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Is there a specific diet that can prevent migraine headaches?

 

  A Low Omega 6 and High Omega 3 diet has been shown to prevent migraines

 

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As a headache specialist I am often asked, “Are there specific foods that I should be eating to prevent migraines?”  Until recently, I would just recommend avoiding specific foods, such as MSG and red wines, that can trigger migraines, but not a specific type of diet.  Recently, evidence is mounting that the foods that you eat not only can trigger a migraine, but also can alter the metabolic pathway of pain and increase systemic inflammation.  This results in elevating your risk of having a migraine even after the food is out of your system.  A likely culprit of doing this is Omega 6 fatty acids (N-6).  Unfortunately, N-6 is bigger part of our diet then one may realize.

The Omega 6 fatty acids (N-6) include Linoleic acid (LA) and Arachidonic acid (AA).  Linoleic acid is the predominant polyunsaturated fatty acid (PUFA) in US western diet.  High LA oils include soybean, corn, cottonseed, safflower, and sunflower.  It is also found in salad dressing, margarines, mayonnaises and cooking oils.  LA oils are also added to a lot of packaged foods including breads, cereals, cookies and chips.  Since the early 1960s, intake of LA has increased three fold due to the dietary advice to substitute vegetable oil instead of animal fats.

It has been hypothesized that the overabundance of N-6 in the nervous system is a fundamental metabolic basis for central pain sensitization.  Dietary patterns of high N-6 are felt to promote pain by increasing the amount of Arachidonic acid (AA), the breakdown product of LA, in the nervous system.  High AA is believed to increase pain by inducing inflammation and by directly stimulating pain triggering N-methyl-d-aspartate (NMDA) receptors.

Omega 3 acids (N-3) are the “good” omega fatty acids, which have been shown to have anti-inflammatory and anti-pain properties.  Alpha linolenic acid (ALA) is the vegetable sources of Omega 3, found mainly in flaxseed.  Docosahexaemoic acid (DHA) and 3-eicosapentaenic acid (EPA) is the Omega 3 fatty acid that are found in fatty fish.

N-6 and N-3 fatty acids compete for enzymatic conversion, tissue incorporation and metabolism to bioactive derivatives.  So, if there is too much of N-6 in your diet or not enough N-3, N-6 will win.  Your body will be more in a pro-inflammatory, pro-nociceptive (pro-pain) state.  This state potentially would then cause headaches in headache susceptible people.

A recent study published in the journal Pain was a12 week study looking to see if a dietary intervention would improve headaches.  Patients with chronic headaches were randomized into 2 groups.  The first group reduced N-6 intake while eating ‘normal’ levels of N-3.  The second group were to reduced the N-6 intake but were to also eat high levels of N-3.  The rest of the diet was to remain the same. To decrease N-6 levels, both groups were to use only low LA oils and fat sources such as macadamia nut oil, coconut oil, low LA olive oil, butter and fat free mayonnaise.  The participants in the second group, who were to also increase the N-3, were also encouraged to eat flaxseed and 4 oz servings of fatty fish a day.

This randomized trial found that both groups showed improvements in clinical outcomes compared to the pre-intervention phase.  The high N-3 + low N-6 group also produced significantly greater improvement in their HIT-6 disability score (-7.5 vs. -2.1; p<0.001)  as compared to low N-6 group.  The number of headache days per month was also significantly improved in the high N-3 + low N-6 group (-8.8 vs. -4.0; p=0.02) as compared to low N-6 group.   The probability of experiencing a severe headache day was also improved in the high N-3 + low N-6 group  (-28 % vs. -8%; p=0.02) as compared to low N-6 group.   The amount of medication that was used to treat headache compared to base line was reduced in the N-3 + low N-6 group, with no change in the low N-6 group.

Thus, the study showed that the combination of increasing dietary N-3 with concurrent lowering of N-6 fatty acids produced a clinically relevant and significant improvement in headache days, hours per day, severe headache days, and headache related quality of life compared to base line and compared to just lowering N-6.

A prior study looking at the effects of just supplementing N-3 without lower N-6 levels showed no clinical benefit.  A possible explanation to why just adding more N-3 did not improve migraines is when there is too much N-6 around.  This is secondary to their competing for enzymatic conversion and metabolism.  The high level of N-6 does not allow the N-3 to be active despite taking in extra N-3.

Currently, the average American eats N-6 to N-3 omega fatty acids at a ratio of 16:1 where the ratio should be closer to 1:1.  To get your ratio closer to those recommended in this diet, there are 3 steps you can do to improve your diet.

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The first step is to limit the amount of N-6 omega fatty acids.  Unfortunately, it is almost impossible t avoid N-6 entirely.  Thus, focus on avoiding as many vegetable oils such as safflower, corn, sunflower, cottonseed, and soybean as possible.  Also avoid the processed fat-based foods that utilize these oils including mayonnaise and bottled salad dressings.

The second step is to replace those oils with the oils that have better ratios of N-6 to N-3 including olive oil, avocado oil, coconut oil and organic butter.

The third step to improve your ratio of N-6 to N-3 fatty acids is to increase the amount of N-3 in your diet.  Foods that are rich in omega-3 fatty acids include fatty fish (salmon, mackerel, tuna, sardines, and anchovies) and some grass feed animal products.  Vegetarian sources include: flax seed, chia seed, sachi inchi, walnuts, quinoa, brussels sprouts, kale, and spinach.  My favorite source of N-3 is Shakeology, which contains sachi inchi, flax seed, chia seed, spinach and quinoa.

I realize changing your diet is difficult, but so is living with chronic migraines.  Isn’t having less headaches worth giving it a try?

Works Cited

Finkel, A. G. (2013). Dietary Considerations in Migraine Management: Does a consistent Diet Improve Migraine? Current Pain Headache Report , 17 (373), 1-8.
Ramsden, C. E. (2011). Low omega-6 vs low omega-6 plus high omega-3 dietary intervention for Chronic Daily Headache: Protocol for a randomized clinical trial. Trials , 12 (97), 1-11.
Ramsden, C. E. (2013). Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: A randomized trial. Pain (154), 2442-2451.