Chronic migraine headaches are a neurovascular reaction with multiple mechanisms in the brain being affected. They are associated with several symptoms including head pain, nausea, photophobia and more, and can depend on several triggering factors including certain foods, stress, dehydration, hormonal changes and more. Several prescription drugs are used in the prevention of headache attacks in frequent migraine patients. There are also numerous natural agents that have been shown to reduce the frequency, severity and/or duration of migraine attacks including butterbur, ginger, feverfew, riboflavin, 5-hydroxytryptophan and magnesium.
Two of the mechanisms that are affected in the brain of individuals with migraines are issues with serotonin receptors and various inflammatory processes. This is the basis for studying omega 3 fatty acids in migraine prevention, because they have important actions in the central nervous system by stimulating the synthesis of serotonin receptors and alleviating several inflammatory processes.
The current study is important because they investigated the effectiveness of omega-3 fatty acids as a prophylaxis in patients with chronic migraines. This was a prospective, controlled, double-blind study with comparison to placebo. Two groups were established. In group 1, prophylaxis was evaluated with omega 3 fatty acid supplement and group 2 with placebo. Amitriptyline at 10 mg/day was administered to both the treatment and placebo group. The omega 3 supplement was delivered as a sachet of 400 mg eicosapentaenoic acid (EPA) and 350 mg of docosahexaenoic acid (DHA). Patients then took the sachet and diluted it in 150 ml of water, twice daily before meals with a total day’s dose of 1.5 gm. Placebo was delivered in a sachet also, twice per day, before meals. Of the 60 individuals with chronic migraines, 51 completed the study including 15 men and 36 women. Six men and 21 women received the omega 3 supplement and 9 men and 15 women received the placebo. In 66.7% of the patients who received omega 3, there was a reduction of more than 80.0% of the number of headaches days. In the control group, there was a similar reduction in 33.3% of the patients.
Commentary: Few studies have been conducted on the role of omega-3 fatty acids in chronic migraine patients, despite relevance of the actions of omega 3 fatty acids on relevant mechanisms. The neurogenic and perivascular inflammation and the vasodilation of the meningeal arteries are known physiologic mechanisms of the disease and it is also known that the eicosanoid prostaglandins and leukotrienes are mediators of this inflammation that produce pain, nausea and vomiting. Prostaglandins, thromboxanes, arachidonic acid and cyclooxygenase are potent mediators of inflammation and are higher in individuals with migraines. This is the basis for the use of anti-inflammatory drugs for treatment of migraine attacks.
Dietary research on individuals with chronic migraines has revealed that the omega 3 fats , not synthesized by humans, can help in reducing the frequency and intensity of headache attacks by stimulating the synthesis of serotonin receptors, and alleviating inflammatory processes. These fatty acids are found in deep water fish oils such as salmon, tuna, mackerel, herring, cod, albacore, anchovy, dogfish and sardines. The current study is consistent with other dietary supplement research that has shown that the omega-3 fatty acids can decrease the frequency and intensity of migraine attacks. Given the multiple benefits of omega 3 fatty acids on many disease processes, as a prevention strategy, I would conclude that in an individual with frequent recurring migraine headaches, let’s say one or more per week, it is likely that I will add this 1.5 grams per day of omega 3 fatty acids from fish oil as a prevention strategy, even though I will continue to use supplements that include the butterbur, ginger, riboflavin, magnesium and feverfew.
Reference: Soares A, Loucana P, Nasi E, et al. A double-blind, randomized and placebo-controlled clinical trial with omega-3 polyunsaturated fatty acids for the prevention of migraine in chronic migraine patients using amitriptyline. Neuroscience 2017; January 7.
