April 23, 2015
Targeted Alterations in Dietary n-3 and n-6 Fatty Acids Improve Life Functioning and Reduce Psychological Distress Among Patients With Chronic Headache
Pain
TAKE-HOME MESSAGE
- There is a known association of headache with psychological distress. This in turn exacerbates the headache, and ultimately negatively impacts health-related quality of life (HRQOL). This is a secondary analysis of data from the CDH trial, a randomized, parallel-group trial that tested the effects of a diet high in n-3 and low in n-6 fatty acids (the H3-L6 intervention) compared with a diet low in n-6 fatty acids (the L6 intervention) in a population with chronic headaches. The H3-L6 intervention showed significant reduction in headache compared with the L6 intervention. This analysis looked specifically at psychological distress and HRQOL.
- The H3-L6 intervention resulted in significant improvement in psychological distress (6.56-point difference in BSI-18) and quality of life measured by SF-12.
– Codrin Lungu, MD
Written by David Rakel MD, FAAFP and Tricia C Elliott MD, FAAFP
More Fish, Less Headache and Distress
This study is a continuation of a previous study published in Pain in 2013 looking at the effect that manipulation of essential fatty acids through the diet has on headaches.1 The researchers found a significant reduction in headache frequency in a group in whom omega-3 fatty acids were increased and omega-6 fatty acids were reduced compared with a group in whom only omega-6 fatty acids were reduced.
This paper used these data to also show how this dietary manipulation resulted in improvement in psychological distress, quality of life, and function.2
What Is the Mechanism?
Let us oversimplify to make this easy to understand and implement. Omega-3 fatty acids include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omega-6 fatty acids are often sources of arachidonic acid, which is the precursor to the inflammatory cascade. For example, steroids work in part by preventing arachidonic acid from being released from the cell membrane. This diet promoted omega-3 fatty acids (EPA and DHA) and reduced omega-6 (arachidonic acid). This is where the oversimplification comes in: Omega-3 fatty acids are anti-inflammatory/anti-nociceptive and omega-6 fatty acids are more inflammatory/nociceptive.
Of the omega-3 fatty acids, think of DHA as structural and EPA as functional. Breast milk is rich in DHA, which is needed for fetal brain development. EPA is important in cell membrane communication. EPA (more than DHA) has been found to be beneficial for mood and inflammation in previous studies. But both are likely important in pain.
What Foods Have EPA and DHA?
Omega-3 fatty acids are polyunsaturated oils with have multiple double bonds, which makes them unstable and more likely to spoil. This is why butter (a saturated fat) lasts longer on your kitchen counter than fish (a polyunsaturated fat). All animals have a combination of saturated and unsaturated fat, but those animals that live in cold climates have more unsaturated omega-3 fatty acids to maintain fluidity of their cells. If salmon were made of mostly saturated fat (butter), it would stiffen like a board in the cold Atlantic. Thus, cold-water fish have more omega-3 fatty acids and eat algae, a rich source. Nuts and green leafy vegetables are also good sources of omega-3 fatty acids.
Does this sound like the Mediterranean diet? There are many similarities. The Mediterranean diet includes many omega-3 fatty acid food sources and is low in the two largest sources of arachidonic acid: red meat and dairy. Click here for a handout on what foods to eat and what to avoid to increase omega-3 fatty acids and reduce omega-6 fatty acids.
One Physician’s Personal Experience
I (Tricia Elliott) have a clinical interest in headache/migraine management; however, on a personal note, I do have chronic daily headaches (≥15 headache days/month), and, if you name a treatment out there, I have likely tried it. Coincidentally, in the last couple weeks, I endeavored to make a determined effort to adopt an anti-inflammatory diet (increasing the omega-3 fatty acid foods and decreasing the omega-6 fatty acid foods). Although I am an “n of 1,” my results are thus far consistent with those in this small randomized study of 67 participants with severe headaches, showing decreased headache frequency and decrease in headache impact. Overall, I am feeling a significant benefit with less pain. In the study, patients also reported substantial psychological distress at baseline, which was largely reduced with this targeted dietary change.
Both increasing the omega-3 fatty acids and decreasing the omega-6 fatty acids in food seem to demonstrate a greater impact than solely limiting the omega-6 fatty acids in the diet. For some patients with chronic pain, counseling may be helpful on the added benefits of the anti-inflammatory diet, and the Mediterranean diet can be a cornerstone of treatment for chronic pain in the primary care practice. Using the language of “adding” such foods may be a starting point for patients to feel more empowered to make these positive changes. My own personal experience is that the benefits can start to be felt in just a short period of time. I’ll keep you posted.
References
- Ramsden CE, Faurot KR, Zamora D, et al. Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain. 2013;154(11):2441-2451.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850757/
- Ramsden CE, Faurot KR, Zamora D, et al. Targeted alterations in dietary n-3 and n-6 fatty acids improve life functioning and reduce psychological distress among patients with chronic headache: a secondary analysis of a randomized trial. Pain. 2015;156(4):587-596.http://journals.lww.com/pain/pages/articleviewer.aspx?year=2015&issue=04000&article=00005&type=abstract