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Can omega-3s prevent migraines?

Chronic migraine is a pain, both literally and figuratively, especially since it doesn’t have many good prevention methods. Could omega-3 supplementation help?

Study under review: A double-blind, randomized, and placebocontrolled clinical trial with omega-3 polyunsaturated fatty acids (OPFA ω-3) for the prevention of migraine in chronic migraine patients using amitriptyline.

Introduction

Migraine is a common and often debilitating neurological condition in which patients experience severe headaches, frequently called “attacks,” that last from four to 72 hours and can cause significant disability. Migraines are estimated to affect 11-12% of the worldwide population, with rates being higher in Central and South America (16.4%) compared to other parts of the world (9.7-11.4%) and higher in women than men (13.8 vs. 6.9%). However, it is estimated that a large proportion of those with migraine go undiagnosed.

Migraine is a diagnosis of exclusion and can present in several forms and with many different symptoms, as shown in Figure 1. While throbbing or pulsing headaches located on one side of the head is the most common characteristic[1], sufferers (sometimes called migraineurs) can experience a number of other neurological symptoms, including face and extremity tingling, visual changes, nausea and vomiting, or light or sound sensitivity. There is a strong genetic component for incidence of migraine. First degree relatives of migraineurs are about two to four times more likely to develop migraine. Of those who experience migraines, there are two classificationsPMID: 0 based on migraine frequency. Those who have migraine fewer than 15 days per month are said to have “episodic migraine.” More frequent migraines are considered “chronic migraine.”

Figure 1: Migraine symptoms that occur in most people

Reference: Lipton et al. Headache. 2001 Jul/Aug.

An enduring mystery is why migraines happen and why they frequently happen after “triggers.” Migraineurs are encouraged to track what behaviors or events happen prior to a migraine attack in order to identify and potentially avoid these triggers. However, it is unclear if events frequently classified as triggers (like lack of sleep, bright light, or hunger) bring on the attack or if they are simply the early effects of migraine onset, called premonitory symptoms[1].

While the triptan class of drugs, a type of selective serotonin receptor antagonist, is usually effective for treating acute migraine, migraine prevention is a key priority for people who experience chronic migraine. Currently, the FDA has[2] approved only five drugs for the prevention of episodic migraine, and only one for chronic migraine: the injectable botulinum neurotoxin, Botox. However, tricyclic antidepressants (TCAs), including the drug amitriptyline, can be used off-label for migraine prophylaxis.

Naturally, there is a lot of interest in how lifestyle modification, including diet and supplementation, may affect the frequency and intensity of migraine. Food additives like nitritesPMID: 0 and MSG have been implicated in triggering migraines, though evidence is not currently conclusive. Fasting, hunger, and alcohol are consistently associated with migraine onset. Additionally, various (and often contradictoryPMID: 0) versions of “anti-migraine” diets have been examined for migraine prevention, with many of them finding benefits. However, altered diets often caused significant weight loss that may confound results, as obesity is associated with greater prevalence of migraine and weight loss is associated with some migraine relief.

Like dietary changes, supplements may be used in the hope of reducing migraine frequency and at least 10%[3] of migraine sufferers in the US report using supplements as preventive therapy. Currently, migraineurs can be advised to try any number of supplements[4], often based on small studies or poor quality evidence, including magnesium, riboflavin (vitamin B2), CoQ10, lipoic acid, and the herbs butterbur and feverfew.

Omega-3 fatty acids, often considered with relation to cardiovascular disease, are frequently examined in relation to numerous inflammatory and autoimmune diseases due to their touted anti-inflammatory effects. While intake of polyunsaturated fatty acids (PUFAs) are generally recommended for reduction in cardiovascular disease risk, research has shown that the type of unsaturated fatty acid (omega-6 vs. omega-3) matters for systemic inflammation. Diets higher in omega-3 fatty acids, which are found in fish oil, are associated with lower risks of autoimmune disease and inflammation. This may be due to modulation of proinflammatory prostaglandin synthesis in a diet with a higher ratio of omega-3 to omega-6 fatty acids. Increasing this ratio is often theorized to reduce many unpleasant symptoms, including migraine. However, current research linking omega-3 intake and migraine prevention is not robust[4].

In the study under review, researchers examined the effect of omega-3 fatty acids on frequency of migraine in subjects with chronic migraine.

Migraine is a common and often debilitating condition that is characterized primarily by a severe headache and categorized as an episodic migraine (EM, less than 15 days per month) or chronic migraine (CM, more than 15 days per month) depending on the frequency of headaches. The only treatment currently approved by the FDA for chronic migraines is a Botox injection. However, several supplements have also been investigated for their efficacy. The study under review investigated whether supplemental omega-3 fatty acids had an effect on frequency of migraine.

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