1. Diet with higher levels of omega-3 fatty acid and lower omega-6 fatty acid decreased incidence and severity of migraines in participants with chronic and episodic migraines.
2. Changing dietary fatty acid intake also led to changes in circulating levels of oxylipins (lipid mediator that regulates pain).
Evidence Rating Level: 1 (Excellent)
Fatty acids play an important role in migraine pathogenesis due to their conversion into oxylipins (lipid mediators that regulate pain). Interestingly, omega-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have pain reducing properties, whereas omega-6 fatty acids (such as linoleic acid) have pain promoting properties. However, whether changes in dietary fatty acids can effectively modulate pain in patients with migraines has not been tested.
In this randomized controlled trial, 182 adult participants (88% women) with chronic and episodic migraine were randomized into 3 different diets with varying amount of EPA, DHA, and linoleic acid for 16 weeks. 61 participants were put on H3 diet (increasing EPA+DHA to 1.5g/day), 61 participants on H3-L6 diet (increase EPA+DHA and concurrent reduction in linoleic acid) and 60 participant in control diet containing average amounts of EPA, DHA and linoleic acid in the United States. Patients who were pregnant, breastfeeding, with history of head trauma or surgery, or used fish oil as supplements were excluded. The primary endpoints were blood oxylipin levels, frequency of headaches, and impact on quality of life.
Patients on both the H3-L6 and H-3 diet had increased circulating oxylipin 17-hydroxydocosahexaeonic acid levels (associated with pain reduction) as well as decreased total headache hours per day. Interestingly, patients on H3-L6 diet also had decreased use of NSAIDs or aspirin compared to control. However, both H3-L6 and H3 diet did not lead to significantly changed quality of life compared to control diet. This study was limited by the small study population and short study period. Nonetheless, the significant changes in quantitative measures such as headache frequency and severity highlight the potential for dietary fatty acid to be tested as adjunct migraine therapy.
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