High Dosage Omega-3 Fatty Acids Outperform Existing Pharmacological Options for Migraine Prophylaxis: A Network Meta-Analysis
Tseng P-T, Zeng B-Y, Chen J-J, Kuo C-H, Zeng B-S, Kuo JS, Cheng Y-S, Sun C-K, Wu Y-C, Tu Y-K, Stubbs B, Carvalho AF, Liang C-S, Chen T-Y, Hsu C-W, Suen M-W, Yang C-P, Hsu S-P, Chen Y-W, Shiue Y-L, Hung C-M, Su K-P, Lin PY. (2024) Adv Nutr 15(2) 100163. doi: 10.1016/j.advnut.2023.100163.
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Abstract:
Migraine is a highly prevalent neurologic disorder with prevalence rates ranging from 9% to 18% worldwide. Current pharmacologic prophylactic strategies for migraine have limited efficacy and acceptability, with relatively low response rates of 40% to 50% and limited safety profiles.Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are considered promising therapeutic agents for migraine prophylaxis. The aim of this network meta-analysis (NMA) was to compare the efficacy and acceptability of various dosages of EPA/DHA and other current Food and Drug Administration-approved or guideline-recommended prophylactic pharmacologic interventions for migraine.
Randomized controlled trials (RCTs) were eligible for inclusion if they enrolled participants with a diagnosis of either episodic or chronic migraine. All NMA procedures were conducted under the frequentist model.
The primary outcomes assessed were 1) changes in migraine frequency and 2) acceptability (i.e., dropout for any reason).
Secondary outcomes included response rates, changes in migraine severity, changes in the frequency of using rescue medications, and frequency of any adverse events.
Forty RCTs were included (N = 6616; mean age = 35.0 y; 78.9% women).
Our analysis showed that supplementation with high dosage EPA/DHA yields the highest decrease in migraine frequency [standardized mean difference (SMD): -1.36; 95% confidence interval (CI): -2.32, -0.39 compared with placebo] and the largest decrease in migraine severity (SMD: -2.23; 95% CI: -3.17, -1.30 compared with placebo) in all studied interventions.
Furthermore, supplementation with high dosage EPA/DHA showed the most favorable acceptability rates (odds ratio: 1.00; 95% CI: 0.06, 17.41 compared with placebo) of all examined prophylactic treatments.
This study provides compelling evidence that high dosage EPA/DHA supplementation can be considered a first-choice treatment of migraine prophylaxis because this treatment displayed the highest efficacy and highest acceptability of all studied treatments.
This study was registered in PROSPERO as CRD42022319577.
FAB RESEARCH COMMENT:
Supplementation with long-chain omega-3 fatty acids (EPA and DHA, found in fish oils) is both more effective in reducing migraine severity and frequency, and more acceptable to patients, than the best available drug treatments for migraine prevention and treatment, according to this new review of controlled clinical trials.These latest findings of the benefits of omega-3 EPA/DHA for migraine came from a meta-analysis in which researchers pooled the results from 40 clinical trials involving over 6000 patients with recurrent migraines.
Long-chain omega-3 EPA/DHA - relevant background
The long-chain omega-3 fatty acids found in fish oils - EPA and DHA - are absolutely essential for normal brain development and function, as well as physical health, but they are seriously lacking from modern. western-type diets.
Instead, modern diets provide an excess of omega-6 fats - from the industrialised seed oils used in ultra-processed foods, margarines and spreads, and common cooking oils (such as corn oil, sunflower oil, safllower oil, soybean oil etc)
As a result most people's diets and tissues have an abnormally high ratio of omega-6 to omega-3 long-chain polyunsaturated fatty acids (LC-PUFA) compared with the diets on which humans evolved, and to which our brains and bodies are adapted.
Furthermore, a huge literature shows that this relative omega-3 deficiency - i.e. the imbalance between omega-3 and omega-6 LC-PUFA in brain and body tissues - increases risks for a very wide range of physical and mental health disorders, including heart disease and stroke, inflammatory disorders (both auto-immune diseases and allergies) and depression, among numerous others.
Why omega-3 supplementation has been studied as a potential treatment for migraine
Low dietary intakes and tissue levels of omega-3 EPA and DHA are consistently associated with chronic pain and inflammation, as well as vascular (blood vessel) disease in both the body and brain.
Numerous different mechanisms have been identified that explain why omega-3 deficiency reliably increases pain sensitivity as well as inflammation, and also restricts blood flow - all of which are factors that can contribute to migraine headaches.
Previous clinical trials have shown that migraine and other forms of chronic headache and other pain can be reduced by increasing dietary intakes of omega-3 LC-PUFA - either by supplementatition with EPA /DHA, or via dietary changes that reduce the ratio of long-chain omega-6 to omega-6 fats.
This new review of trials to date not only confirms the superiority of high-dose omega-3 EPA/DHA for migraine prevention over current pharmaceutical options in terms of efficacy, but also shows that patients themselves find this kind of supplementation preferable to those drug treatments.
As the authors conclude (emphasis added):
“Based on 40 randomized controlled trials and 6616 participants, high dosage prophylactic EPA/DHA supplementation can be considered a first-choice treatment of migraine prophylaxis because this treatment displayed the highest efficacy and highest acceptability of all studied treatments… as compared with other FDA-approved/guideline-recommended medications.”
For the related news article, see:
See also:
And for more information on omega-3 for the allevation of pain, see also the following lists of articles, which are regularly updated:
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