The New York Times recently highlighted a study published in the British Medical Journal which looked at a specific diet and how it affected people with migraine.  This study was funded by the National Institutes of Health, and sought to find cheap and effective ways of improving the quality of life of people with migraine. 

This randomized controlled trial split people with a history of episodes of migraine into three groups assigned to different diets: 1) enriched in omega-3 fats, 2) enriched in omega-3 fats and restriction in omega-6 fats, and 3) a diet with typical amounts of omega-3 and omega-6 fats. The idea behind this was that certain fats contain proteins that may be used by the brain to propagate migraine, and by avoiding those fats and increasing healthy fats there would be fewer migraine attacks. 

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The diets were continued over 16 weeks, and the subjects in this study were given blood tests looking at the levels of certain proteins in the blood, as well as given a validated questionnaire called the HIT-6 which assesses the quality of life for people with headache disorders.  The participants also tracked their headaches with a tracker (which we encourage everyone with migraine to do as well!) 

The results of the study were very interesting.  The people on the diets with higher omega-3 fats and lower omega-6 fats had lower levels of certain pro-migraine proteins, but not others.  Those especially on a lower omega-6 fat diet also experienced fewer headache days, shorter and less severe headaches.  Interestingly, the improvement in quality of life scores was not statistically significant, which complicates the interpretation of this study. The question of what constitutes the most meaningful outcome in migraine studies is not fully determined yet. The International Headache Society guidelines recommend the use of headache frequency as the primary outcome for trials on migraine prevention. However, quality of life improvement is so important to patients and was one of the primary outcomes in this study. 

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What does a diet rich in omega-3 fats and lower in omega-6 fats look like? Fish – especially cold-water fish such as salmon, tuna, trout, sardine, mackerel, herring, anchovy – is high in omega-3 fatty acids. Please keep in mind that some fish contain high levels of mercury such as swordfish and king mackerel, which are better to avoid during pregnancy. 

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However, you don’t need to eat fish to enrich your diet with omega-3 fats. You have plenty of other options such as some algae, flaxseeds, chia seeds, walnuts, leafy vegetables (like Brussels sprouts or spinach), and legumes (such as beans). It is quick and easy, and adding one tablespoon of chia seeds or flaxseeds to your foods (salad, smoothie, oatmeal) is enough. Be cautious with fish oil supplements, and discuss with your physician first. 

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Our Western diet tends to be very rich in omega-6 fats. Lowering our omega-6 fat consumption starts with avoiding fried, processed, and fast foods. It is usually written in small letters on oil bottles, but cold-pressed oils are the least processed. Plant oils are preferred such as avocado, canola, olive, walnut, pumpkin seed oils. You can also prepare your own non-processed dressings with lemon juices, spices, herbs, mustard, water, miso, flaxseeds, and nutritional yeast for example. The best diets are those that are sustainable and keep you happy. When making dietary changes, small progressive changes are recommended. Dietary changes should not be adding stress to your already busy lives, otherwise, they may worsen your headaches. 

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Prior studies looked at many migraine diets, including elimination diets, gluten-free, lactose-free and diets that avoided the most common triggers for each individual person.  A meta-analysis of these diets revealed that they did not significantly improve migraine frequency or severity. There was low to moderate evidence for maintaining steady glucose levels for migraine prevention, which can be achieved by not skipping breakfast, preferentially eating slow carbohydrates over fast carbohydrates, combining carbs with protein and healthy fats, and adding healthy snacks to daily food intake.

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As discussed at the June 2021 American Headache Society Annual Scientific Meeting, some food cravings during the migraine prodrome phase may be mistakenly identified as “triggers.” Since they are not real triggers, eliminating them from the diet will not help. A longitudinal study published after this meta-analysis suggests that adhering to a healthy diet helps with migraine prevention. There are few good-quality studies on migraine and dietary interventions for several reasons, including the limitation in funding and technical difficulties regarding the planning and monitoring of participants’ food intake. There is increasing evidence on the relationship between the gut microbiome on brain health, but more studies are needed on this topic, especially in the field of headache medicine.  

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So should you follow this diet high in omega-3 fats and limited in omega-6 fats to improve your migraine frequency and severity? Eating healthier will not hurt you. Although not compared head-to-head, the improvement in headache frequency with the diet high in omega-3 fats and limited in omega-6 fats in this study was comparable (if not better) to the improvement shown in studies of medications for migraine prevention. Although it would not “cure” your headaches, it would complement the rest of the plan you have with your headache specialist.

It can be hard to make any lifestyle changes without the guidance of professionals, especially when it comes to eating habits. If you are looking to get more information on how you can adjust your diet to improve your migraine and headache symptoms, join Neura Health today and get help from a certified specialist.