Triggers, triggers, triggers. We are so focused on figuring out these bedeviling culprits. Food triggers are often tricky and can turn into an obsession for some. So, the recent study about omegas 3s and migraine headaches was welcome news as the focus shifted in a truly wonderful way. Instead of telling us about what foods we should avoid, it specified what we should eat to help minimize the frequency and intensity of migraine episodes.
Raise your hand if you’ve heard the phrase, “fish is brain food.” This is not just old an wives’ tale. There are old and new studies that have consistently inspired healthcare providers to encourage their patients to eat more fish for brain health . An exciting new study suggests that eating more fish may be helpful in preventing migraine headaches .
By the end of this article, you will understand:
1- Why fish oil is important to you if you have migraine.
2- Important details on recent research about omega 3s and migraine.
3- Good sources of these important nutrients even if you don’t eat much fish.
What is fish oil made of?
There are lots of important nutrients in seafood. Fish such as sea bass, cod and shellfish are good sources of protein, vitamins and minerals. Some varieties like salmon and albacore tuna are also high in omega-3 fatty acids.
Certain omega-3 fatty acids have been the subject of many research studies and are considered healthy for us in a variety of ways.
Natural fish oils consist of a blend of omega-3 fatty acids as well as other types of fats and fat-soluble nutrients like vitamins A and D. The omega-3s usually make up less than 30% of the fats that are removed from the fish when fish oil supplements are being processed.
The major components of commercial fish oil supplements are the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosaexaenoic acid). Other fats and nutrients are removed before antioxidants are added to the extracted EPA and DHA. The addition of the antioxidants is a must as the omega-3s are very prone to deterioration from natural oxidation.
As an example of the concentration of EPA and DHA in different foods, a regular egg has about 30 mg of DHA and EPA whereas 3 ounces of albacore tuna has about 700 mg.
* While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Do humans need Omega-3 fatty acids?
Fish oil contains the essential fatty acids EPA and DHA in significant amounts. The adjective, “essential,” is used as our body cannot make enough of these nutrients on its own. Essential nutrients must be eaten in our diet or taken as a supplement. A healthy human body, especially the brain, consists of a great deal of omega-3s, but the source is mainly from foods that are eaten.
We must eat these essential fats to maintain our wellness.
Essential fatty acids are in 2 categories, omega-3s and omega-6s. Over the past few decades our intake of omega-6 fatty acids has greatly increased. Highly processed oils like corn, soy, canola and safflower oils are rich in omega-6 content.
These oils are in many popular processed foods so those with a typical Western diet tend to have a diet high in omega-6s.
The essential omega-3s are EPA, DHA and ALA. ALA is mainly found in plants but has not been shown to be as helpful in disease prevention. The focus of this article will mainly be on the richest source of EPA and DHA, fish oil.
Omega 3s and migraine prevention
Let’s take a look at the most recent, compelling research on Omega 3s and migraine prevention.
The 2021 fish oil and migraine study 
The lead research investigator, Christopher E. Ramsden, MD, and a similar research team published the study as the findings from an earlier study on fish oil and migraine looked promising. Dr. Ramsden is an expert of fat metabolism with a special interest on how fatty acids are metabolized and influence chronic pain and neurodegenerative conditions. It seems that natural pain relief is one of his passions.
The study looked at 3 diets designed and provided by the research team for 16 weeks. In one group, the study participants were provided a diet high in omega 3s. This was done by giving them fish naturally high in EPA and DHA (1.5g per day).
In another study group, the participant’s diet had 2 important modifications. Their diet had the same fish naturally high in EPA and DHA (1.5g/day) but also was reduced in omega-6 fats from corn, soy, safflower and canola oil.
The third group was considered the control group. Their diet consisted of fish that was low in DHA and EPA (less than 150 mg/day) and an amount of omega-6s that is considered typical for Western diets.
Both groups with boosted fish oil enjoyed more migraine-free days. Those whose diet was manipulated only by increasing the DHA and EPA had an average of 2 fewer migraine days per month than those on the control diet.
What is most interesting is that those who ate the diet higher in omega-3s but lower in omega-6s had an average of 4 fewer migraine days per month.
Let that sink in. 4 fewer migraine days per month. Some daily migraine preventives we take cannot boast about that degree of success.
Additional omega-3 and migraine benefits
Not only did the diets being studied reduce headache and migraine days, the fish oil also helped reduce the severity of attacks. The participants tracked their symptom severity and duration and both were helped by the increase in dietary fish oil. They experienced a reduction in headache hours between 30% and 40%.
It was also noted that there was a decrease in acute medication use. This would be logical as the frequency, severity and duration of the migraine episodes were all decreased with the diet higher in oily fish.
Given the side-effects or some medications, limitations of dosages and costs of drugs, this gives us reason to rejoice!
How does fish oil help with migraine?
Based on the most recent study of omega-3 benefits for migraine and the large number of research studies done on fish oil’s effect on other diseases and pain, the mechanism probably has to do with prostaglandins and oxylipins. Both are involved with pain and inflammation in migraine and other chronic pain and neurological conditions.
Omega-3s have been show to reduce neuroinflammation as well as oxidative stress . They seem to have a neuroprotective role. Contrarily, certain Omega-6s seem to have the opposite neuroactive role and contribute to inflammation and pain.
Is the source of fish oil important? Food sources or supplements?
Fish oil has been studied for many years. The topic must have peaked the interest of researchers when the positive correlation between increased seafood intake and several health conditions were made. In general, health and longevity are associated with greater intake of fish, especially oily fish like salmon and sardines.
Contrarily, when many studies assess the value of using a commercial supplement instead of changes in the diet, the benefits disappear. That may or may not be the case with fish oil for migraine. We won’t know until we have more studies. In a published report that specifically looked at supplementary omega 3s and migraine , the study quality was lousy and the results were equally unimpressive. Let’s get some good studies as we would love to have recommendations for the best omega 3 supplements for migraine.
The entourage effect
I’m borrowing the phrase used in the research and marketing of cannabinoids. The entourage effect is a theory postulating the different components must work together to get the best effect. When they are taken alone, the effect is not as great. Perhaps this can partially explain why some studies using fish oil supplements sometimes fall short of expectations.
As stated above, when commercial fish oil is processed, the DHA and EPA are concentrated and put in the capsule. The rest of the fish oil and nutrients are is discarded. Perhaps the power behind omega 3s and migraine is other substances that are eaten along with the fish oil.
What about the role of the omega-6 fats?
It’s important to understand that in the exciting study discussed, the best results happened after the diet was manipulated in 2 ways- increasing dietary omega-3s and decreasing dietary omega-6s.
The western diet has dramatically changed in the past few decades. Generations before us primarily relied on foods prepared in home kitchens. However, today, many people have meals that are semi-prepared in factories. Fast-food, and “fast casual” dining are in many people’s weekly routine. Supermarkets have dedicated more square footage in their stores for prepared, “grab-and-go” items that just need to be reheated. These foods are often deep fried and/or contain a high amount of inexpensive, shelf-stable omega-6 fats.
These changes have altered the ratio of omega-3s to omega-6s. In part, this may explain some increases in preventable diseases that we see today. And, this ratio may be a factor that is having an effect on our hyper-responsive migraine brain.
It would be interesting to see if there are similar benefits to supplementing with commercial omega-3 supplements while decreasing the omega-6s.
Omega-6s and inflammation
It is currently accepted that chronic inflammation is either the cause or significant contributor to many of today’s current diseases. Heart disease, arthritis, nonalcoholic fatty liver disease, Alzheimer’s disease and inflammatory bowel disease all involve chronic inflammation.
After certain omega-6s are eaten, a portion of them are metabolized and increase circulating compounds that promote inflammation  as well as pain. It’s plausible that excessive omega-6 intake could contribute to inflammation and pain associated with migraine.
How to use this information to help prevent migraine
As a registered dietitian specializing in migraine prevention, I have changed my personal diet. I have included more oily fish and further decreased highly processed vegetable oils. This way of eating will also be added to Migraine Strong’s short list of recommended diets for minimizing migraine**.
In the study diet discussed above, they included 1.5 grams of fish oil each day. For many of us, this is a challenge. Seafood may not be a favorite. Finding good, tasty sources may be inconvenient.
The following is a list of seafood sources highest in fish oil:
Salmon, mackerel, tuna, sardines, seabass, herring, anchovies, halibut caviar, oysters and mussels.
Some examples of how to get 1.5 grams or more from seafood in a day would be one of the following:
- A can of albacore tuna for lunch, mussels marinara for dinner.
- shrimp cocktail for lunch, halibut for dinner along side Caesar salad with anchovies
- 3 ounces of farmed salmon
What if this amount of daily seafood in not practical?
Since starting my research for this article, I have unsuccessfully attempted to get a minimum of 1000 mg of fish oil from my diet each day. Unlike the study participants, I don’t have someone preparing all my meals. For salmon lovers, this could be easy!
Even though there have not been studies supporting the use of fish oil supplements for migraine, I have consulted with my doctor and take them. Supplements of omega 3s may be helpful for migraine in spite of the lack of published studies.
Aside from migraine, perhaps the supplements will help with other health concerns and overall wellness.
Supplementing with fish oil
Our Migraine Strong Dispensary has several products that I use currently or have used in the past.
A favorite is Barlean’s Mango Peach Smoothie. 1 Tablespoon provides 1080 mg fish oil without the fishy taste. I didn’t think it was possible, but I chilled the bottle and didn’t taste any fishiness.
Nordic Natural’s ProDHA 1000 has 1660 mg in 2 softgels.
Dr. Alexander Mauskop, a prominent headache specialist, founder and director of the New York Headache Center, includes an informative section in his book about fish oil and migraine. The End of Migraines: 150 Ways to Stop Your Pain, is a must-read for the 149 other ways. Dr. Mauskop has increased his fish intake but also supplements with Omax3® Ultra Pure Omega 3 Fish Oil.
There are many fish oil brands to choose from. Look for quality brands so you get the omega-3s and not contaminants.
What about mercury levels in fish?
Unfortunately, seafood can have some contaminants. One of the more worrisome is mercury. It is a special concern for pregnant women, those who plan on becoming pregnant and children.
In general, smaller fish that are lower in the food chain and live shorter lives are lower in mercury. Certain varieties of bigger, older fish have higher amounts of mercury due to processes called bioaccumulation and biomagnification.
To help you navigate through the many choices of seafood and select good sources of omega-3 fatty acids while limiting the potential of having too much mercury, I put together a handy chart. Primarily, it’s based on a nice chart from the Seafood Nutrition Partnership  that I cross-referenced with charts from the EPA. 
The serving size of the different seafood is 3- 4 ounce portions, cooked. Please keep in mind that the available data shows fairly wide ranges of both omega-3 content as well as mercury levels due to the varieties of fish and the environment in which they lived.
*** The recommended limitations in the Table are more conservative and based on the recommendations for a pregnant woman. The EPA reference[6} has additional information. For example, there are 0s and 1s as recommended limits for some nutritious and delicious selections like bluefish tuna and albacore tuna as that is the recommended limit during pregnancy or when trying to conceive. Limits also apply to young children. Please educate yourself on this topic so you can enjoy the benefits of oily fish while minimizing risks.
Don’t overlook the importance of reducing vegetable/seed oils.
For emphasis, the study participants who increased fish oil and decreased highly processed vegetable/seed oils had double the results of those who only increased fish high in omega-3s. This can’t be stressed enough.
In all the the migraine-oriented diet approaches** we discuss here and in our social media groups on Facebook and Instagram, our focus is on eating more wholesome foods and less highly processed foods. This study underscores that important point.
To decrease omega 6s, avoid deep fried foods like French fries, chips, chicken fingers, chicken wings, etc. Make or buy dressings and sauces that use olive oil and avocado oil rather than the highly processed oils mentioned earlier. Also, avoid baked goods made with these oils in favor of items that use more wholesome ingredients or come from “scratch bakeries.” If you make a cake from a box, use avocado oil in place of the recipe’s call for “vegetable oil.”
Clearly, there is a relationship between omega 3s and migraine, but there seems to also be a benefit to limiting omega 6s from highly processed foods.
Final thoughts on omega-3s and migraine:
What would you do with 4 fewer migraine days each month PLUS 30-40% reduction in migraine headache hours?
Yes, changing your diet takes time and effort. If you have frequent or chronic migraine, this diet, along side your current medical regimen might help you find significantly more relief with the added benefits of helping your overall health and wellness. If you have infrequent migraine attacks, perhaps the diet shift toward more fish and away from processed vegetable oils will help. I think it’s worth a try after getting the OK from your doctor.
This article has been updated and refreshed from its original publication date in August, 2021.