New Insights on Dietary Intake and Headache

September 10, 2018

A large study found an association between consumption of foods high in omega-3s and severe headache.

Long chain omega-3 polyunsaturated fatty acids were found to be associated with lower prevalence of severe headache in the US.

People who have higher levels of long chain omega-3 polyunsaturated fatty acids (PUFAs) in their diet may have lower prevalence of severe headache, according to a recent study.1 Nationally representative data was used to evaluate whether there is a link between increased consumption of omega-3 PUFAs and protection against headache or migraine in the US.

“We analyzed NHANES nutrition data over a six-year period during which severe headache and migraine was assessed in a representative sample of the US adult population. We found inverse dose-dependent associations between EPA and DHA and prevalence of severe migraine or headache that persisted when adjusted for potential confounders including body mass index and total energy intake,” wrote first author Anne Elizabeth Sanders, PhD of the University of North Carolina at Chapel Hill (Chapel Hill, NC), and colleagues.

Related content: Case Report: Woman With Headache Pain, Dizziness, and Nausea

Research has suggested that omega-3 PUFAs may have pain-killing and anti-inflammatory properties. Both eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) are omega-3 PUFAs found in high concentrations in oily cold-water fish, such as salmon and sardines. Both are precursors to several immune modulators and may play a role in decreasing inflammation. Because of these properties, they are used in inflammatory disorders like rheumatoid arthritis, and may decrease the need for nonsteroidal anti-inflammatory medications (NSAIDs).

The study is noteworthy because it quantified serum concentration of CRP as a measure of inflammation and a potential mediator of the analgesic properties of PUFAs. Similar studies have relied solely on dietary recall questionnaires.

In the study, researchers used data from the National Health and Nutrition Examination Surveys (NHANES) for 1999-2004. The analysis included data from 12,318 adults with self-reported severe headache or migraine in the past three months. Researchers estimated EPA and DHA levels from 24-hour dietary recall questionnaires. A subset of 11,733 participants underwent blood draws, from which serum concentrations of CRP were measured.

Key results and take home points >

Key results

• 22.0% overall prevalence of severe headache or migraine (females 28.2%; males 15.5%)

• Greater intake of omega-3 PUFAs linked to lower prevalence of severe headache or migraine (p for trend for both EPA and DHA = 0.004)

-Adjusted for NHANES cycle, sociodemographic characteristics, BMI, total energy intake

• Each additional mg/dL increase in CRP was associated with 8% increase in prevalence of severe headache or migraine (p = 0.006).

Further analyses showed that higher consumption of EPA and DHA were linked to lower CRP concentrations. However, when CRP was added to multivariable analyses, omega-3 PUFAs remained significant predictors of severe headache and migraine. That suggests CRP does not fully mediate the association between headache and PUFAs, and other factors may be involved.

The authors noted that overall omega-3 intake in this study was lower than recommended by the 2010 Dietary Guidelines for Americans (8 ounces of seafood per week)2 or by the American Heart Association (at least two 3.5 ounces servings of fish per week).3

“[R]ecommended omega-3 dosages are made with cardiovascular endpoints in mind, and these may well exceed levels needed for pain management in headache. It is possible that the low levels of omega-3 intake seen here may be sufficient to prevent headache in the population at large,” they wrote.

Take home points

• First nationally representative study found higher consumption of omega-3 PUFAs was linked to lower prevalence of severe headache or migraine

• Higher intake of EPA and DHA were linked to lower CRP levels, while increased CRP levels were linked higher levels of severe headache

• Further analyses suggested CRP does not fully mediate the link between omega-3 PUFAs and headache, and other factors may be involved


1. Sanders AE, Shaikh SR, Slade GD. Long-chain omega-3 fatty acids and headache in the U.S. population. Prostaglandins Leukot Essent Fatty Acids. 2018;135:47-53.
2. U.S. Department of Agriculture and U.S. and Department of Health and Human Services. Dietary Guidelines for Americans 2010. Accessed September 10, 2018.
3. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586-613.