A diet higher in fatty fish helped frequent migraine sufferers reduce their monthly number of headaches and intensity of pain compared to participants on a diet higher in vegetable-based fats and oils, according to a new study. The findings by a team of researchers from the National Institute on Aging (NIA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), parts of the National Institutes of Health; and the University of North Carolina (UNC) at Chapel Hill, were published in the July 3 issue of The BMJ.

This study of 182 adults with frequent migraines expanded on the team’s previous work on the impact of linoleic acid and chronic pain. Linoleic acid is a polyunsaturated fatty acid commonly derived in the American diet from corn, soybean, and other similar oils, as well as some nuts and seeds. The team’s previous smaller studies explored if linoleic acid inflamed migraine-related pain processing tissues and pathways in the trigeminal nerve, the largest and most complex of the body’s 12 cranial nerves. They found that a diet lower in linoleic acid and higher in levels of omega-3 fatty acids (like those found in fish and shellfish) could soothe this pain pathway inflammation.

In a 16-week dietary intervention, participants were randomly assigned to one of three healthy diet plans. Participants all received meal kits that included fish, vegetables, hummus, salads, and breakfast items. One group received meals that had high levels of fatty fish or oils from fatty fish and lowered linoleic acid. A second group received meals that had high levels of fatty fish and higher linoleic acid. The third group received meals with high linoleic acid and lower levels of fatty fish to mimic average U.S. intakes.

During the intervention period, participants monitored their number of migraine days, duration, and intensity, along with how their headaches affected their abilities to function at work, school, and in their social lives, and how often they needed to take pain medications. When the study began, participants averaged more than 16 headache days per month, over five hours of migraine pain per headache day, and had baseline scores showing a severe impact on quality of life despite using multiple headache medications.

The diet lower in vegetable oil and higher in fatty fish produced between 30% and 40% reductions in total headache hours per day, severe headache hours per day, and overall headache days per month compared to the control group. Blood samples from this group of participants also had lower levels of pain-related lipids. Despite the reduction in headache frequency and pain, these same participants reported only minor improvements in migraine-related overall quality of life compared to other groups in the study.

Migraine, a neurological disease, ranks among the most common causes of chronic pain, lost work time, and lowered quality of life. More than 4 million people worldwide have chronic migraine (at least 15 migraine days per month) and over 90% of sufferers are unable to work or function normally during an attack, which can last anywhere from four hours to three days. Women between the ages of 18 and 44 are especially prone to migraines, and an estimated 18% of all American women are affected. Current medications for migraine usually offer only partial relief and can have negative side effects including sedation, and the possibility of dependence or addiction.

“This research found intriguing evidence that dietary changes have potential for improving a very debilitating chronic pain condition like migraine without the related downsides of often prescribed medications,” said Luigi Ferrucci, M.D., Ph.D., scientific director of NIA.

The NIH team was led by Chris Ramsden, a clinical investigator in the NIA and NIAAA intramural research programs, and UNC adjunct faculty member. Ramsden and his team specialize in the study of lipids — fatty acid compounds found in many natural oils — and their role in aging, especially chronic pain and neurodegenerative conditions. The UNC team was led by Doug Mann, M.D., of the Department of Neurology, and Kim Faurot, Ph.D., of the Program on Integrative Medicine. Meal plans were designed by Beth MacIntosh, M.P.H., of UNC Healthcare’s Department of Nutrition and Food Services.

“Changes in diet could offer some relief for the millions of Americans who suffer from migraine pain,” said Ramsden. “It’s further evidence that the foods we eat can influence pain pathways.”

The researchers noted that these findings serve as validation that diet-based interventions increasing omega-3 fats while reducing linoleic acid sources show better promise for helping people with migraines reduce the number and impact of headache days than fish-oil based supplements, while reducing the need for pain medications. They hope to continue to expand this work to study effects of diet on other chronic pain conditions.

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This study was supported by the NIH NIA and NIAAA intramural research programs; and NIH grants including 1R01AT007813-01A1, T32 AT003378, DK056350, and UL1TR002489.

Eating a diet rich in omega 3 (n-3) fatty acids reduces the frequency of headaches compared with a diet with normal intake of omega 3 and omega 6 (n-6) fatty acids, finds a study published by The BMJ today.

Modern industrialised diets tend to be low in omega 3 fatty acids and high in omega 6 fatty acids. These fatty acids are precursors to oxylipins – molecules involved in regulating pain and inflammation.

Oxylipins derived from omega 3 fatty acids are associated with pain-reducing effects, while oxylipins derived from omega 6 fatty acids worsen pain and can provoke migraine. But previous studies evaluating omega 3 fatty acid supplements for migraine have been inconclusive.

So a team of US researchers wanted to find out whether diets rich in omega 3 fatty acids would increase levels of the pain-reducing 17-hydroxydocosahexaenoic acid (17-HDHA) and reduce the frequency and severity of headaches.

Their results are based on 182 patients at the University of North Carolina, USA (88% female; average age 38 years) with migraine headaches on 5-20 days per month who were randomly assigned to one of three diets for 16 weeks.

The control diet included typical levels of omega 3 and omega 6 fatty acids. Both interventional diets raised omega 3 fatty acid intake. One kept omega 6 acid intake the same as the control diet, and the other concurrently lowered omega 6 acid intake.

During the trial, participants received regular dietary counseling and access to online support information. They also completed the headache impact test (HIT-6) – a questionnaire assessing headache impact on quality of life. Headache frequency was assessed daily with an electronic diary.

Over the 16 weeks, both interventional diets increased 17-HDHA levels compared with the control diet, and while HIT-6 scores improved in both interventional groups, they were not statistically significantly different from the control group.

However, headache frequency was statistically significantly decreased in both intervention groups.

The high omega 3 diet was associated with a reduction of 1.3 headache hours per day and two headache days per month. The high omega 3 plus low omega 6 diet group saw a reduction of 1.7 headache hours per day and four headache days per month, suggesting additional benefit from lowering dietary omega-6 fatty acid.

Participants in the intervention groups also reported shorter and less severe headaches compared with those in the control group.

This was a high quality, well designed trial, but the researchers do point to some limitations, such as the difficulty for patients to stick to a strict diet and the fact that most participants were relatively young women so results may not apply to children, older adults, men, or other populations.

“While the diets did not significantly improve quality of life, they produced large, robust reductions in frequency and severity of headaches relative to the control diet,” they write.

“This study provides a biologically plausible demonstration that pain can be treated through targeted dietary alterations in humans. Collective findings suggest causal mechanisms linking n-3 and n-6 fatty acids to [pain regulation], and open the door to new approaches for managing chronic pain in humans,” they conclude.

These results support recommending a high omega 3 diet to patients in clinical practice, says Rebecca Burch at the Brigham and Women’s Hospital, in a linked editorial.

She acknowledges that interpretation of this study’s findings is complex, but points out that trials of recently approved drugs for migraine prevention reported reductions of around 2-2.5 headache days per month compared with placebo, suggesting that a dietary intervention can be comparable or better.

What’s more, many people with migraine are highly motivated and interested in dietary changes, she adds. These findings “take us one step closer to a goal long sought by headache patients and those who care for them: a migraine diet backed up by robust clinical trial results.”

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Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Randomised controlled trial; Opinion
Subjects: US adults

Changing consumption of certain fatty acids can lessen severity of headaches

A new study shows how a change in diet based on certain classes of fatty acids decreased headaches in patients over a 16-week period

University of North Carolina Health Care

Research News

CHAPEL HILL, NC – Migraine is one of the largest causes of disability in the world. Existing treatments are often not enough to offer full relief for patients. A new study published in The BMJ demonstrates an additional option patients can use in their effort to experience fewer migraines and headaches – a change in diet.

“Our ancestors ate very different amounts and types of fats compared to our modern diets,” said co-first author Daisy Zamora, PhD, assistant professor in the UNC Department of Psychiatry in the UNC School of Medicine. “Polyunsaturated fatty acids, which our bodies do not produce, have increased substantially in our diet due to the addition of oils such as corn, soybean and cottonseed to many processed foods like chips, crackers and granola.”

The classes of polyunsaturated fatty acids examined in this study are omega-6 (n-6) and omega-3 (n-3). Both have important functions within our body, but need to be in balance, as n-3 fatty acids have been shown to decrease inflammation and some derivatives of n-6 have been shown to promote pain. However, due to the amount of processed food consumed today, most people in the U.S. are eating substantially more n-6 and fewer n-3 fatty acids.

To see whether the amount of these fatty acids in a person’s diet could impact pain from headaches, 182 patients currently diagnosed with and seeking treatment for migraines were enrolled in this randomized, controlled trial, led by Doug Mann, MD, professor of Neurology and Internal Medicine in the UNC School of Medicine. In addition to their current treatments, patients adhered to one of three diets for 16 weeks: a control diet that maintained the average amount of n-6 and n-3 fatty acids that a person living in the U.S. consumes, a diet that increased n-3 and maintained n-6 fatty acids, and a diet that increased n-3 and decreased n-6 fatty acids. Participants were provided with 2/3 of their daily food requirements, and were also given an electronic diary to record how many hours each day they had headache pain.

“Participants seemed highly motivated to follow these diets due to the amount of pain they were experiencing,” said Beth MacIntosh, MPH, RD, clinical nutrition manager for the UNC Metabolic and Nutrition Research Core.

“The results are quite promising,” Zamora said. “Patients who followed either diet experienced less pain than the control group. Those who followed the diet high in n-3 and low in n-6 fatty acids experienced the biggest improvement.”

Participants reported fewer days a month with headaches, and some were able to decrease the amount of medication they needed for their pain. However, participants did not report a change in quality of life.

“I think this modification in diet could be impactful,” Zamora said. “The effect we saw for the reduction of headaches is similar to what we see with some medications. The caveat is that even though participants did report fewer headaches, some people did not change their perception of how headaches affected them.”

“This study specifically tested n-3 fatty acids from fish and not from dietary supplements,” said study co-author Keturah Faurot, assistant professor of Physical Medicine and Rehabilitation, and assistant director of the Program on Integrative Medicine. “Our findings do not apply to supplement use.”

Zamora says the biochemical hypothesis of how certain fatty acids affect pain applies to a wide variety of chronic pain. She and her colleagues are currently working on a new study to test diet modification in other pain syndromes.

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This study is the result of a large collaboration of 24 interdisciplinary researchers. First co-authors are Zamora and Christopher Ramsden, MD, a researcher with the National Institute on Aging and former UNC clinical fellow. Sixteen of the co-authors are affiliated with the University of North Carolina.

This project was funded in part by a grant from the National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health (NIH).