Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: A randomized trial

C.E. Ramsden, K.R. Faurot, D. Zamora, C.M. Suchindran, B.A. Macintosh, S.A. Gaylord, A. Ringel, J.R. Hibbeln, A.E. Feldstein, Trevor Mori, Anne Barden, C. Lynch, R.S. Coble, Emilie Mas, O.S. Palsson, D.A. Barrow, J. Mann

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116 Citations (Scopus)

Abstract

Omega-3 and n-6 fatty acids are biosynthetic precursors to lipid mediators with antinociceptive and pronociceptive properties. We conducted a randomized, single-blinded, parallel-group clinical trial to assess clinical and biochemical effects of targeted alteration in dietary n-3 and n-6 fatty acids for treatment of chronic headaches. After a 4-week preintervention phase, ambulatory patients with chronic daily headache undergoing usual care were randomized to 1 of 2 intensive, food-based 12-week dietary interventions: a high n-3 plus low n-6 (H3-L6) intervention, or a low n-6 (L6) intervention. Clinical outcomes included the Headache Impact Test (HIT-6, primary clinical outcome), Headache Days per month, and Headache Hours per day. Biochemical outcomes included the erythrocyte n-6 in highly unsaturated fatty acids (HUFA) score (primary biochemical outcome) and bioactive n-3 and n-6 derivatives. Fifty-six of 67 patients completed the intervention. Both groups achieved targeted intakes of n-3 and n-6 fatty acids. In intention-to-treat analysis, the H3-L6 intervention produced significantly greater improvement in the HIT-6 score (-7.5 vs -2.1; P <0.001) and the number of Headache Days per month (-8.8 vs -4.0; P = 0.02), compared to the L6 group. The H3-L6 intervention also produced significantly greater reductions in Headache Hours per day (-4.6 vs -1.2; P = 0.01) and the n-6 in HUFA score (-21.0 vs -4.0%; P <0.001), and greater increases in antinociceptive n-3 pathway markers 18-hydroxy-eicosapentaenoic acid (+118.4 vs +61.1%; P <0.001) and 17-hydroxy-docosahexaenoic acid (+170.2 vs +27.2; P <0.001). A dietary intervention increasing n-3 and reducing n-6 fatty acids reduced headache pain, altered antinociceptive lipid mediators, and improved quality-of-life in this population. © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Original languageEnglish
Pages (from-to)2441-2451
JournalPain
Volume154
Issue number11
DOIs
Publication statusPublished - 2013

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