New Meta-analysis Shows High Dose Omega-3s Outperform Migraine Medications

24th January 2024 - Grassroots Health

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Data from 40 RCTs combined shows that high dose DHA+EPA was best at decreasing frequency and severity of migraines.

Key Points

• A new network meta-analysis analyzed data from 40 randomized controlled trials (RCTs) involving participants with either episodic or chronic migraines; a total of 6,616 participants with an average age of 35 years old was included in the study

• The study found the highest decrease in migraine frequency and severity among those supplementing with high-dose EPA+DHA supplements (1500 mg/day of EPA+DHA or higher), as well as the best acceptability rates compared to other treatments

• A meta-analysis of 21 studies found that oral magnesium, used for migraine prevention, was found to significantly reduce the frequency of migraines by 80% and the intensity of migraines by 78%

Migraines are among the most common chronic diseases worldwide, with many migraine sufferers experiencing high levels of pain and even disability, despite the use of medications. In fact, current pharmacologic treatments for migraine have been shown to have limited efficacy, poor response rates, and concerning safety profiles.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are two omega-3 fatty acids that have shown promise in the treatment of migraines, likely due to their anti-inflammatory effects, actions on nociceptive responses (to reduce neuropathic pain), and their inhibiting effect on cerebral vasodilation. It is also known that omega-3 and omega-6 fatty acids are a major component of the tissues involved; for example, the omega-3 fatty acid DHA makes up approximately 8% of the weight of the brain! Previous research on the effect of EPA and DHA on migraines has demonstrated varying effectiveness based on the dose of DHA and EPA – a new network meta-analysis further supports this dose-dependent effect of DHA and EPA on migraines.

EPA+DHA Supplementation Associated with a Superior Prophylactic Effect on Migraine Frequency & Severity

A new 2024 network meta-analysis by Tseng et al. looked at data from 40 randomized controlled trials (RCTs) involving participants with either episodic or chronic migraines. A total of 6,616 participants with an average age of 35 years old was included; the average duration of treatment was 18 weeks. The primary goal of the analysis was to assess the effect of treatment, including different doses of DHA+EPA, on migraine frequency, treatment acceptability (how likely the participant was to stay on a specific treatment), response rates, frequency of rescue medication use, changes in migraine severity, and frequency of adverse events.

Data for EPA+DHA supplementation was divided into 3 groups based on dosage:

1. EPA+DHA supplementation of less than 900 mg/day (LowPUFA)
2. EPA+DHA supplementation between 900-1500 mg/day (MedPUFA)
3. EPA+DHA supplementation of 1500 mg/day or higher (HighPUFA)

The study found the highest decrease in migraine frequency and severity among those supplementing with high-dose EPA+DHA supplements, as well as the best acceptability rates compared to other treatments.

For changes in migraine frequency, the following top treatments were significantly related to reduced frequency compared to placebo:

1. High dose EPA+DHA supplementation (HighPUFA, SMD -1.36)
2. Valproate (SMD -0.82)
3. Topiramate (SMD -0.34)

The forest plot below illustrates these findings by showing the standardized mean differences (SMD) of migraine frequency for each treatment group compared to placebo. The ‘0’ line represents no effect while the points below 0 represent the amount of improvement with the intervention. As you can see, the HighPUFA group has the greatest beneficial effect among all treatment groups, and the effect is large.