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

Grassroots Health

headache Credit Pixabay CC0 public domain.jpg

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

FAB RESEARCH COMMENT:

Migraine affects at least 1 in 10 adults worldwide, and - unless well controlled - can be a seriously disabling as well as distressing condition.

It therefore seems extraorinary that no mainstream media attention whatsoever appears to have been given to this new review, showing that

  • high-dose supplementation with the omega-3 found in fish oils (EPA and DHA) outperforms the best available drugs in preventing migraine headaches.

Unfortunately, safe, effecttive, cheap and simple, treatment with food supplements like omega-3 are not usually available from mainstream medicine. This is because even when high-quality evidence is available, it usually takes a very long time indeed for such evidence to be accepted by regulatory authorities (if this happens at all).

What this new review shows


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.

These latest findings of the benefits of omega-3 EPA/DHA for migraine are from a meta-analysis of 40 clinical trials involving over 6000 patients with recurrent migraines.


Background on omega-3 EPA/DHA


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.”

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:

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.