A Fish a Day May Keep the Migraine Away

“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,” MacIntosh says.

The investigators behind the BMJ study enrolled 182 adults who experienced headaches 5 to 20 days per month that met the criteria for migraine, with or without aura. They didn’t specifically look at the relationship between fish oil and migraine but sought to determine if increasing the amount of omega-3 fatty acids through diet could improve migraine symptoms.

The participants kept a daily online headache diary in the lead-up to the study to create a baseline. They were then assigned one of three diet plans. One group ate meals that had high levels of omega-3s and 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. The third group was the control.

“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 saw significant reduction in the number of total headache hours per day and the daily number of moderate to severe headache hours 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. This suggests that 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 an impact in chronic pain, including headache,” says Kiran Rajneesh, MD, a neurologist and pain physician in Webster, Texas. Dr. Rajneesh was not involved in this research.

Increased omega-3s and reduced 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.

“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, an associate professor of neurology and the 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.

A piece of salmon or olive oil may actually decrease molecules in the pain pathway, whereas a doughnut might raise them, says Baute Penry (adding that it’s okay to choose the doughnut sometimes).

“I’ve experienced firsthand 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, neurological pain, or another form of chronic pain,” she says.

This isn’t the first time that researchers have explored the connection between foods and migraine, but the focus is typically on foods that may trigger migraine. This study is noteworthy because it takes a more proactive approach in identifying nutrients and foods that can help reduce the risk of migraine.

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.

The hope is that these findings may extend to other conditions as well. 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.

• The exact cause of migraine is unknown, but it’s thought to be the result of inflammation around the nerves and blood vessels in the head.
• Researchers determined that a diet rich in anti-inflammatory omega-3 fatty acids and lower in inflammatory omega-6 fatty acids reduced the frequency and severity of headaches in people with migraine.
• The research focuses specifically on omega-3-rich fish, but omega-3 can also be sourced as a supplement in the form of fish oil, which may have a similar effect on migraine.