FAQ Episode 41: When is extra fat good for your migraines?

Frequently Asked Questions about Natural Migraine Relief for Women

While most people view fat in a negative light, in today’s post I want to review the potential benefit of a special kind of ‘good fat’, the omega-3 fatty acid family, in the prevention and management of migraine headaches. In my Natural Migraine Relief course, I address 10 key Root Cause Factors in migraine. The use of the omegas as therapy cleans up one of the most significant of these promoting factor groups: Inflammation, although it also addresses other key root factors.¹

Comparing omega-3s to common drug therapy options for migraine

Past studies have suggested that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), omega-3 fatty acids that are found in fish like herring, mackerel and salmon can be an useful therapeutic measure for the prevention and treatment of migraines. In this article I’d like to use a recent published report, Efficacy of High-Dosage Anti-inflammatory EPA/DHA for Migraine Prophylaxis: A Network Meta-analysis as a springboard for our discussion of their benefits.²

This study conducted an analysis of 40 randomized controlled studies, which included a total of 6,616 participants, 79% women, with a mean age of 35 years. It looked at the effectiveness and safety of different combined doses of the omega-3’s EPA and DHA in preventing and treating migraine.

The aim of this network meta-analysis was to compare the efficacy and acceptability of various dosages of EPA/DHA with current Food and Drug Administration–approved or guideline-recommended prophylactic pharmacologic interventions for migraine. This is a head-to-head comparison study and it doesn’t get much better than that.

Have you taken any of these meds?

The study looked at studies using oral forms of topiramate, valproate, propranolol, timolol, amitriptyline, venlafaxine, lisinopril, frovatriptan, and candesartan, but did not include botulinum toxin or CGRP treatments.

This study then compared the benefit of these drugs for migraines to that from various doses of omega (EPA/DHA) combinations, all in comparison to placebo (no treatment of any kind.) The key comparisons were for 1) frequency and 2 ) intensity of migraine headaches.

The results showed that "EPA/DHA supplementation is associated with a superior prophylactic (preventive) effect on migraine frequency and severity compared to other FDA-approved and guideline-recommended medications.” They also concluded that the study provided “compelling evidence that high-dose prophylactic EPA/DHA supplementation can be considered a first-choice treatment for migraine prophylaxis since this treatment displayed the highest efficacy and highest acceptability for all studied treatments.”  Now that’s what I would call a strong endorsement!

Good news! The “high dose” of omegas is easy to take

One great finding is that the amount of EPA/DHA needed to get the best response in the “high dose” range was only 600 mg EPA and 300 mg of DHA per day. That’s not a lot, really. These supplements are safe to take, easy to find and generally inexpensive.

Additional health benefits of omega-3 fatty acids

Augmenting levels of omega-3 fatty acids can also be helpful for:

1. Reducing anxiety and depression³ Several studies indicate that people who get healthy dietary omega-3s regularly are less likely to have depression and anxiety symptoms.

2. Visual health DHA, a type of omega-3 is a major structural component of your retina. Sufficient omega-3 is linked to a reduced risk of macular degeneration, which is a leading cause of visual impairment.

3. Improving risk factors for heart disease

   Heart attacks and strokes are the world’s leading causes of death. For decades researchers have observed that communities with a high fish content in the diet had measurably lower rates of these diseases, linked to their omega-3 consumption. Further research has tied healthy omega-3 levels to numerous heart health benefits, including:

   • A significant reduction in triglyceride levels.

   • Elevation of the ‘good’ HDL cholesterol levels.

   • Inhibiting your platelets from clumping together to form blood clots.

   • Reducing the level of several inflammatory proteins released during your body’s response to stress or damage. See footnote #1 for details.

4. Helping to prevent age-related mental decline and Alzheimer’s disease

   Many people experience a decline in brain function as they get older.

   Several studies link higher omega-3 intake to decreased age-related mental decline and a reduced risk of Alzheimer’s disease.⁴ The data suggests that omega-3 supplements may be more beneficial at or before disease onset, when the symptoms of cognitive decline are less advanced.

5. Reducing non-alcoholic fatty liver disease (NAFLD)

   NALFD is a common condition characterized by the accumulation of fat in the liver and is a leading cause of several other liver conditions, including cirrhosis. Research suggests that supplementing with omega-3 fatty acids may help reduce liver fat and inflammation in people with NAFLD.

6. May help alleviate menstrual pain

   Several studies show that women who consume the most omega-3s may have milder menstrual pain. A 2011 study determined that an omega-3 supplement was more effective than ibuprofen in treating severe pain during menstruation.⁵

7. May improve sleep

   Good sleep is one of the foundations of optimal health and migraine management. Low levels of DHA have been linked to lower levels of the hormone melatonin, which plays an important role in sleep regulation. See Lesson 18: Hormone Root cause in Migraine: The Pineal gland in the Natural Migraine Relief course for additional details on the melatonin/sleep/migraine connection.

8. May support skin health

   DHA is an important structural component of skin. EPA also benefits your skin by protecting against premature aging of your skin and reducing the risk of acne. It can also prevent the hyperkeratinization of hair follicles, which appears as the little red bumps often seen on the back of the upper arms.

So if you have any of the above problems…and migraines as well, all the better reason to give omega-3 supplementation a trial run.

First, consider foods that are high in omega-3s

While there are some very high omega content foods, most people will need to add some daily omega-3 supplementation to their diet to get the intended metabolic benefit for migraine management. Here are some dietary choices that can augment your omega-3 levels:

Fish sources of omega-3s:

1. Mackerel are small fatty fish which are commonly smoked and eaten as whole fillets. Omega-3 content: 4,580 mg of EPA and DHA (combined) in 3.5 oz (100 g.)

2. Salmon is one of the most nutrient-dense foods on the planet. Studies show that people who regularly eat fatty fish such as salmon have a lower risk of conditions such as heart disease, dementia, and depression. Omega-3 content: 2,150 mg of EPA and DHA (combined) in a 100 gram serving.

3. Cod liver oil is more often taken as a supplement than as a food. Just one tablespoon of cod liver oil more than satisfies your need for Vitmin A, Vitamin D and omega-3. Its best not to take more than a tablespoon at a time to avoid getting too much vitamin A. Most brands recommend just a teaspoon per day. Omega-3 content: 2,438 mg of EPA and DHA per tablespoon.

4. Herring comes cold-smoked, pickled, or precooked and sold as a canned snack. Omega-3 content: 2,150 mg of EPA and DHA (combined) in 3.5 oz (100 g) of herring.

5. Sardines are very small oily fish commonly eaten as appetizers, snacks, or delicacies. Omega-3 content: typically ~1000 EPA/DHA mg per 100 g.

6. Anchovies are small oily fish typically used as condiments for other dishes. Anchovies can be rolled around capers, stuffed into olives, or used as pizza and salad toppings. Omega-3 content: 411 mg of EPA/DHA per 5 anchovies.

The following four foods are rich in the plant sourced omega-3 called ALA (alpha-linolenic acid). It can augment EPA & DHA, but for the purpose of this discussion should not be considered a substitute for them.

1. Flaxseeds are often ground, milled, or pressed to extract oil. They are one of the richest whole food sources of the omega-3 fat alpha-linolenic acid (ALA). Therefore, flaxseed oil is often used as an omega-3 supplement. Because your intestines cannot break down the tough outer shells of whole flaxseed, it may be better to use ground flaxseed or grind whole flaxseed in a grinder. Omega-3 content: 2,350 mg of ALA per tablespoon (10.3 g) of whole seeds.

2. Chia seeds are incredibly nutritious and rich in manganese, selenium, magnesium, and other nutrients. A 1-oz (28-g) serving of chia seeds also contains 5 grams of protein. Omega-3 content: 5,050 mg of ALA per oz (28 g).

3. Walnuts are very nutritious and loaded with fiber. Make sure not to remove the skin, as it packs most of the walnuts’ phenol antioxidants. Omega-3 content: 2,570 mg of ALA per oz (28 g), which is roughly 14 walnut halves.

4. Soybeans are a good source of fiber and vegetable protein and are very high in omega-6 fatty acids. Omega-3 content: 670 mg of ALA in 1/2 cup (47 g) of dry roasted soybeans.

Side effects or cautions when using omega-3s

• Most important to consider is that high levels of omega-3s could potentiate the effect of blood thinning medications. If on such meds, consult your physician about using omega-3 supplements.

• Rarely I hear about heartburn, nausea or loose stools as potential side effects. Usually this concern is reduced by taking your dose with a regular meal to ensure its absorption.

• If you experience bad breath or bad-smelling sweat you may need to get a better brand of omegas. Some versions can get rancid, especially if past their expiration dates or if stored at warm temperatures.

Conclusion and Actions:

Although this gives you “yet one more thing to do,” and I’m sure you already have a stack of those, if you have migraines this intervention could make my “Top 10 Things to do for Migraine Prevention” list.

Start by augmenting your diet with omega-3 rich foods. Then consider a specified daily dose of supplementation. It is safe, easy, relatively inexpensive and has multiple other potential side benefits. It costs ~$15-18/month to get a quality EPA/DHA combination delivering EPA 600-650 mg and DHA 250-350 mg per day. Plan to take it with a regular meal to optimize absorption. I would give it a full 90 day trial to assess your response. If you get a measured benefit, you may want to consider making this supplement a routine part of your health care regimen. This would be especially useful as the omega-3s are likely addressing an underling inflammatory root causes that could promote other forms disease and aging damage in your future.

Additionally, while the study I referenced compared omega-3 therapy to common prescription drugs, I would advise that if you are taking one of theses medications, that you do not quit the medication now, but rather:

1. continue to take the medication routinely them during the three months of omega-3 trial

2. discuss phasing off and drug therapy with your prescribing physician as there may be additional health factors relating to your prescription that need consideration in that process.

Let me know your thoughts on this article, or on your own past experience with taking omega-3s in the comments section.

1. EPA/DHA supplementation also:

• reduces the expression of tumor necrosis factor α (TNF-α), which can assist with vasodilation

• reduces cyclooxygenase-2/NO synthase

• reduces IL-1β concentrations

all of which are believed to contribute to neuroinflammation and neurogenic pain in the central nervous system.

This supplementation also:

• reduces nociceptive (pain) responses in patients with neuropathic pain, which might be occuring through activation of the opioid system

• helps to restore serotonin and dopamine concentrations, which play important roles in the trigeminal nerve-trigeminocervical complex-ventroposteromedial thalamic nucleus pain pathway.

And last but not least, omega 3 fatty acids help to reduce blood viscosity (document)

2. “High Dosage Omega-3 Fatty Acids Outperform Existing Pharmacological Options for Migraine Prophylaxis: A Network Meta-Analysis” Ping-Tao Tseng and 22 other authors. Published in Advances in Nutrition, the international review journal of the American Society for Nutrition. Volume 15, Issue 2, 100163, Feb 2024 https://advances.nutrition.org/article/S2161-8313(23)01450-3/fulltext

3. “Efficacy of omega-3 PUFAs in depression: A meta-analysis” Translational Psychiatry 2019 Aug 5;9(1):190. Yuhua Liao, et.al.   https://pubmed.ncbi.nlm.nih.gov/31383846/

4. “Dietary and supplemental long-chain omega-3 fatty acids as moderators of cognitive impairment and Alzheimer’s disease” Amy H. R. Wood et. al. Eur J Nutr. 2022; 61(2): 589–604. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8854294/ Published online 2021 Aug 15. doi: 10.1007/s00394-021-02655-4

5. “Effect of omega-3 fatty acids on intensity of primary dysmenorrhea” Int J Gynaecol Obstetrics Nahid Rahbar, et. al. 2012 Apr;117(1):45-7 doi: 10.1016/j.ijgo.2011.11.019. Epub 2012 Jan 17. https://pubmed.ncbi.nlm.nih.gov/22261128/ DOI: 10.1016/j.ijgo.2011.11.019