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

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.