The ketogenic diet, originally developed to treat epilepsy in the 1920s, has emerged as a potential game-changer for migraine sufferers.

Arecent review paper suggests that the high-fat, low-carbohydrate approach of the ketogenic diet on average has a very positive impact on migraine frequency, intensity and medication use, even if not all studies have reached statistical significance.

While a ketogenic diet comes with its own difficulties, ketosis isn't just another health trend—it's a beneficial metabolic shift that could transform how we understand and treat these complex neurological events.

Whether you're considering keto specifically for migraine relief, or you're already following the diet and wondering how it might affect your headaches, this comprehensive guide will walk you through the science, benefits, potential pitfalls, and practical considerations of using ketosis (the state of elevated ketone bodies in your blood) as a migraine management strategy.

From blood sugar stabilization to ketone bodies as alternative brain fuel, we'll explore exactly how this dietary approach might help quiet the storm in your head—and when it might not be the right solution.

The Keto-Migraine Connection

Before we dive into the keto-migraine connection, let’s quickly go over the most important definitions needed to navigate the keto space:

• Ketogenic Diet: A high-fat, moderate-protein, and very low-carbohydrate diet designed to shift the body’s metabolism toward fat-burning and ketone body production.
• Ketosis: The metabolic state in which ketone bodies are elevated in blood and organs.
• Ketone Bodies: Energy molecules (acetoacetate, beta-hydroxybutyrate, and acetone) produced in the liver from fat metabolism during periods of low carbohydrate availability or more recently also in the lab to consume as supplements.
• Beta-Hydroxybutyrate (BHB): The most abundant and stable ketone body in the blood, serving as a key energy source for the brain and muscles during ketosis.
  

The relationship between the ketogenic diet and migraine relief isn't just coincidental—it's rooted in fascinating neurobiological mechanisms.

When you transition to a ketogenic state, your body undergoes profound metabolic changes that may directly address several underlying issues in migraine.

This metabolic shift creates a cascade of effects: stabilizing glucose levels that would otherwise fluctuate dramatically, reducing neuroinflammation that contributes to pain sensitivity, and providing ketones as an alternative fuel source for brain cells that may be experiencing energy deficits during migraine attacks.

Understanding this connection helps explain why many migraine sufferers report significant improvement after adopting this dietary approach, often when traditional treatments have failed.

Some beneficial mechanisms are due to changes in the diet itself, such as reduction in processed carbohydrates or increase of healthy fats and some mechanisms are due to the increase in the ketone bodies themselves.

Recent research highlights how ketone bodies—especially D-β-hydroxybutyrate (D-BHB)—support brain function. These findings help explain why the ketogenic diet benefits people sensitive to energy fluctuations in the brain.

Let's explore the key pathways through which the ketogenic diet may transform your migraine experience.

Blood Sugar Stabilization and Migraine

While the connection between blood sugar stabilization and migraine isn't entirely understood, the ketogenic diet might offer valuable insights into this intricate relationship.

By excluding sugar and most carbohydrates  this diet stabilizes blood sugar levels, which helps the glucose supply to the brain and can potentially reduce migraine frequency.

Fluctuating blood sugar can trigger migraine, so maintaining stable levels can be crucial in preventing these attacks.

Compensating for Low Brain Energy in Migraine

The connection between low blood sugar and migraine has been recognized for decades. Fasting can trigger migraine in sensitive individuals, and brain scans show reduced energy production in certain cases.

Shifting to nutritional ketosis means your body uses ketone bodies instead of glucose, which may stabilize brain energy metabolism, a key factor in migraine management.

D-BHB helps by:

• Supporting brain cell survival under low-glucose conditions

• Boosting ATP (energy) production

• Providing an efficient energy source that reduces reliance on glucose

• Generating more ATP per oxygen molecule than other fuel sources

• Sparing glucose for other essential functions

Historical studies found that people prone to migraine showed increased free fatty acid (FFA) and ketone levels before experiencing symptoms, suggesting a natural metabolic response to energy shortages.

Alternative Fuel for the Migraine Brain 

Some individuals have difficulty transporting glucose into the brain due to genetic or metabolic factors. 

Ketone bodies bypass this limitation by using a different transport system (MCTs), ensuring a steady energy supply. 

Research also shows that ketogenic diets may enhance glucose and ketone transport, further optimizing brain energy availability.

The keto diet's impact on metabolic dysfunctions is another factor to consider.

Migraine may result from metabolic issues, and using ketones instead of glucose might help bypass these dysfunctions.

Research suggests that the alternative energy source from ketosis could support brain energy metabolism, which is relevant for migraine.

Supporting Mitochondrial Function 

Mitochondria are the powerhouses of cells, and many neurological challenges, including migraine, have been linked to mitochondrial dysfunction. Evidence suggests:

• Higher prevalence of migraine in mitochondrial disorders

• Genetic links between mitochondrial function and migraine

• Reduced mitochondrial enzyme activity in some individuals with migraine

D-BHB enhances mitochondrial function by:

• Stimulating new mitochondria production

• Supporting alternative energy pathways

• Maintaining ATP production even when some pathways are impaired

Reducing Oxidative Stress 

Oxidative stress, caused by an imbalance between free radicals and antioxidants, has been observed in those with neurological sensitivities, including migraine. Research has found:

• Reduced antioxidant enzyme activity in affected individuals

• Accumulation of pro-oxidant compounds in the brain over time

D-BHB combats oxidative stress by:

• Neutralizing free radicals

• Enhancing the body's antioxidant defenses (e.g., increasing glutathione production)

• Regulating key protective genes

Balancing Brain Excitability 

An overly excitable nervous system is commonly seen in individuals prone to sensory overload. The link between neurological sensitivity and other conditions like epilepsy suggests overlapping mechanisms.

D-BHB helps regulate brain activity by:

• Increasing GABA (a calming neurotransmitter)

• Reducing excessive neuronal firing

• Modulating glutamate activity

• Supporting energy-sensitive potassium channels that stabilize nerve function

Anti-Inflammatory Effects 

Inflammation plays a role in migraine. D-BHB has been shown to:

• Reduce inflammation-related signaling

• Prevent excessive immune activation in the brain

• Lower levels of pro-inflammatory molecules

Microbiome Influence 

The gut microbiome is increasingly recognized as a factor in brain health. People with neurological issues such as migraine often also have GI issues. Studies indicate that a ketogenic diet can:

• Improve microbiome balance

• Increase beneficial bacteria like Akkermansia

• Reduce gut-related inflammation that affects the brain

Healthy Fats and Their Impact on Headaches

Incorporating healthy fats into your diet may play a crucial role in managing headaches, particularly for those following the ketogenic diet.

Healthy fats, such as those found in avocados and olive oil, are a key dietary intervention that can help reduce inflammation.

Inflammation is often linked to migraine episodes, so minimizing it might decrease headache frequency and severity.

By consuming these fats, you provide your body with essential nutrients that support overall health and potentially ease migraine discomfort.

Additionally, healthy fats contribute to maintaining stable energy levels, which is vital in migraine management.

Research indicates that a higher intake of healthy fats, such as omega 3 fats, can modulate inflammatory responses, offering a promising approach for those seeking relief from migraine headaches through dietary changes.

These various different mechanisms highlight how ketosis might offer relief for migraine sufferers. 

The metabolic adaptations triggered by the ketogenic diet appear to address multiple pathways involved in migraine generation and persistence.

This is the beauty of this approach: Migraine is a very heterogenous disease and the fact that it works via so many different mechanisms at the same time might explain why it is so potent in so many different patients.

While promising, it's vital to consult a healthcare provider before making dietary changes for migraine management and the ketogenic approach has challenges, and not everyone finds it easy to follow. 

Understanding potential drawbacks can help determine if it's the right fit for your needs, which we’ll explore next.

Getting Started with Keto for Migraine Management

Transitioning to a ketogenic diet requires careful planning, especially when your goal is migraine relief.

The initial adjustment period, often called "keto flu," can temporarily worsen headaches before improvement occurs.

Start by gradually reducing carbohydrates rather than eliminating them overnight. This gentler approach may help minimize transition symptoms.

Focus on increasing healthy fats like avocados, olive oil, and fatty fish while maintaining adequate hydration and electrolyte balance, this includes increased salt and mineral intake.

It may also be beneficial to add an exogenous ketone body source during the transition period, where you will have less glucose than before, but are not yet making ketone bodies in your liver. 

Brain Ritual for example combines D-BHB with electrolytes, trace minerals, nutrients and antioxidants, which can be helpful during the transition.

Track your food intake and migraine patterns in a detailed journal to identify potential triggers that persist even on keto and be aware of personal triggers, such as diary or other food intolerances that are still present on a keto diet.

Most importantly, if you decide to go down the keto route, eat real and whole foods. Replacing processed carbs by processed keto snacks is not going to make things better! Real foods with real nutrients are essential, no matter which dietary regimen you decide to follow.

Here's a table outlining a timeline for getting started with a ketogenic diet for migraine management, including what a person might notice over time:

It's important to note that individual experiences may vary, and it's crucial to consult with a healthcare provider before starting any new diet, especially for migraine management.

Some people may experience benefits sooner, while others might take longer to adapt.

Keto As Nutritional Powerhouse for Migraine Management

Now that you understand how the ketogenic diet affects migraine mechanisms and have a roadmap for getting started, let's explore why this approach is more than just a metabolic intervention—it's a nutritional powerhouse for migraine management.

Beyond the benefits of ketosis itself,  a whole foods ketogenic diet naturally emphasizes nutrient-dense foods that address common deficiencies linked to migraine susceptibility.

While following your keto plan, you'll likely consume higher amounts of essential micronutrients, quality proteins, and specific minerals that support neurological health and resilience against migraine triggers.

This nutritional enhancement complements the metabolic benefits discussed earlier, creating a comprehensive approach to migraine management.

The foods that keep you in ketosis also provide the building blocks your brain needs to function optimally and resist pain signals.

Essential Micronutrients in the Keto Diet

You see, a well formulated ketogenic diet naturally incorporates foods rich in magnesium, riboflavin (vitamin B2), and omega-3 fatty acids—all shown to may help prevent migraine.

• Magnesium, found abundantly in avocados, nuts, and leafy greens, helps regulate neurotransmitters and blood vessel function.

• Riboflavin, present in eggs and certain meats, supports mitochondrial function, is known to play a role in migraine

• Omega-3 fatty acids from small fatty fish and flaxseeds have anti-inflammatory properties that may positively impact headaches

• Vitamin D, often found in fatty fish and egg yolks, plays a crucial role in reducing inflammation

• Vitamin E from nuts and seeds provides antioxidant protection that may reduce oxidative stress involved in migraine pathophysiology.

• Coenzyme Q10, found in fatty meats and nuts, supports mitochondrial energy production and has been studied in migraine controlled trials

These nutrients work synergistically to support neurological health and mitigate migraine triggers.

By consuming these micronutrients regularly through keto-friendly foods or supplementation, you're not just avoiding carbohydrates—you're actively nourishing your nervous system with compounds scientifically linked to migraine management.

Protein and Iron Intake for Migraine Management

It is not only important to focus on micronutrients, but protein quality and iron intake also play critical roles in migraine management.

High-quality proteins provide essential amino acids that serve as precursors for neurotransmitters regulating pain perception.

Iron, found in red meat and organ meats common in ketogenic diets, helps potentially prevent the fatigue and brain fog that can trigger migraine.

When properly formulated, a ketogenic diet delivers these nutrients in bioavailable forms, potentially addressing deficiencies that conventional migraine treatments often overlook.

This nutritional completeness contributes significantly to the diet's effectiveness and long-term sustainability as a migraine management strategy.

Electrolyte Balance and Hydration

Proper electrolyte balance is crucial for neurological function and migraine support.

The ketogenic diet naturally increases your body's excretion of sodium, potassium, and magnesium, making deliberate supplementation necessary.

• Sodium: 3-5g daily, especially during the adaptation phase

• Potassium: Found in avocados, nuts, and leafy greens

• Magnesium: Consider supplementing 300-600mg daily

• Calcium: Include dairy or fortified alternatives if tolerated

Adequate hydration works synergistically with electrolyte balance to maintain proper nerve function and prevent dehydration-triggered migraine.

Aim for 2-3 liters of water daily, adjusting based on activity level and climate.

When properly balanced, electrolytes and hydration support the ketogenic diet's effectiveness for migraine support by:

• Stabilizing neuronal excitability

• Reducing inflammation

• Supporting proper blood flow to the brain

• Reducing the headaches commonly associated with the "keto flu"

Many migraine sufferers report that maintaining this careful balance is key to maximizing the benefits of ketogenic protocol.

Potential Pitfalls of Keto for Migraine Sufferers

As you consider the keto diet for migraine management, it's crucial to be aware of potential pitfalls, such as longer-term hormonal imbalances that can arise from strict carbohydrate restriction and stress for the liver or nutrient deficiencies if not done correctly.

Hormonal Imbalances and Their Headache Risks

While the ketogenic diet offers potential benefits for migraine management, it's crucial to consider its impact on long-term hormonal balance, particularly for women.

Drastic changes in macronutrient intake can lead to hormonal imbalances, which can impact menstruation or thyroid hormone production. 

It's vital to be aware of potential pitfalls, especially if you're a woman considering this dietary approach.

Here's what you should keep in mind:

• Hormonal fluctuations: A strict keto diet may alter estrogen and progesterone levels, this can affect menstruation and many other pathways influenced by female hormones, which are strong antioxidants and also vital for metabolism. This may also impact headache frequency and migraine.  

• Stress response: A strict keto regimen can stress your body, potentially increasing headache risk long term.

• Individual variability: Not everyone will experience the same hormonal impacts, so personalized monitoring is essential.

• Thyroid function: Some individuals experience altered thyroid hormone levels on keto, which can influence metabolism and migraine patterns.

• Adrenal impact: The initial adaptation to ketosis may stress adrenal glands, potentially triggering headaches.

For women with menstrual-related migraine, these hormonal shifts deserve special attention.

Consider implementing a more moderate low-carb approach (50-100g daily) rather than strict ketosis, especially during certain phases of your cycle. This modified approach may provide metabolic benefits while minimizing hormonal disruptions that could counteract migraine improvement.

Liver Stress and Medication Interactions

Considering the relationship between the ketogenic diet and liver stress, it's essential to understand how this dietary approach might impact individuals with migraine histories, especially those who've relied heavily on medication.

The liver plays a pivotal role in both ketone production and processing medications, as well as toxins.

If you have taken a lot of migraine medication over the years, the added strain of a ketogenic diet forcing the liver to make ketone bodies may exacerbate liver stress or lead to insufficient ketone body production..

This stress can interfere with the liver's ability to produce ketone bodies effectively , potentially complicating migraine management in some patients.

Moreover, the ketogenic diet's demands on the liver might hinder its capacity to detoxify, potentially increasing the risk of adverse interactions between ketones and migraine medications.

It's crucial to consult healthcare professionals when considering this diet to ensure safe and effective migraine management.

Initial Side Effects and Adaptation Challenges

As your body transitions from glucose to ketone bodies for fuel, you might experience what's commonly known as the "keto flu." This temporary condition includes:

• Fatigue and headaches: These can occur as your body adapts to carbohydrate restriction.

• Digestive issues: Constipation or diarrhea can result from dietary shifts.

• Electrolyte imbalances: These can lead to muscle cramps or dizziness.

These initial side effects are generally short-lived but can be particularly challenging for migraine sufferers already sensitive to changes.

It's important to stay hydrated, ensure adequate electrolyte intake, and consult with a healthcare provider to navigate these adaptation challenges effectively during your keto journey and potentially adding exogenous sources of ketone bodies during the transition.

Beyond Strict Keto Alternatives for Migraine Management

While the ketogenic diet shows promise for migraine management, its strict macronutrient requirements can be challenging to maintain long-term for many people.

Fortunately, the scientific understanding of ketosis and migraine has evolved to offer more flexible approaches that capture many of the benefits without requiring such dietary rigor.

Brain Ritual as Ketone-based Migraine Medical Food

For individuals seeking migraine relief without the stringent requirements of a ketogenic diet, Brain Ritual represents a scientifically advanced alternative or addition developed specifically for migraine management.

Developed in Switzerland by neuroscientist Dr. Elena Gross—herself a former chronic migraine sufferer—Brain Ritual is the world's first medical food designed to address the metabolic aspects of migraine pathophysiology.

MigraKet delivers the benefits of ketosis through exogenous ketone bodies (D-Beta-Hydroxybutyrate) while simultaneously addressing multiple nutritional pathways involved in migraine:

• Alternative Brain Fuel: Provides 8,560mg of D-Beta-Hydroxybutyrate per day, offering your brain an efficient energy source beyond glucose

• Mitochondrial Support: Contains Coenzyme Q10 (150mg) and L-Carnitine (500mg) per day to enhance cellular energy production

• Comprehensive Micronutrients: Includes therapeutic doses of migraine-specific nutrients like Riboflavin (400mg) and Magnesium (650mg)

• Antioxidant Protection: Delivers vitamins A, C, E, and mixed tocopherols to combat oxidative stress implicated in migraine pathogenesis

The formula works in a four-step process:

1. Boosting brain energy with alternative fuel sources

2. Supplying vital nutrients that support optimal nervous system function

3. Delivering antioxidants for cellular protection

4. Supporting hydration via electrolytes and trace minerals

Advantages of Brain Ritual Over a Strict Ketogenic Diet

Unlike a traditional ketogenic diet, Brain Ritual offers several practical advantages:

• Convenience: No need to adhere to very strict dietary limitations or calculate macronutrient ratios

• Comprehensive Formulation: Contains over 30 bioavailable, human-identical nutrients specifically selected for migraine management

• Rapid Adaptation: May show benefits within weeks, compared to the longer adaptation period of dietary ketosis

• Sustainability: Easier to maintain long-term than a full ketogenic diet

• Precision Dosing: Delivers exact therapeutic amounts of key nutrients known to support migraine management

For optimal results, Brain Ritual is taken twice daily (morning and late afternoon) mixed with water, and is recommended to be taken long-term for the full metabolic benefits.

As a medical food, it should be used under medical supervision as part of a comprehensive migraine management strategy.

This science-backed approach makes Brain Ritual a viable option for those seeking the advantages of metabolic strategies without completely restructuring their dietary lifestyle.

Combining Keto Principles with Traditional Treatments

Brain Ritual can be a great option for those seeking the metabolic benefits of ketosis without the challenges of maintaining a strict ketogenic diet.

However, some individuals may prefer combining keto principles with their existing migraine treatments.

For many migraine sufferers, the most effective approach may not be an either/or decision between ketogenic principles and conventional treatments, but rather a strategic integration of both.

Here are potential approaches for combining ketogenic principles with conventional treatments:

1. Modified Ketogenic Diet: Rather than strict ketosis, aim for a moderate carbohydrate restriction (50-100g daily) while emphasizing healthy fats and quality proteins. This approach is often more sustainable while still providing metabolic benefits.

2. Strategic Supplementation: Consider these targeted nutrients that support both ketogenic metabolism and traditional migraine management:

• Exogenous ketone bodies in mineral salts form: 5-15g daily to boost blood ketone levels without strict dietary adherence

• Magnesium: 300-600mg daily 

• Riboflavin (B2): 400mg daily, shown inclinical trials to positively impact migraine

• CoQ10: 100-300mg daily to support mitochondrial function

• Omega-3 fatty acids: 1-3g daily to reduce inflammation

3. Medication Optimization: Work with your healthcare provider to:

• Time medications appropriately with meals to maximize absorption

• Adjust dosages as your metabolic health improves

• Consider preventive medications that don't interfere with ketosis (if applicable)

4. Lifestyle Integration: Incorporate complementary practices that enhance both ketogenic and pharmaceutical approaches:

• Stress management: Meditation, yoga, or breathing exercises to reduce a common migraine trigger

• Sleep optimization: Prioritize 7-9 hours of quality sleep to support metabolic health and reduce migraine susceptibility

• Regular movement: Moderate activity 3-5 times weekly to improve insulin sensitivity and stress resilience

To effectively combine approaches, implement these tracking strategies:

• Migraine diary: Document frequency, intensity, and duration of attacks alongside treatments used

• Ketone monitoring: Use blood ketone meters (optimal) or breath analysis or urine strips to verify metabolic effects

• Medication usage: Track acute medication use to identify patterns and potential reductions over time

• Trigger identification: Note potential triggers that persist despite metabolic interventions

By thoughtfully integrating ketogenic principles with conventional treatments under proper medical supervision, you can create a personalized, multi-faceted approach that addresses migraine from multiple angles—potentially achieving greater relief than either strategy alone could provide.

Frequently Asked Questions

After exploring the intriguing relationship between the keto diet and migraine, you may still have some questions.

We’ve compiled some frequently asked questions to provide you with clearer insight into this topic.

Can the ketogenic diet be used for migraine prophylaxis in patients who don't respond to medication?

Yes, the ketogenic diet shows promise as a migraine prophylaxis option for patients with refractory migraine who haven't responded well to traditional preventive medications.

Research indicates that the beneficial effects of ketosis may positively impact migraine pathways, such as metabolism, that are not commonly addressed by standard migraine medications. .

However, this approach should be implemented under medical supervision as part of a comprehensive treatment plan, especially for patients who have not responded to multiple preventive therapies.

How does a ketogenic diet compare to other dietary treatments for migraine management?

When comparing the ketogenic diet to other dietary treatments for migraine management,research suggests it may be more effective than low-calorie diets or low-glycemic-index diets for certain patients.

The role of ketone bodies as an alternative fuel source appears to provide unique benefits beyond simple caloric restriction.

However, each dietary approach has its merits, especially when based on whole foods and the optimal choice depends on individual factors including comorbidities, lifestyle, and specific migraine triggers.

Some patients may benefit from a less restrictive approach that still incorporates principles from these various dietary protocols.

What should I include in my headache diary when starting keto for migraine?

When starting a ketogenic diet for migraine management, your headache diary should track more than just your daily headache frequency and intensity.

Include measurements of body mass and composition (including free-fat mass and adipose tissue changes), food intake with special attention to intake of carbs, proteins and fats, levels of ketosis (measured via blood or breath ketones), potential triggers, medication use, sleep quality, stress levels, and any side effects experienced.

In addition, certain potentially problematic food groups, such as dairy, should be monitored.

This comprehensive tracking helps identify patterns and determine whether insufficient levels of ketosis might be limiting your results, or if certain foods within the ketogenic framework still act as triggers.

Is the ketogenic diet appropriate for adolescents with chronic migraine?

The ketogenic diet can be considered as a diet for adolescents with chronic migraine, particularly when conventional treatments have failed.

However, special considerations are necessary due to growth and developmental needs. The diet should be carefully formulated to ensure adequate nutrition while maintaining therapeutic levels of ketosis.

Close monitoring by both a neurologist and dietitian with experience in ketogenic therapy is essential to ensure proper implementation and to monitor for potential side effects.

Parents should be educated about the importance of maintaining a balanced diet within ketogenic parameters to support their adolescent's overall health.

How can I manage abdominal pain while transitioning to a ketogenic diet for migraine?

Abdominal pain is a common side effect during the transition to a ketogenic diet, which can be particularly concerning for migraine sufferers who may already experience gastrointestinal symptoms during attacks.

To minimize this discomfort, gradually reduce carbohydrates over 4 weeks rather than eliminating them suddenly.

Ensure adequate hydration, increase salt intake to maintain electrolyte balance, and consider digestive enzymes with meals.

Adding MCT oil gradually rather than all at once can also help. If abdominal pain persists beyond the adaptation period (typically 2-3 weeks), consult with a healthcare provider as this could indicate gallbladder issues or other concerns that need medical attention.

What are the protective effects of ketosis against migraine triggers?

The protective effects of ketosis against common migraine triggers operate through several mechanisms.

Ketone bodies are an alternative and more effective energy source for the brain and a keto diet helps stabilize blood glucose levels.

Ketosis may help stabilize neuronal excitability, potentially reducing sensitivity to environmental triggers like bright lights or loud sounds.

The anti-inflammatory and antioxidant properties of ketosis may decrease reactivity to dietary triggers by reducing systemic inflammation.

Additionally, a ketogenic diet may improve the gut microbiome and fat mass loss and metabolic improvements from the ketogenic diet may also be beneficial.

This multi-faceted protection explains why some patients report being less sensitive to their usual triggers when in nutritional ketosis, even when deliberately exposed to them.

Conclusion

The ketogenic diet offers a promising metabolic approach to migraine management, helping to stabilize blood sugar, decrease inflammation, and improve brain energy metabolism.

While traditional keto requires careful implementation, alternatives like Brain Ritual or modified low-carb approaches provide more accessible options for those seeking benefits without strict dietary constraints.

Individual responses vary, and the most effective strategy may combine ketogenic principles with conventional treatments under medical supervision.

Whether you choose strict ketosis or a modified approach, metabolic therapy represents a valuable consideration in the comprehensive management of migraine—one that addresses the condition at its neurobiological roots rather than simply masking symptoms.