Omega-3
Fatty Acids and Migraine
by
Morten Bryhn, MD, Ph D
8/5/2002
Migraine is a common type
of severe headache affecting women three times as often
as men. The pharmaceuticals most commonly used are addressing
pathological events in the blood vessels. Omega-3 fatty
acids have well known vascular effects. Three clinical studies
are presented demonstrating the effects of omega-3 fatty
acids in migraine.
Migraine
is a common type of intermittent, severe headache with a
prevalence of about 20% in the population, women affected
three times as often as men. The first attack is usually
occurring in early adolescence. There is no difference in
occurrence between the rural population and people living
in cities and there is a clear hereditary disposition for
the disease. The frequency of the attacks may be subjected
to change in the individual over time. Pre-menstrual accentuation
is common. Migraine has traditionally been regarded as a
disease originating from the vessels of the meninges, covering
the central nervous system. However, the thinking today
is that migraine starts in the central nervous system engaging
the brain vessels in the course of the attack. The most
common symptoms are headache and nausea often preceded by
neurological symptoms like visual flickering, numbness in
the face or lips, or drowsiness. The pharmaceuticals most
commonly used prophylactically as well as during the attacks
are addressing pathological events in the blood vessels.
Epidemiological studies during the 60-ies in Greenland concluded
that migraine was extremely uncommon among the Inuites.
Their diet is characterized by containing very high amounts
of fish in combination with meat and fat from sea mammals.
The fat from these species are very high in the polyunsaturated
fatty acids called omega-3 fatty acids. Having dilating
effects on the vessels as well as other mode-of-actions
important for the prevention of vascular diseases the idea
was brought up to test the possible effect on migraine attacks.
Two
uncontrolled pilot studies were conducted separately in
Sweden and Denmark testing the prophylactic effect of 4
capsules of an omega-3 concentrate providing a dose of 2.4
grams of omega-3 fatty acids daily during three months.
All patients continued their normal medication. The Swedish
study (1) involved 49 subjects. Eight people did not complete
the study protocol leaving 41 for evaluation, 37 women and
4 men. Most of the participants, 33 individuals, had more
than 1 attack per week the others 8 in number had not so
frequent attacks. Effects before and after 3 months treatment
were evaluated by means of a questionnaire.
The
medication was well tolerated with only 3 subjects reporting
regurgitation with fishy taste. Overall positive results
were obtained by the treatment especially in the group with
most frequent attacks reporting a reduction in number of
migraine attacks by 28% and a reduction in attack intensity
by 32%. Both reductions are statistically significant. Those
with not so many attacks had lower reductions not reaching
statistical significance. The quality-of-life questionnaire
revealed that in the group of participants with most frequent
attacks 67% were significantly improved while 30% were unchanged.
In the other group the percentage improvements were 63%
and 37%, respectively.
In the
Danish study 41 were recruited but only 35 completed the
study protocol. Study duration and dose omega-3 fatty acids
were identical with the Swedish study. Eight patients had
minor problems related to fishy regurgitation's. 21 subjects
had frequent attacks and 14 had fewer attacks. 57% of those
with frequent attacks and 43% of the others experienced
fewer attacks after three months of treatment while 57%
and 36%, respectively, had reduced the severity of attacks.
For the total group 87% answered that omega-3 medication
had improved their migraine condition while 13% did not
respond favorably.
In a
large study from the US 196 migraine patients were recruited
to a study with 6g of omega-3 fatty acids daily or placebo
(3). After 4 weeks on placebo the patients were randomly
allocated to treatment with omega-3 FA's or placebo during
16 weeks. The study was followed by another 4 weeks placebo
period. 96 patients on omega-3 FA's and 87 on placebo completed
the protocol. The total number of attacks during the 16-week
period of the study was significantly different between
the groups with 7.05 in the placebo group and 5,95 in the
omega-3 group (p<0.05). However mean intensity and duration
of attacks and rescue medication did not differ significantly
between the two groups. A very strong placebo effect was
observed in the trial with a 45% reduction of the attacks,
which could partly explain the negative results on attack
intensity.
In conclusion
the results of two small pilot studies from two Scandinavian
countries and one large US study show somewhat conflicting
results. However, the number of attacks were reduced in
all three studies confirming the early observations done
in Greenland that intake of marine omega-3 fatty acids may
positively affect the clinical course of migraine. It is
important to realize that the effects of omega-3 fatty acids
will increase over time and not be experienced as fast as
the pharmaceuticals used on this indication. The dose in
the Scandinavian studies was 4 capsules of a 60% omega-3
concentrate (EPAX 5500TG). Patients with severe or frequent
attacks would possibly benefit by increasing the dose to
6 capsules daily. Overall the treatment was very well tolerated
with only minor adverse effects reported. Marine omega-3
fatty acid concentrates may offer additional therapeutic
benefits to migraine patients in combination with anti-migraine
pharmaceuticals.
REFERENCES:
1) Lejnemark NO. Fiskolja hjälp mot migrän?
Migränbladet 1995;20:9
2) Kan
migræne påvirkes av fiskeolje? Et åbent
studie.
Migrænenyt 1990;5:20-22
3) Pradalier
A, et al. Failure of omega-3 polyunsaturated fatty acids
in prevention of migraine: a double-blind study versus placebo.
Cephalgia 2001;21:818-822
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