-title":"Nat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1038\/nm.3804","article-title":"The ketone metabolite \u03b2-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease","volume":"21","author":"Youm","year":"2015","journal-title":"Nat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/nrgastro.2009.35","article-title":"Principles and clinical implications of the brain-gut-enteric microbiota axis","volume":"6","author":"Rhee","year":"2009","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s10194-025-02039-7","article-title":"Unravelling the gut-brain connection: A systematic review of migraine and the gut microbiome","volume":"26","author":"Mugo","year":"2025","journal-title":"J. Headache Pain"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Biagioli, V., Mela, F., Ferraro, P., Villano, G., Orsini, A., Diana, M.C., Striano, P., and Santangelo, A. (2025). The Interplay Between Gut Microbiota, Adipose Tissue, and Migraine: A Narrative Review. Nutrients, 17.","DOI":"10.3390\/nu17020337"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Banfi, D., Moro, E., Bosi, A., Bistoletti, M., Cerantola, S., Crema, F., Maggi, F., Giron, M.C., Giaroni, C., and Baj, A. (2021). Impact of Microbial Metabolites on Microbiota-Gut-Brain Axis in Inflammatory Bowel Disease. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22041623"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4137","DOI":"10.4049\/jimmunol.173.6.4137","article-title":"The essential role of the intestinal microbiota in facilitating acute inflammatory responses","volume":"173","author":"Souza","year":"2004","journal-title":"J. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.conb.2019.12.003","article-title":"The microbiota and the hypothalamus-pituitary-adrenocortical (HPA) axis, implications for anxiety and stress disorders","volume":"62","author":"Frankiensztajn","year":"2020","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1186\/s10194-024-01891-3","article-title":"Microbiota alterations are related to migraine food triggers and inflammatory markers in chronic migraine patients with medication overuse headache","volume":"25","author":"Vuralli","year":"2024","journal-title":"J. Headache Pain"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e00105-16","DOI":"10.1128\/mSystems.00105-16","article-title":"Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort","volume":"1","author":"Gonzalez","year":"2016","journal-title":"mSystems"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/19490976.2015.1134082","article-title":"Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism","volume":"7","author":"Morrison","year":"2016","journal-title":"Gut Microbes"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"105526","DOI":"10.1016\/j.rvsc.2024.105526","article-title":"Bile acids alleviate intestinal inflammation by modulating gut microbiota composition in LPS-challenged broilers","volume":"184","author":"Fan","year":"2025","journal-title":"Res. Vet. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.bbr.2014.07.027","article-title":"Serotonin, tryptophan metabolism and the brain-gut-microbiome axis","volume":"277","author":"Clarke","year":"2015","journal-title":"Behav. Brain Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.pmn.2022.06.002","article-title":"Associations between the Gut Microbiome and Migraines in Children Aged 7\u201318 Years: An Analysis of the American Gut Project Cohort","volume":"24","author":"Bai","year":"2023","journal-title":"Pain Manag. Nurs."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bilal, M., Ashraf, S., and Zhao, X. (2022). Dietary Component-Induced Inflammation and Its Amelioration by Prebiotics, Probiotics, and Synbiotics. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.931458"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"de Aquino, C.C., Leit\u00e3o, R.A., Oliveira Alves, L.A., Coelho-Santos, V., Guerrant, R.L., Ribeiro, C.F., Malva, J.O., Silva, A.P., and Ori\u00e1, R.B. (2018). Effect of Hypoproteic and High-Fat Diets on Hippocampal Blood-Brain Barrier Permeability and Oxidative Stress. Front. Nutr., 5.","DOI":"10.3389\/fnut.2018.00131"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/j.cell.2020.04.027","article-title":"Ketogenic Diets Alter the Gut Microbiome Resulting in Decreased Intestinal Th17 Cells","volume":"181","author":"Ang","year":"2020","journal-title":"Cell"},{"key":"ref_48","first-page":"87","article-title":"Association of dietary patterns with migraine: A matched case-control study","volume":"22","author":"Martami","year":"2023","journal-title":"Curr. J. Neurol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Di Lorenzo, C., Pinto, A., Ienca, R., Coppola, G., Sirianni, G., Di Lorenzo, G., Parisi, V., Serrao, M., Spagnoli, A., and Vestri, A. (2019). A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones?. Nutrients, 11.","DOI":"10.3390\/nu11081742"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Haslam, R.L., Bezzina, A., Herbert, J., Spratt, N., Rollo, M.E., and Collins, C.E. (2021). Can Ketogenic Diet Therapy Improve Migraine Frequency, Severity and Duration?. Healthcare, 9.","DOI":"10.3390\/healthcare9091105"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/03331024211043792","article-title":"Efficacy and safety of exogenous beta-hydroxybutyrate for preventive treatment in episodic migraine: A single-centred, randomised, placebo-controlled, double-blind crossover trial","volume":"42","author":"Putananickal","year":"2022","journal-title":"Cephalalgia"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1186\/s12967-023-04561-1","article-title":"Very-low-calorie ketogenic diet vs hypocaloric balanced diet in the prevention of high-frequency episodic migraine: The EMIKETO randomized, controlled trial","volume":"21","author":"Caprio","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_53","first-page":"8","article-title":"Early and long period follow-up results of low glycemic index diet for migraine prophylaxis","volume":"30","author":"Evcili","year":"2018","journal-title":"Agri\u2014J. Turk. Soc. Algol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1017\/S000711452100444X","article-title":"Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on clinical, quality of life and mental health outcomes in women with migraine: A randomised controlled trial","volume":"128","author":"Arab","year":"2022","journal-title":"Br. J. Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1016\/j.pain.2013.07.028","article-title":"Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: A randomized trial","volume":"154","author":"Ramsden","year":"2013","journal-title":"Pain"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1177\/0333102410361404","article-title":"Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised, cross-over trial","volume":"30","author":"Alpay","year":"2010","journal-title":"Cephalalgia"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/1475-2891-10-85","article-title":"Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches","volume":"10","author":"Mitchell","year":"2011","journal-title":"Nutr. J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1111\/j.1526-4610.2012.02296.x","article-title":"IgG-based elimination diet in migraine plus irritable bowel syndrome","volume":"53","author":"Aydinlar","year":"2013","journal-title":"Headache"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"7890461","DOI":"10.1155\/2019\/7890461","article-title":"Effects of Diet Based on IgG Elimination Combined with Probiotics on Migraine Plus Irritable Bowel Syndrome","volume":"2019","author":"Xie","year":"2019","journal-title":"Pain Res. Manag."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Zhao, Z., Yang, M., Wan, F., Ning, B., Song, T., Fu, J., and Zhang, L. (2025). Food-specific IgG-based elimination diet decreased IL-6, TNF-\u03b1, and CGRP and improved symptoms in adults with migraine. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1720389"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/1129-2377-15-69","article-title":"Nutrition intervention for migraine: A randomized crossover trial","volume":"15","author":"Bunner","year":"2014","journal-title":"J. Headache Pain"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/j.1526-4610.1991.hed3105298.x","article-title":"Magnesium prophylaxis of menstrual migraine: Effects on intracellular magnesium","volume":"31","author":"Facchinetti","year":"1991","journal-title":"Headache"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1046\/j.1468-2982.1996.1604257.x","article-title":"Prophylaxis of migraine with oral magnesium: Results from a prospective, multi-center, placebo-controlled and double-blind randomized study","volume":"16","author":"Peikert","year":"1996","journal-title":"Cephalalgia"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1046\/j.1468-2982.1996.1606436.x","article-title":"Magnesium in the prophylaxis of migraine\u2014A double-blind placebo-controlled study","volume":"16","author":"Pfaffenrath","year":"1996","journal-title":"Cephalalgia"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1046\/j.1526-4610.2003.03102.x","article-title":"Oral magnesium oxide prophylaxis of frequent migrainous headache in children: A randomized, double-blind, placebo-controlled trial","volume":"43","author":"Wang","year":"2003","journal-title":"Headache"},{"key":"ref_66","first-page":"101","article-title":"The effects of magnesium prophylaxis in migraine without aura","volume":"21","author":"Talaslioglu","year":"2008","journal-title":"Magnes. Res."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s12011-012-9487-5","article-title":"The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis","volume":"150","author":"Mahdavi","year":"2012","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s13760-019-01101-x","article-title":"The efficacy of magnesium oxide and sodium valproate in prevention of migraine headache: A randomized, controlled, double-blind, crossover study","volume":"121","author":"Karimi","year":"2021","journal-title":"Acta Neurol. Belg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s10194-021-01234-6","article-title":"Comparative study of magnesium, sodium valproate, and concurrent magnesium-sodium valproate therapy in the prevention of migraine headaches: A randomized controlled double-blind trial","volume":"22","author":"Khani","year":"2021","journal-title":"J. Headache Pain"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1212\/WNL.50.2.466","article-title":"Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial","volume":"50","author":"Schoenen","year":"1998","journal-title":"Neurology"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1177\/0883073808318053","article-title":"High-dose riboflavin for migraine prophylaxis in children: A double-blind, randomized, placebo-controlled trial","volume":"23","author":"MacLennan","year":"2008","journal-title":"J. Child Neurol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1177\/0333102410365106","article-title":"Medium-dose riboflavin as a prophylactic agent in children with migraine: A preliminary placebo-controlled, randomised, double-blind, cross-over trial","volume":"30","author":"Bruijn","year":"2010","journal-title":"Cephalalgia"},{"key":"ref_73","first-page":"1344","article-title":"Effectiveness of Vitamin B2 versus Sodium Valproate in Migraine Prophylaxis: A randomized clinical trial","volume":"7","author":"Rahimdel","year":"2015","journal-title":"Electron. Physician"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"6279","DOI":"10.19082\/6279","article-title":"Prophylactic effect of riboflavin on pediatric migraine: A randomized, double-blind, placebo-controlled trial","volume":"10","author":"Talebian","year":"2018","journal-title":"Electron. Physician"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1212\/01.WNL.0000151975.03598.ED","article-title":"Efficacy of coenzyme Q10 in migraine prophylaxis: A ran-domized controlled trial","volume":"64","author":"Coppola","year":"2005","journal-title":"Neurology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1177\/0333102411406755","article-title":"A randomized, double-blinded, placebo-controlled, crossover, add-on study of CoEnzyme Q10 in the prevention of pediatric and adolescent migraine","volume":"31","author":"Slater","year":"2011","journal-title":"Cephalalgia"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"43","DOI":"10.4103\/abr.abr_235_20","article-title":"A Comparative Study on the Efficacy of Coenzyme Q10 and Amitriptyline in the Prophylactic Treatment of Migraine Headaches in Children: A Randomized Controlled Trial","volume":"11","author":"Yaghini","year":"2022","journal-title":"Adv. Biomed. Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"257","DOI":"10.7762\/cnr.2023.12.4.257","article-title":"The Effects of Coenzyme Q10 Supplementation on Oxidative Status and Lipid Profile in Migraine Patients: A Randomized Double-Blinded Controlled Clinical Trial","volume":"12","author":"Dahri","year":"2023","journal-title":"Clin. Nutr. Res."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1002\/ana.24534","article-title":"Simvastatin and vitamin D for migraine prevention: A randomized, controlled trial","volume":"78","author":"Buettner","year":"2015","journal-title":"Ann. Neurol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1080\/03007995.2018.1519503","article-title":"A randomized, double-blinded, placebo-controlled, parallel trial of vitamin D(3) supplementation in adult patients with migraine","volume":"35","author":"Gazerani","year":"2019","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1007\/s10072-019-04220-8","article-title":"Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: A randomized clinical trial","volume":"41","author":"Ghorbani","year":"2020","journal-title":"Neurol. Sci."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Tirani, S.A., Khorvash, F., Saneei, P., Moradmand, Z., and Askari, G. (2024). Effects of probiotic and vitamin D co-supplementation on clinical symptoms, mental health, and inflammation in adult patients with migraine headache: A randomized, triple-blinded, placebo-controlled trial. BMC Med., 22.","DOI":"10.1186\/s12916-024-03684-6"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/j.1526-4610.2004.04170.x","article-title":"A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: A randomized trial","volume":"44","author":"Maizels","year":"2004","journal-title":"Headache"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/FPC.0b013e32832af5a3","article-title":"The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability","volume":"19","author":"Lea","year":"2009","journal-title":"Pharmacogenet. Genom."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1186\/s10194-015-0516-6","article-title":"Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: A randomized, placebo-controlled, double-blind, multicenter trial","volume":"16","author":"Gaul","year":"2015","journal-title":"J. Headache Pain"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1177\/0333102418821661","article-title":"The effects of concurrent Coenzyme Q10, L-carnitine supplementation in migraine prophylaxis: A randomized, placebo-controlled, double-blind trial","volume":"39","author":"Hajihashemi","year":"2019","journal-title":"Cephalalgia"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.plefa.2003.09.007","article-title":"The therapeutic implications of ketone bodies: The effects of ketone bodies in pathological conditions: Ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism","volume":"70","author":"Veech","year":"2004","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1126\/science.1227166","article-title":"Suppression of oxidative stress by \u03b2-hydroxybutyrate, an endogenous histone deacetylase inhibitor","volume":"339","author":"Shimazu","year":"2013","journal-title":"Science"},{"key":"ref_89","first-page":"305","article-title":"Diet transiently improves migraine in two twin sisters: Possible role of ketogenesis?","volume":"28","author":"Sirianni","year":"2013","journal-title":"Funct. Neurol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/ene.12550","article-title":"Migraine improvement during short lasting ketogenesis: A proof-of-concept study","volume":"22","author":"Coppola","year":"2015","journal-title":"Eur. J. Neurol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"3865","DOI":"10.1007\/s10072-021-05078-5","article-title":"Effectiveness of ketogenic diet in treatment of patients with refractory chronic migraine","volume":"42","author":"Bongiovanni","year":"2021","journal-title":"Neurol. Sci."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"6479","DOI":"10.1007\/s10072-022-06311-5","article-title":"Ketogenic diet in refractory migraine: Possible efficacy and role of ketone bodies-a pilot experience","volume":"43","author":"Lovati","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Francini-Pesenti, F., Favaretto, S., D\u2019Angelo, M., Cacciapuoti, M., and Cal\u00f2, L.A. (2024). The Long-Term Treatment of Drug-Resistant Migraine with the Modified Atkins Ketogenic Diet: A Single-Center, Retrospective Study. Nutrients, 16.","DOI":"10.3390\/nu16244324"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1038\/nature05485","article-title":"Inflammation and metabolic disorders","volume":"444","author":"Hotamisligil","year":"2006","journal-title":"Nature"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s10194-023-01635-9","article-title":"2:1 ketogenic diet and low-glycemic-index diet for the treatment of chronic and episodic migraine: A single-center real-life retrospective study","volume":"24","author":"Tereshko","year":"2023","journal-title":"J. Headache Pain"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Lelleck, V.V., Schulz, F., Witt, O., K\u00fchn, G., Klein, D., Gendolla, A., Evers, S., Gaul, C., Tha\u00e7i, D., and Sina, C. (2022). A Digital Therapeutic Allowing a Personalized Low-Glycemic Nutrition for the Prophylaxis of Migraine: Real World Data from Two Prospective Studies. Nutrients, 14.","DOI":"10.3390\/nu14142927"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Papetti, L., Moavero, R., Ferilli, M.A.N., Sforza, G., Tarantino, S., Ursitti, F., Ruscitto, C., Vigevano, F., and Valeriani, M. (2021). Truths and Myths in Pediatric Migraine and Nutrition. Nutrients, 13.","DOI":"10.3390\/nu13082714"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1016\/j.clnu.2024.06.015","article-title":"Mediterranean ketogenic diet accounts for reduced pain frequency and intensity in patients with chronic migraine: A pilot study","volume":"43","author":"Olivito","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1080\/1028415X.2021.1954294","article-title":"The effects of the dietary approaches to stop hypertension (DASH) diet on oxidative stress and clinical indices of migraine patients: A randomized controlled trial","volume":"25","author":"Arab","year":"2022","journal-title":"Nutr. Neurosci."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1111\/apa.70157","article-title":"Systematic Review Suggests Nutraceuticals Containing Vitamin B2 Could Provide an Alternative Treatment for Paediatric Migraines","volume":"114","author":"Martello","year":"2025","journal-title":"Acta Paediatr."},{"key":"ref_101","first-page":"E97","article-title":"Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomized Controlled Trials","volume":"19","author":"Chiu","year":"2016","journal-title":"Pain Physician"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s00394-019-01905-w","article-title":"Magnesium and health outcomes: An umbrella review of systematic reviews and meta-analyses of observational and intervention studies","volume":"59","author":"Veronese","year":"2020","journal-title":"Eur. J. Nutr."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s10072-024-07794-0","article-title":"Effects of selected dietary supplements on migraine prophylaxis: A systematic review and dose-response meta-analysis of randomized controlled trials","volume":"46","author":"Talandashti","year":"2025","journal-title":"Neurol. Sci."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/jcpt.12548","article-title":"Prophylaxis of migraine headaches with riboflavin: A systematic review","volume":"42","author":"Thompson","year":"2017","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Yamanaka, G., Suzuki, S., Morishita, N., Takeshita, M., Kanou, K., Takamatsu, T., Morichi, S., Ishida, Y., Watanabe, Y., and Go, S. (2021). Experimental and Clinical Evidence of the Effectiveness of Riboflavin on Migraines. Nutrients, 13.","DOI":"10.3390\/nu13082612"},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Guilbot, A., Bangratz, M., Ait Abdellah, S., and Lucas, C. (2017). A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: A prospective observational study. BMC Complement. Altern. Med., 17.","DOI":"10.1186\/s12906-017-1933-7"},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Fajkiel-Madajczyk, A., Wici\u0144ski, M., Kurant, Z., S\u0142awatycki, J., and S\u0142upski, M. (2025). Evaluating the Role of Coenzyme Q10 in Migraine Therapy-A Narrative Review. Antioxidants, 14.","DOI":"10.3390\/antiox14030318"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s10194-020-01090-w","article-title":"The effects of vitamin D supplementation on interictal serum levels of calcitonin gene-related peptide (CGRP) in episodic migraine patients: Post hoc analysis of a randomized double-blind placebo-controlled trial","volume":"21","author":"Ghorbani","year":"2020","journal-title":"J. Headache Pain"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1111\/head.13892","article-title":"Serum Homocysteine, Pyridoxine, Folate, and Vitamin B12 Levels in Migraine: Systematic Review and Meta-Analysis","volume":"60","author":"Liampas","year":"2020","journal-title":"Headache"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Rivera-Mancilla, E., Al-Hassany, L., Villal\u00f3n, C.M., and MaassenVanDenBrink, A. (2021). Metabolic Aspects of Migraine: Association with Obesity and Diabetes Mellitus. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.686398"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Nguyen, K.V., and Schytz, H.W. (2024). The Evidence for Diet as a Treatment in Migraine\u2014A Review. 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