Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial

SPS commentary:

The H3 diet (n=61) involved increase EPA+DHA to 1.5 g/day and maintain linoleic acid at around 7% of energy; H3-L6 diet (n=61)—increase n-3 EPA+DHA to 1.5 g/day and decrease linoleic acid to ≤1.8% of energy; control diet (n=60; average US intake of n-3 and n-6 fatty acids)—maintained EPA+DHA at <150 mg/day and linoleic acid at around 7% of energy. control diet

According to an editorial notes, although this is statistically a negative study with regard to the primary clinical endpoint (week 16 antinociceptive mediator 17-hydroxydocosahexaenoic acid [17-HDHA] in blood and headache impact test), there are several factors that make the overall findings clinically meaningful. International Headache Society guidelines and regulatory standards specify the use of headache or migraine frequency as the preferred outcome measure for trials of preventive interventions for migraine and the prespecified primary outcome would have been positive if judged by more guideline adherent endpoints. It notes that the results are also notable for the magnitude of the response to intervention, as trials of recently approved pharmacological treatments for migraine prevention, such as CGRP monoclonal antibodies reported reductions of ~2–2.5 headache days per month in the intervention group compared with placebo; and the study findings suggest a dietary intervention can be comparable or better. It adds that it is reassuring the intervention diets increased 17-HDHA as expected, which supports the concept that there is a biological underpinning to the study findings. It suggests that these data support recommending a high omega 3 diet to patients in clinical practice, but acknowledges the major barrier to widespread success of any dietary intervention is adherence because strict diets require time, financial investment, and change in habits.