For those who know the pain of migraines, anything that might offer the possibility of relief is worth a try. According to a new study, a diet higher in fatty fish helped frequent migraine sufferers reduce their monthly number of headaches and intensity of pain compared to participants on a diet higher in vegetable-based fats and oils.

Published in The BMJ, the study was a collaborative effort conducted by researchers from the National Institute on Aging (NIA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), both of which aere parts of the National Institutes of Health (NIH), and the University of North Carolina (UNC), Chapel Hill. Led by Chris Ramsden, a clinical investigator in the NIA and NIAAA intramural research programs, and a UNC adjunct faculty member, the research team specializes in the study of lipids—fatty acid compounds found in many natural oils—and their role in aging, especially chronic pain and neurodegenerative conditions.

A Debilitating Neurological Disease

Migraine is a neurological disease and ranks among the most common causes of chronic pain, lost work time and lowered quality of life. An estimated 1.4 to 2.2% of the population have chronic migraine (at least 15 migraine days per month) and more than 90% of sufferers are unable to work or function normally during an attack, which can last anywhere from four hours to three days. Women between the ages of 18 and 44 are especially prone to migraines, and an estimated 18% of all American women are affected. Current medications for migraine usually offer only partial relief and can have negative side effects, including sedation and the possibility of dependence or addiction.

“This research found intriguing evidence that dietary changes have potential for improving a very debilitating chronic pain condition such as migraine without the related downsides of often-prescribed medications,” says Luigi Ferrucci, MD, PhD, scientific director of NIA.

The Study

This study of 182 adults with frequent migraines expanded on the team’s previous work on the impact of linoleic acid and chronic pain. Linoleic acid, also referred to as omega-6 fatty acid, is a polyunsaturated fatty acid commonly derived in the American diet from corn, soybean and other similar oils, as well as some nuts and seeds. The team’s previous smaller studies explored if linoleic acid inflamed migraine-related pain processing tissues and pathways in the trigeminal nerve, the largest and most complex of the body’s 12 cranial nerves. They found that a diet lower in linoleic acid and higher in levels of omega-3 fatty acids (like those found in fish and shellfish) could soothe this pain pathway inflammation.

In a 16-week dietary intervention, participants were randomly assigned to one of three healthy diet plans. Participants all received meal kits that included fish, vegetables, hummus, salads and breakfast items. One group received meals that had high levels of fatty fish or oils from fatty fish and lowered linoleic acid. A second group received meals that had high levels of fatty fish and higher linoleic acid. The third group received meals with high linoleic acid and lower levels of fatty fish to mimic average US intakes (these participants served as the control group). Meal plans were designed by Beth MacIntosh, MPH, of UNC Healthcare’s Department of Nutrition and Food Services.

During the intervention period, participants monitored their number of migraine days and the duration and intensity of those episodes, how their headaches affected their abilities to function at work, school and in their social lives, and how often they needed to take pain medications. When the study began, participants averaged more than 16 headache days per month, more than five hours of migraine pain per headache day and had baseline scores showing a severe impact on quality of life despite using multiple headache medications.

The diet lower in vegetable oil and higher in fatty fish produced between 30 and 40% reductions in total headache hours per day, severe headache hours per day and overall headache days per month compared to the control group. Blood samples from this group of participants also had lower levels of pain-related lipids. Compared to the other groups in the study, these participants reported some improvement in migraine-related overall quality of life, although it wasn’t as significant as researchers expected given the reduction in headache frequency and severity they had reported.

Even so, says Dr. Ramsden, “changes in diet could offer some relief for the millions of Americans who suffer from migraine pain. It’s further evidence that the foods we eat can influence pain pathways.”

What the Research Means for Health and Exercise Professionals

Migraines can be debilitating, making it impossible to perform even the most basic activities of life, including physical activity. For this reason, helping clients who regularly experience migraines uncover triggers and devise strategies that might help alleviate that pain is crucial.

While it is outside your scope of practice to recommend specific food plans, it can be helpful to share this type of research with affected clients. Consider encouraging clients to pay attention to their diets and to determine which types of food may be triggering their migraines. The researchers note that these findings serve as validation that diet-based interventions that involve increasing omega-3 fats while reducing linoleic acid sources show better promise for helping people with migraines reduce the number and impact of headache days than fish-oil based supplements, while reducing the need for pain medications.

Take the time to educate your clients on sources of omega-3s, including which types of foods to emphasize and which foods to avoid, such as vegetable oils and processed foods (see box). The goal should be to consume more foods containing omega-3 fatty acids, as opposed to limiting healthy sources of omega-6 fatty acids (such as nuts and seeds). Currently, the typical American diet is heavy on omega-6s and light on omega-3s. Research such as this study suggests that most of us need to tip the scales the other way, as opposed to trying to cut out omega-6s from our diets altogether.

Combined with other lifestyle-related measures, including getting adequate sleep, staying hydrated and reducing stress, it is encouraging to know that dietary interventions may be highly effective in helping to quell the pain and improve the quality of life for those who live with the pain of chronic migraine.

Sources of Omega-3 Fatty Acids

A diet rich in omega-3 fatty acids, antioxidants and phytochemicals provides the body with powerful anti-inflammatory nutrients. A Mediterranean-style eating plan, which includes ample fish, olive oil, fruits, vegetables, nuts/seeds and beans may be helpful for individuals who experience chronic pain.

Omega-3s are found naturally in some foods and are added to some fortified foods. According to the National Institutes of Health, you can get adequate amounts of omega-3s by eating a variety of foods, including:

  • Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring and sardines)
  • Nuts and seeds (such as flaxseed, chia seeds and walnuts)
  • Plant oils (such as flaxseed oil, soybean oil and canola oil)
  • Fortified foods (such as certain brands of eggs, yogurt, juices, milk and soy beverages)