A dietary approach to reducing migraine

One of our more popular Ask Health meets Food questions is the following:

Are there any foods or food groups that contribute to migraine headaches? Are there any foods or food groups that assuage migraine headaches?

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 doesn't depend on avoiding certain foods (BMJ 2021;374:n1448).

This research protocol 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 authors recruited 182 men and women in 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 one of three meal plans, designed to have the right number calories to maintain their pre-study 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.

One hundred forty-one participants completed the 16-week trial.

One of the primary endpoints for this study was the individual participants' 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 experienced fewer headache hours per day, fewer moderate-to-severe headache hours, and fewer overall headache days per month than those 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 this means for you

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 grams (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) of 2001-2002, the average intake of omega-6 fatty acids in the United States is about 14.8 grams per day, or about 6.7% of calories in a 2000-calorie diet (Circ 2009;119:902-907). The average intake of omega-3s is only about 100mg per day, while the National Institutes of Health recommends 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's 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 fishes like mackerel and salmon, but also in walnuts, kidney beans, and flaxseed oil.

First posted: July 14, 2021