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

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.

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  • Authors+Show Affiliations

    ,

    Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA; Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina-Chapel Hill, NC, USA. Electronic address: chris.ramsden@nih.gov.

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    Source

    Pain 154:11 2013 Nov pg 2441-51

    MeSH

    Adult
    Diet
    Eating
    Erythrocytes
    Fatty Acids
    Fatty Acids, Omega-3
    Fatty Acids, Omega-6
    Female
    Headache Disorders
    Humans
    Male
    Neural Pathways
    Quality of Life
    Socioeconomic Factors
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23886520

    Citation

    Ramsden, Christopher E., et al. "Targeted Alteration of Dietary N-3 and N-6 Fatty Acids for the Treatment of Chronic Headaches: a Randomized Trial." Pain, vol. 154, no. 11, 2013, pp. 2441-51.
    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):2441-51.
    Ramsden, C. E., Faurot, K. R., Zamora, D., Suchindran, C. M., Macintosh, B. A., Gaylord, S., ... Mann, J. D. (2013). Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Pain, 154(11), pp. 2441-51. doi:10.1016/j.pain.2013.07.028.
    Ramsden CE, 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):2441-51. PubMed PMID: 23886520.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. AU - Ramsden,Christopher E, AU - Faurot,Keturah R, AU - Zamora,Daisy, AU - Suchindran,Chirayath M, AU - Macintosh,Beth A, AU - Gaylord,Susan, AU - Ringel,Amit, AU - Hibbeln,Joseph R, AU - Feldstein,Ariel E, AU - Mori,Trevor A, AU - Barden,Anne, AU - Lynch,Chanee, AU - Coble,Rebecca, AU - Mas,Emilie, AU - Palsson,Olafur, AU - Barrow,David A, AU - Mann,J Douglas, Y1 - 2013/07/22/ PY - 2013/06/06/received PY - 2013/07/11/revised PY - 2013/07/17/accepted PY - 2013/7/27/entrez PY - 2013/7/28/pubmed PY - 2014/5/29/medline KW - Clinical trial KW - Headache KW - Migraine KW - Omega-3 KW - Omega-6 SP - 2441 EP - 51 JF - Pain JO - Pain VL - 154 IS - 11 N2 - 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. SN - 1872-6623 UR - https://www.unboundmedicine.com/medline/citation/23886520/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0304-3959(13)00396-5 DB - PRIME DP - Unbound Medicine ER -