A Dietary Approach to Reducing Migraine

While omega-6 fatty acids should not be eliminated from your diet completely, it is clear that most Americans would do well to reduce the prevalence of these fats in their diet.

Some of the more-popular “Ask Dr Gourmet” questions include: Are there any foods or food groups that contribute to migraines? Are there any foods or food groups that assuage migraines?

When I answered these questions a couple of years ago, we knew that avoiding foods that are high in tyramines could help people avoid migraines, but at the time, I had to say that I knew of no foods "that have been definitively shown to help relieve migraines."

On the one hand, we still have no evidence for foods to help relieve migraines once they start, but a recent randomized, controlled trial suggests a way to help prevent migraines that does not depend on avoiding certain foods.¹

The Research

This research protocol¹ grew out of previous research in rodents and had been previously piloted in humans in a 12-week trial of 67 adults. For this more-robust trial in humans, the researchers recruited 182 men and women around the area of University of North Carolina at Chapel Hill who experienced migraine at least 5 days per month, both with and without aura. This study was designed to last for 16 weeks.

Each participant was randomly assigned to 1 of 3 meal plans, designed to have the right number of calories to maintain their prestudy weight:

1. A diet high in omega-3 fatty acids and low in omega-6 fatty acids
2. A diet that only increased omega-3 fatty acids, keeping the levels of omega-6 fatty acids at the average level for Americans
3. A control group that consumed the average levels (for Americans) of both omega-3 fatty acids and omega-6 fatty acids

Participants were provided study foods, including fatty fish, and were counseled by dietitians to help them adhere to their assigned diet.

A total of 141 participants had completed the 16-week trial.

The Results

One of the primary endpoints for this study was the individual participants' Headache Impact Test 6 (HIT-6) score, a 6-item survey designed to assess the impact of the respondents' migraines on their quality of life. Throughout the study, the participants also kept track of their migraine symptoms through a desktop/smartphone app.

The participants' HIT-6 scores improved in both the high omega-3/low omega-6 and high omega-6 groups but not to a statistically significant degree.

That said, in both test diet groups, the participants had experienced fewer headache hours per day, fewer moderate to severe headache hours, and fewer overall headache days per month than participants on the control diet. In fact, the diet higher in omega-3s and lower in omega-6 fatty acids reduced headache days per month more than the diet that was high in omega-3s alone.

What’s the Take Home?

The high omega-3/low omega-6 diet increased the intake of two common subtypes of omega-3 fatty acids, eicosapentaenoic and docosahexaenoic acids, to 1.6 g (total) per day, while reducing the intake of omega-6 fatty acids to less than 1.8% of total caloric intake.

According to the National Health and Nutrition Examination Survey (NHANES) 2001-2002, the average intake of omega-6 fatty acids in the United States is about 14.8 g per day, or about 6.7% of calories in a 2000-calorie diet.² The average intake of omega-3s is only about 100 mg per day, while the National Institutes of Health recommend 270 mg per day.

How to increase your omega-3s and decrease your omega-6s? While omega-6 fatty acids should not be eliminated from your diet completely, it is clear that most Americans would do well to reduce the prevalence of these fats in their diet. Processed foods like fast foods and packaged snack foods are often made with vegetable oils like safflower oil or sunflower oil, both of which are higher in omega-6 fatty acids.

Omega-3 fatty acids are found not only in fatty fishes³ like mackerel and salmon but also in walnuts, kidney beans, and flaxseed oil.

References:

1. Ramsden CE, Zamora D, Faurot KR, et al. Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. BMJ. 2021;374:n1448. https://doi.org/10.1136/bmj.n1448
2. Harris WS, Mozaffarian D, Rimm E, et al. Omega-6 fatty acids and risk for cardiovascular disease: a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation. 2009;119(6):902-907. https://doi.org/10.1161/circulationaha.108.191627
3. Harlan TS. The health of it all. Dr Gourmet. Accessed January 11, 2022. https://www.drgourmet.com/health/omega3-fish.shtml  

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, associate professor of medicine at Tulane University in New Orleans, and faculty chair of the all-new Certified Culinary Medicine Specialist program.