Daily Supplementation of Omega-3 Fatty Acids Decreases Frequency and Severity of Chronic Headache Symptoms

Written by Taylor Woosley, Staff Writer. Participants following a 16-week diet focused on increasing EPA & DHA levels (designed to increase EPA&DHA to 1.5g/day) and either maintaining or reducing linoleic acid levels decreased the rate of occurrence and severity of chronic headaches.

Chronic headaches are one of the most prevalent neurological disorders and can occur at any stage of life. Headache disorders (cluster headaches, migraines) are the sixth leading cause of disability globally ¹. Chronic headaches, defined as headaches occurring 15 days or more per month for at least 3 months, affect around 1%-4% of the population ². During a migraine, a type of headache often associated with severe symptoms, blood flow increases in the thalamus, basal ganglia, and cortex ³. Chronic migraines are associated with both structural and functional alterations in certain brain regions leading to brainstem dysfunction and defective descending pain modulatory activity ⁴. The pathophysiology of chronic migraines is not fully understood but certain risk factors (stress, poor quality of sleep, overuse of medication) have been associated with chronic severity of migraines ⁵.

One potential method of treating or improving the severity of headache and migraine symptoms is through omega-3 (n-3) fatty acids. Omega-3 fatty acids are long-chain polyunsaturated fatty acids (PUFAs) that contain antioxidant and neuroprotective properties ⁶. The prominent bioactive PUFAs found in Omega-3 fatty acids are EPA and DHA, which can be found in fish, nuts and seeds. Additionally, omega-3 fatty acids regulate multiple inflammatory and pain-related biochemical pathways and can be converted to lipid mediators with pro-resolvin and anti-nociceptive (pain-inhibiting) properties ⁷. Omega-6 (n-6) fatty acids (can be found in vegetable oils, nuts and soybeans) are also essential fatty acids with pro-nociceptive (pain-promoting) properties ⁸. The standard Western diet contains high levels of vegetable oils, often leading to higher levels of omega-6 compared to omega-3 levels, linoleic acid (LA) found in omega-6 sources can produce pro-inflammatory responses when consumed in a saturated form ⁹. Increasing dietary intake of omega-3s (EPA & DHA) and lowering omega-6 (LA) consumption may offer a therapeutic approach to chronic pain management.

In this three-arm, parallel group, randomized, modified double blind, controlled trial 182 participants were randomly assigned to one of three specific diets with altering levels of EPA, DHA, and LA to observe changes of pain intensity relating to chronic migraines. Participants had certified chronic migraine disorders after a neurologist reviewed their headache history and exam. Further inclusion criteria consisted of a history of headaches for at least two years, seeking headache management through a physician’s care, and willingness to maintain an online daily headache diary. Participants were randomly assigned to one of three diets:

Study participants recorded headaches and drug use in the online headache diary daily for at least four weeks before being assigned to a diet group. Afterwards they maintained the daily diary for 16 weeks and were provided dietician counseling at 2-3-week intervals throughout the intervention phase. Fasting blood was collected at the end of the run-in phase, and after week 4, 10, and 16 of diet exposure to observe changes in lipid and omega levels, particularly to observe levels of 17-hydroxydocosahexaeonic acid (17-HDHA), which is the pathway precursor for a variety of oxylipins with anti-nociceptive effects. Nutrient intakes were gathered from two unannounced, telephone administered, 24-hour recalls, and participants also completed The Expectation of Benefit/Credibility Questionnaire to analyze participant’s rationale credibility and treatment expectancy. The endpoint test consisted of a six-item headache impact test (HIT-6), a self-reported test to gage to what degree the headaches had on everyday functioning. At the end of the study, the results were as follows:

• H3 and H3-L6 diets increased circulating 17-HDHA compared with the control group, baseline adjusted mean differences were 0.7 (95% confidence interval 0.4 to 1.1, p<0.001) and 0.6 (0.2 to 0.9, p=0.001), respectively.
• Compared to the control group. The H3 and H3-L6 diet groups significantly reduced the number of total headache hours per day (−1.3, −2.1 to −0.5, and −1.7, −2.5 to −0.9, respectively) and moderate to severe headache hours per day (−0.7, −1.1 to −0.3, and −0.8, −1.2 to −0.4, respectively; p≤0.001 for all comparisons with control group.
• The H3-L6 diet group had four fewer headaches days/month compared to control (−4.0, −5.2 to −2.7, p<0.001) and experienced two fewer headache days/month compared with the H3 diet group (−2.0, −3.2 to −0.8, p=0.001).

Although no significant changes were noted for improved quality of life, H3 and H3-L6 diet groups showed significant improvements in the reduction of the frequency and severity of headaches. The reduction of dietary intake of omega-6 linoleic acid produced a more robust improvement in reduction of headache days per month compared to the H3 diet alone, suggesting reduction of LA can improve inflammatory levels. Study limitations include the role of the unblinded dietician and the use of HIT-6 as the primary outcome to measure levels of pain. Future research should explore the role higher levels of EPA & DHA and further decreased levels of LA can play in positively improving the quality of life for those suffering from chronic headaches and migraines.

Source: Ramsden, Christopher E., Daisy Zamora, Keturah R. Faurot, Beth MacIntosh, Mark Horowitz, Gregory S. Keyes, Zhi-Xin Yuan et al. “Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial.” bmj 374 (2021).

Click here to read the full text study.

Posted March 14, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

1. Anheyer D, Klose P, Lauche R, Saha FJ, Cramer H. Yoga for Treating Headaches: a Systematic Review and Meta-analysis. J Gen Intern Med. Mar 2020;35(3):846-854. doi:10.1007/s11606-019-05413-9
2. Straube A, Andreou A. Primary headaches during lifespan. J Headache Pain. Apr 8 2019;20(1):35. doi:10.1186/s10194-019-0985-0
3. Probyn K, Bowers H, Caldwell F, et al. Prognostic factors for chronic headache: A systematic review. Neurology. Jul 18 2017;89(3):291-301. doi:10.1212/wnl.0000000000004112
4. Su M, Yu S. Chronic migraine: A process of dysmodulation and sensitization. Mol Pain. Jan-Dec 2018;14:1744806918767697. doi:10.1177/1744806918767697
5. Agostoni EC, Barbanti P, Calabresi P, et al. Current and emerging evidence-based treatment options in chronic migraine: a narrative review. J Headache Pain. Aug 30 2019;20(1):92. doi:10.1186/s10194-019-1038-4
6. Cardia L, Calapai F, Mondello C, et al. Clinical use of omega-3 fatty acids in migraine: A narrative review. Medicine (Baltimore). Oct 16 2020;99(42):e22253. doi:10.1097/md.0000000000022253
7. Mann JD, Faurot KR, MacIntosh B, et al. A sixteen-week three-armed, randomized, controlled trial investigating clinical and biochemical effects of targeted alterations in dietary linoleic acid and n-3 EPA+DHA in adults with episodic migraine: Study protocol. Prostaglandins Leukot Essent Fatty Acids. Jan 2018;128:41-52. doi:10.1016/j.plefa.2017.11.002
8. Silva JR, Burger B, Kühl CMC, Candreva T, Dos Anjos MBP, Rodrigues HG. Wound Healing and Omega-6 Fatty Acids: From Inflammation to Repair. Mediators Inflamm. 2018;2018:2503950. doi:10.1155/2018/2503950
9. D’Angelo S, Motti ML, Meccariello R. ω-3 and ω-6 Polyunsaturated Fatty Acids, Obesity and Cancer. Nutrients. Sep 10 2020;12(9)doi:10.3390/nu12092751