Could this be the best migraine treatment?
Following 13 years of crippling migraine attacks and several attempts at treatment, Lily Earle was desperate for solutions. Could a course of fasting at a German clinic hold the key to getting her symptoms under control?
Here Lily explores her life with migraines and her experience at Buchinger Wilhelmi – a medically supervised fasting clinic in Überlingen, Germany.
If you have a medical condition, always consult your doctor before changing your diet.
Sitting in the departure lounge, I was a bag of nerves. I'd shared on my Instagram stories that I was going to do a 10-day fasting programme and lots of other migraine sufferers had messaged saying that going without food brought on their migraine attacks. The same was true for me, so I felt slightly bewildered as to why I had agreed to go at all.
My migraine attacks started at 19 but ramped up in my mid 20s. Aged 27, I had an attack so bad that I collapsed and was rushed to A&E. For the next five years, I was mainly bed- or sofa-bound, living in the dark because I was so sensitive to light. I couldn’t work, and I’d often be in the last stage of a migraine attack when the next one was starting.
My attacks are aggravated by other conditions. One is an autoimmune condition – mast cell activation syndrome (MCAS) – where the body can’t break down histamine effectively, leading to toxic levels in the body. The other is Ehlers-Danlos syndrome (EDS),
a connective tissue disorder of extreme hypermobility, joint pain and inflammation, which is sometimes so bad that my hands have turned into claws.
My neurologist has left no stone unturned. I’ve seen a string of specialists, had years of tests, scans and treatments and have been left with a lot of medical trauma. Twice I’ve had harrowing surgical injections of steroids with very long needles into my neck joints (I had to be knocked out the second time). I’ve been admitted to hospital for pain more times than I can count. I’ve tried a whole pharmacy of medications in various dosages: some failed, some worked for a time, some had terrible side-effects – one even left me blind for three days.
By my early 30s, I had almost given up hope of recovery. Finally, I found pain relief that worked: medical cannabis. I was lucky enough to get a private prescription via the charity Drug Science. It was worth every penny, making my migraine attacks shorter and more bearable.
Then, in mid-2022, my mother, Liz Earle, came back from a stay at Buchinger Wilhelmi – a medically supervised fasting clinic in Überlingen, Germany – feeling incredible. She’d quizzed the doctors on the science of fasting and how it speeds up a bodily process called autophagy, the recycling of old cells into new and healthy ones. The doctors explained that fasting puts the body into a state of ketosis – which levels blood sugar and reduces inflammation – and that they’ve had great success in treating both chronic migraine and autoimmune diseases. It’s not cheap (prices start at £3,066), but they offered me the chance to test the programme.
Mum insisted that I go to the clinic – cue a massive eye roll from me. For months I said no. Fasting goes against a key tenet of migraine disorder: eat little and often because blood sugar dips can lead to a migraine attack. She insisted I watch a video about the clinic, which explained how Buchinger Wilhelmi has studied 400 migraine patients who fasted for an average of 14 days and 94% saw an improvement. The idea is that there may be an initial migraine attack, but as ketosis stablises blood sugar, they reduce. I decided to ask my neurologist and he was supportive about me going.
The final push came from attending a course called the Lightning Process, which is at the cutting edge of chronic pain management. Chronic pain can begin as an alarm signal that something is wrong, but then your brain’s pain circuits keep firing even when the acute problem is fixed. On the course, we were taught ways to change thought patterns to feel calm, secure and safe, which can eventually help regulate your nervous system so your body is no longer following old pain-inducing pathways. It made me feel resilient enough to try another treatment.
I was still having almost daily migraine attacks when I travelled to the clinic, so I packed a bag full of medication and all my migraine tools (more on that later). Arriving at the clinic reception, I was struck by its glass wall with a huge view across Lake Constance and to the Swiss Alps beyond. The spa itself is a sprawling campus of treatment rooms, gyms and relaxation areas.
My bedroom looked as if a luxury spa and a hospital had a baby: a balcony overlooking the lake, flowers on the table – but also a bell to call the nurse. My 10-day stay started with a transition day: 600 calories of oats and vegetables. Everyone sees the doctor on day two for a tailored eating programme: mine was six days of fasting, then three of re-feeding. While fasting, I ate a tablespoon of honey, two clear vegetable broths, two plain yogurts and a small pot of courgette purée. Refeeding was steamed vegetables with olive oil and small pots of nuts.
A key principle is to chew until food turns to liquid in order to help digestion and reduce bloating. Every morning, I had a check-up with my kind nurse, Anna, who looked after me when, on day two, the promised migraine attack came. It was absolutely
brutal, lasting until I woke up on day four. Due to feeling unwell, I missed out on a lot of the clinic’s daily activities and long walks.
Over the next couple of days, I managed a sunny walk down to the waterfront, some gentle stretching and meditation classes. Then, on the second to last day, something extraordinary happened: I woke up without the debilitating brain fog that had dogged me for five years. And on the last day, I had enough energy to do an aqua aerobics class – my first bit of cardio in five years.
For chronic conditions like mine, the clinic recommends multiple fasts or fasts longer than 10 days. Before I left, my doctor, Dr Siegler, and I put together an eating plan to keep me in ketosis: eating within an eight-hour window with a 16-hour fast, very low carb content and adding in meat, eggs and cheese as well as lots of veg. Fast forward a few months and I’ve stopped the 16:8, but I’m still eating loosely low carbs. My former sweet tooth is completely gone. Even better, my joint pain and inflammation is now minimal and – I still can’t believe I’m writing this – I am having just one migraine attack every two weeks.
Alongside The Lightning Process and taking medical cannabis, I am sure fasting at the Buchinger Wilhelmi has played a big role in my recovery. After five years of spending my life mostly lying down, I know it’ll take me a while to build back my fitness and stamina, but I’m so grateful I have the chance to try. In future, I’d love to go back for a longer fast as I think I’d feel even more benefits.
It’s important to note, though, that this fast was brutal. I’d say it absolutely requires medical supervision and shouldn’t be tried at home. But if you suffer from debilitating migraines, it’s a treatment that could be well worth looking into.
Lily's go-to migraine tools
Living with migraines is tough – don’t be afraid to seek support for your mental health. I have also found journalling and mindfulness helpful in managing my mood.
Any twinge used to send me into panic mode, thinking I was about to have an attack. But now I stop and say out loud: ‘What if it doesn’t?’ This helps stop my mind from preempting the pain.
Lavender oil and massage balms to help me relax.
A heated neck wrap and an ice cap. I find heat at the back of my neck and ice packs on my forehead the best combination to bring relief.
A wraparound eye mask and Avulux migraine glasses for photosensitivity.
Cefaly Dual Migraine Treatment Device – it’s like transcutaneous electrical nerve stimulation (TENS) for your head.
Botox for migraines really helped bring my overall pain levels down over the years.
Any audiobook read by Stephen Fry – his voice is so melodic.
Everything you need to know about migraines
What are migraines?
Migraine is a neurological condition that can cause headaches. But what sets it apart from other headache disorders is the additional symptoms, which can include sickness, sensory and visual disturbances (such as sensitivity to light and sound, as well as numbness, dizziness, tingling and vertigo) and a lack of energy.
‘About a third of people with migraine experience neurological symptoms, such as zigzag lights in their vision or trouble finding and saying words before the headache kicks in,’ says Dr Rebecca Walker, a GP specialist in headache and migraine medicine. ‘These episodes are known as aura.’ Some people have emotional precursors to an attack, including anger, anxiety and feeling stressed.
What causes migraine attacks?
Migraines are caused by ‘a cascade of changes in brain chemistry’, says Professor Anne MacGregor, a specialist in headache and women’s health. Dr Steven Allder, consultant neurologist at Re:Cognition Health, says that migraines are complex and personal, with each person having a mix of contributing factors. ‘These include genetics, neurological factors (such as changes in brain activity, neurotransmitter imbalances, triggers and blood vessel and blood flow changes) and sensitivity to stimuli, such as light, sound or smell.’
Fluctuating hormones are a common trigger, but others include changes in weather conditions or environment, fatigue, sleep disturbance and strenuous exercise. ‘Some women regularly experience migraine attacks around their periods when oestrogen levels are changing,’ says Dr Walker. This is why migraine can get worse during the perimenopause and better after menopause for some women.
People often think certain things such as lights, noises, smells or foods are triggers. However, evidence suggests this may be due to the fact that people are already in the very early stages of the migraine, and so are more sensitive. For example, you may crave sugar
in this early stage, eat chocolate and then blame the chocolate.
There is a link between diet and the gut. Migraines are an inflammatory condition, and gut dysfunction causes an increase in inflammatory proteins – although we don’t yet know the mechanisms by which this influences migraines, says Dr Walker. Avoiding foods that cause you inflammation is key here, so watch out if you are coeliac or have an intolerance to gluten, dairy or foods containing histamine (as Lily does) or tyramine (in cheese).
What treatments are available?
For the best effects, take medication at the first sign of an attack. Specifically, non steroidal anti-inflammatory drugs (NSAIDs), a group that includes ibuprofen, naproxen and aspirin. Caffeine can enhance painkiller action (however, excessive caffeine can also trigger migraines in some people). Antiemetics (metoclopramide or prochlorperazine) relieve nausea and vomiting. Triptans (such as sumatriptan, rizatriptan and eletriptan) and ergotamines (usually prescribed by a doctor as a tablet or nasal spray) work by narrowing blood vessels in the brain.
But you can take medication too often. ‘If migraine is not well controlled with medication, you might benefit from taking a migraine preventive medication. Be wary of symptom treatment more than nine days a month as it can paradoxically result in more frequent migraine,’ says Professor MacGregor.
If your migraine is hormonal, suppressing the menstrual cycle with some hormonal contraceptives can work. Other preventatives that can reduce frequency and severity of attacks include antidepressants (affecting the level of serotonin and other chemicals in your brain), beta blockers (these reduce blood vessel dilation, known to contribute to migraine) and anticonvulsants (which calm the overexcited nerves). The newest preventative medications target CGRP, a chemical messenger that increases during migraine attacks. And if you’ve trialled tablets but they haven’t worked, Botox for chronic migraine care is available on the NHS.
What else can help to get rid of a migraine?
When an attack comes, ‘even just taking 10 to 15 minutes of time out in a quiet, darkened room can help medication work more effectively,’ says Professor MacGregor. ‘Many people find taking it with a sweet fizzy drink helps. Simple strategies such as running a hot shower on the back of your neck, cooling gel strips and menthol sticks can all help to ease the pain.’
For prevention, keep a diary of when attacks occur to find out your triggers and also to show your doctor. Stress can be a factor, too. Make sure your brain gets sufficient food, water and sleep, says Dr Walker.
It’s clear that a drop in blood sugar can lead to an attack but, as in Lily’s experience, there is some evidence that sticking to a keto diet may be helpful over time. A 2021 study found that the keto diet shortened migraine duration by six hours. Sexual activity can also help (although is perhaps not appealing): in a 2013 study of 600 migraine patients surveyed, 60% of respondents who engaged in sexual activity during a migraine reported relief. Dr Allder says many people also find relief with non-drug complementary therapies, such as chiropractic, acupuncture or craniosacral therapy.
If you or someone you know is struggling with migraines, visit the NHS website for more information on the support and treatment available.
This feature originally appeared in the October 2023 issue of Red Magazine.
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