Ocular Migraines

#1

Hi, all. First post.

I’ve been on keto for just over three months. For the most part it’s been going fairly well. I only had a few bouts of mild keto-flu. I know the keto strips aren’t the most accurate, but they’ve been consistently in the moderate to strong range.

I do have a history of ocular migraines—typically one or two a month. Sometimes I will have none for months, then two or three in a week. From 2019 until November 2021 I actually had none. That November I had three (this is pre-keto). However, in the past month I’ve had twelve.

Historically, the majority I get are between 10am and 2pm. Occasionally, some would hit in the late afternoon. I’ve only ever had a handful at night. Many years ago I was not a breakfast person. Then my Optometrist suggested I start, and the migraines lessened in frequency. In 2018 I did an elimination diet, which revealed nothing—no food triggers.

These new migraines are following the same pattern, except many are hitting after I have lunch. I also do IF between 8pm and noon.

Nothing I eat has changed, except with the omission of the obvious culprits on keto.

It seems, to me, that the keto is doing something to cause the migraines, I’m just not sure what. I know electrolyte loss can be an issue on keto, and I’ve been trying to supplement. I do use the Nuun tablets, mainly because they’re convenient. I add more salt (pink himalayan) with my veggies. I also take magnesium (Healthy Calm).

I would prefer not to stop doing the keto. Googling around I did find a few references to migraines being treated with electrolytes (especially in the ER) but nothing specifically about ocular migraines and keto.

Just looking for some advice. Thanks in advance.

(You've tried everything else; why not try bacon?) #2

I get mostly auras on keto, that don’t usually progress to full migraines. They typically go away within minutes if I eat a pinch or two of salt. If I keep my salt intake up, I don’t get them. On Dr. Phinney’s advice, I worked at increasing my salt intake a bit when I went keto, so I never got the keto “flu.” At worst, these days, I get those auras or a bit of constipation if I don’t get enough salt.

Having the omicron variant of COVID made a difference, in that for several weeks after my fever came down, I would get full-blown migraines that nothing helped. Fortunately, that phase of recovery seems to have passed.

I don’t know of any mechanism by which lowering serum glucose and serum insulin could cause migraines, except of course, if you believe that lowered blood pressure causes them. Elevated insulin interferes with the production of nitric oxide, which causes arteries to stiffen, so perhaps you need higher blood pressure, in order to avoid the headaches? To me, that sounds wrong, however. I’d expect hypertension to be more likely to cause migraines than normal blood pressure.

What are you eating for lunch? Anything there that might be a problem? Also, is there a possibility of some other problem that might be giving you headaches? I won’t try to scare you with what comes to my mind, but perhaps you should see a physician. Just because the problem started after you went keto, that’s no reason to assume that keto is the only possible cause. (Post hoc, proper hoc, and all that.)

#3

Lunch is typically a large amount of spring mix, 2-3 chopped hard-boiled eggs, and 2-3 tablespoons of avocado oil. I season in about 1/4 tsp of pink salt, and a bit of pepper. Today, it hit right in the middle of lunch.

The migraines go back about 20 years. The first one I had was after several days of super-high stress, bad (or no) eating, and almost no sleep. My partner—at the time—was undergoing a kindey-pancreas transplant. I remember seeing the aura, and thought I was having a stroke. As I was at Toronto General, I thought “Well, how convenient, I can just walk to the ER”. What actually happened was I just found a quiet waiting room, sat down, and ate a chocolate bar. Within about 20 minutes the aura went away. Ever since, they’ve been with me. I always suspected that hospital event was a low blood sugar thing.

The migraine I got back in November was after a long drive, and a very strong coffee. That’s the first migraine I had in about three years. My Optometrist knows I have them, and says they’re weather related. Perhaps, but I think it’s more than that.

(Bob M) #4

In addition to Paul’s salt advice, have you taken your blood sugar before and after lunch, to rule that out?

Have you tried exogenous ketones, say taken right before lunch?

I’d suggest taking ketones before and after eating, but I don’t know enough about how long changes in ketones in urine take. I would think it’s probably not a great instantaneous gauge of ketones.

#5

I don’t have a tester, and I haven’t used exogenous ketones. I do use MCT oil on occasion, but I don’t think that’s the same thing.

(Bob M) #6

MCT oil might help, though I’m not sure how long it takes to affect the body.

Basically, one theory for some migraines is the body can’t use glucose and has no other useful fuel source. Basically, your brain is “insulin resistant” or maybe glucose intolerant is a better term. Your idea of a migraine caused by low blood glucose is what caused me to suggest ketones. The ketones operate as a different source of energy.

Exogenous ketones should work a lot faster than MCT oils. But you could also try them too, say 1-2 hours before lunch. (I personally can’t take most MCT oils, so I can’t say how long they take to operate.)

I would doubt your blood sugar is changing while eating keto, but I’ve been known to be wrong (a lot) in the past.

My suggestions were to try to rule out low blood sugar or a glucose intolerant brain.

(Robin) #7

I also had the auras frequently for years. They are few and far between now. But when I do get them, I can usually trace it back to needing more salt.

#8

Not just salt, but specifically salt in water.

I listened to a podcast with Angela Stanton on, who has a theory about salt supplementation. I forget the detail, but she discussed how salt is processed by the body differs between it being put on food and it being added to water.

I know it sounds like nonsense, but I suffered terribly from these and it caused me to move away from keto in the past. (I recommend you don’t stop - I regret ever having done so.)

I think I’ll always be susceptible, especially in high stress situations or when artificial lighting is excessively bright - but I started supplementing salt after reading a post from Paul many months ago.

That improved matters by a long way - but the turning point was actually adding salt to my drinking water. It sounds horrible, but it’s not - if you need salt, the water tastes sweet/nicer with the added salt and insipid without it. And your body knows - if you’ve had enough, salted water tastes awful. It’s always a bit of a surprise when you leave half of a drink standing, come back to it an hour later and grimace at the taste.

I’m not cured, I still get them occasionally - but we’re talking months between attacks instead of days.

I also think your low blood sugar theory is likely correct. I had a spate of what I strongly believe were low blood sugar migraines - since going keto and then carnivore, I’ve not had a single one of these instances.

Oh, and to add to Paul’s advice above - I don’t get away with a pinch of salt helping during the attack, but consuming a lot of salt (plus a darkened room) does make the aura significantly less aggressive. Although be warned; it can have a laxative effect if you consume a lot.

(Robin) #9

Yes… salt in water!

(Joey) #10

Yes, this advice is well framed. Lightly salted water is basically Gatorade, without the sugar. I put 1 tsp scoop of NaCl + 1 tsp scoop of Mg Citrate into 28 fl oz of H2O each morning and drink it throughout the day. Gone by dinner time, when I switch to red wine :wink:

I, too, have had the occasional visual aura. Never painful, but can be large enough area to make it hard to see anything but for a small area in the center. (If it ever happened while driving I’d definitely pull over.) The frequency has been vastly reduced since cutting out the carbs and maintaining electrolytes, but still happens on rare occasions.

Wish I had better advice for you. Hard to relate to keto making it worse, although anything’s possible. I’d venture a guess that this is not why it’s happening - despite the curious association you’ve noticed.

Best wishes. Please keep us posted if you come across any apparent solutions. :vulcan_salute:

(Allie) #11

Do you take any supplements that have a high calcium content? That always does it for me.
Collagen is normally a big no for me for this exact reason, but I started taking a daily K2 tablet each morning (in addition to a D3 + K2 each evening) to see if that helped with calcium absorption and so far all good…

#12

Thanks to all for your responses. I’ll just dump my thoughts here …

1 tsp scoop of NaCl + 1 tsp scoop of Mg Citrate into 28 fl oz of H2O - I’m going to start with this (drinking it now)—seems the simplest solution for now.

Exogenous ketones - This will be my fallback if the Nacl/Mg Citrate drink doesn’t work.

Blood sugar - I may just do this out of curiosity. Any recos on a meter? I know there are so many.

Angela Stanton podcast - I’m going to check this out.

Supplements - I take D3 + K2 with lunch, along with 1 tsp of Mg Citrate (Natural Calm)

This had some interesting info …
https://deliverypdf.ssrn.com/delivery.php?https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2690933

(Ethan) #13

I always had these issues—4-6 a month for 20 years. They continued on keto. They were eliminated for two full years on carnivore. I did had 3 in the 3rd year of carnivore.

(You've tried everything else; why not try bacon?) #14

If your thinking is that low serum glucose caused the brain to lack fuel, which in turn caused the migraines, it doesn’t make sense that the brain on a ketogenic diet would run out of fuel, because ketones should take up the slack when glucose drops.

" 'Tis a puzzlement!"

(Edith) #15

You’ve had a lot of good advice here. I’ll just add that my husband gets ocular migraines, as well. They tend to happen when his salt intake is too low and/or he has not had enough to drink and is mildly dehydrated.