These findings, published on July 1 in The BMJ, suggest that significant impacts can be made on headache and migraine through changing the way we eat, says Beth MacIntosh, MPH, RD, clinical nutrition director at the University of North Carolina Medical Center in Chapel Hill and coauthor of the study. “The results on their own are significant, there’s still the question of what could happen if you follow the diet for even longer: What if you’re on it for six months, or a lifetime? It’s extremely promising,” she says. RELATED: Your Everyday Guide to Living Well With Migraine
Could the Way We Eat Be Contributing to Pain?
Essential fatty acids are a necessary part of our diet (hence the name), but the typical American consumes a much higher level of omega-6 fatty acids than omega-3s. Experts believe that our ancestors’ diets contained about the same amount of omega-3 and omega-6 fatty acids. Today, the typical American diet tends to have 14 to 25 times more omega-6 fatty acids than omega-3 fatty acids, according to Mount Sinai Health System. Omega-3s help to reduce inflammation in the body, whereas some omega-6 fatty acids promote inflammation. Most omega-6 fatty acids in the diet come from vegetable oils, such as corn, soybean, and cottonseed oil. These are often ingredients in processed foods like chips, crackers, cookies, and even granola. There is some evidence that higher intakes of omega-6 fatty acids may contribute to different pain conditions. A study published in June 2021 in the journal Nature Metabolism found that mice that were fed a diet high in omega-6 fats developed signs and symptoms of peripheral nerve damage similar to those seen in people with diabetic neuropathic pain. RELATED: The 11 Most Common Headache and Migraine Triggers and How to Deal With Them
Study Finds Dietary Changes Can Make an Impact in Migraine Pain
To find out if increasing the amount of omega-3 fatty acids in the diet could improve migraine symptoms, investigators in the BMJ study enrolled 182 adults with migraine on 5 to 20 days per month that met the criteria for migraine, with or without aura; two-thirds met the criteria for chronic migraine, which means they had more than 15 headache days per month with migraine-like features for at least three months. The mean age of participants was 38, and 88 percent were women. The participants continued to see their doctors for their usual migraine care, and they kept a daily online headache diary in the four-week lead-up to the study to create a baseline for headache frequency, headache severity, and how much medication they took to manage their migraine attacks. Subjects reported being on an average of 4.3 headache-related medications. At the start of the trial, participants were assigned one of three diet plans. One group ate meals that had high levels of omega-3s — which are found in fatty fish or oils from fatty fish — and they lowered their intake of omega-6 fatty acids. The second group ate meals that were higher in omega-3 fatty acids but contained the typical level of omega-6 fatty acids that are contained in the average American diet according to data collected by the National Health and Nutrition Survey (NHANES). The third group was considered the control diet; participants in that group consumed the estimated amount of both fatty acids based on the NHANES data.
Any Omega-3 Increase in the Diet Appears to Help
“We found that compared with the people who ate the control diet, migraines were reduced by four headache days per month in the high omega-3, low omega-6 group and by two headache days per month in the group that increased omega-3 intake and continued to eat the same amount of omega-6 fatty acids,” says MacIntosh. Both the high omega-3 and high omega-3, low omega-6 groups also significantly reduced the number of total headache hours per day and the number of moderate to severe headache hours per day compared with the control group. The authors point out that the average reductions of 1.7 headache hours per day and four fewer headache days per month in the high omega-3, low omega-6 group are comparable with improvements recently reported for Botox injections and monoclonal antibodies targeting calcitonin gene-related peptide (CGRP), suggesting that the dietary intervention could be an effective adjunct for managing migraine. “This is a very impactful study. We’re always looking to make small changes in a patient’s lifestyle that can impact their headaches, and this research shows that dietary changes can make impact in chronic pain, including headache,” says Kiran Rajneesh, MBBS, neurologist and pain medicine specialist at The Ohio State University in Columbus. Dr. Rajneesh was not involved in this research. RELATED: Home Remedies for Headache and Migraine Relief
What Do Fatty Acids Have to Do With Migraine Attacks?
Increasing the amount of omega-3s and reducing the amount of omega-6s in the diet could help move the biochemical imbalance toward normalcy, says Rajneesh. “That’s important, because we define migraine as an electrochemical imbalance in the brain — it’s the underlying pathophysiology for migraine headaches,” he says. Some of these fatty acids are precursors to building cell membranes that either make or break down chemical messengers, he explains. “Chemical messengers are the currency of energy and signal transfer in our bodies. On a cellular level, some of these amino acids, and in this particular case, fatty acids, are responsible for that currency where cells talk to each other and change signals and electrical patterns,” says Rajneesh. This could be part of why people who consumed more omega-3 fatty acids saw improvements in the frequency and severity of their headaches, he says. RELATED: Causes and Risk Factors of Migraine
Foods May Increase or Decrease Pain Pathways
“This study highlights that from a nutritional standpoint, we all have this huge opportunity every time we consume something to either increase or decrease pain pathways,” says Vanessa Baute Penry, MD, associate professor of neurology and associate director of education for the Center for Integrative Medicine at Wake Forest School of Medicine in Winston Salem, North Carolina. “When we look at it that way, it really turns things around; it’s a huge opportunity, but it’s also a burden to take on that responsibility,” Dr. Baute Penry says. Eating a piece of salmon or cooking with olive oil may actually decrease molecules in the pain pathway versus eating a donut, says Baute Penry (while adding that it’s okay to choose the donut sometimes). “I’ve experienced first-hand what happens when a patient takes responsibility for their diet. They can have dramatic improvements in health and even come off some of the medications they are on for pain, whether from headaches, neurologic pain, or another form of chronic pain,” she says.
Expert Advice on Improving Your Diet
Everyone is going to come at this differently from a food preference perspective as well as a financial and cultural perspective, says Baute Penry. “Though this study was very specific in the way it increased the intake of omega-3 fatty acids, you don’t necessarily have to eat fatty fish every day to improve your health,” she says. The group that added healthy fats and subtracted unhealthy ones had the most dramatic reduction in migraine, she points out. “Think about aspects of your diet where you can do that — for example, replace a plain baked potato with a sweet potato. Go beyond just trying to ‘eat healthy’ and really drill down to specific foods in your diet and find suitable replacements,” says Baute Penry. If your life is too busy to incorporate those broad recommendations, or you can’t always afford those types of foods, taking supplements can contain essential fatty acids may help, says Rajneesh. “That being said, it is not just one thing that moves the needle forward; it’s a combination of things, and it’s usually easier to get that combination through eating fresh real foods rather than supplements,” he says. Although this study examined the benefits of increasing omega-3s through fish, there are also plant-based sources that could help you get high-quality fats, such as flaxseed and chia seeds, says MacIntosh. MacIntosh and her group plan to explore a similar intervention in people with other chronic pain conditions such as arthritis or lower back pain, she says. “We also want to explore ways that people can eat this way ‘in the real world’ without the support that a study provides, such as a diet club or nutrition counseling website,” she says. RELATED: Anti-inflammatory Diet Could Help Reduce Low Back Pain
