Advances in Nutrition study provides compelling evidence that high-dose prophylactic EPA/DHA supplementation can be effective

Migraine is a common neurological disorder, with estimates suggesting that 9% to 18% of people worldwide suffer from migraines. In addition to the pain and discomfort associated with migraine headaches, migraine is associated with a lower quality of life and a higher risk of several diseases and disorders, including depression, cardiovascular disease, and sleep disorders. Moreover, migraine can lead to overuse or abuse of medications as a result of patients’ efforts to prevent and ameliorate their symptoms. Unfortunately, current pharmacological treatments and strategies have had limited success in preventing and treating migraines.

Studies have suggested that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), two omega-3 fatty acids that can be found in some fish oil such as herring, mackerel and salmon, may be promising therapeutic agents for the prevention and treatment of migraines. Evidence from randomized controlled trials, the gold standard of clinical trials, however, is mixed. For example, researchers have yet to determine the most effective dose. Moreover, due to the design of some studies, the placebo effect cannot be ruled out.

In response, the authors of Efficacy of High-Dosage Anti-inflammatory EPA/DHA for Migraine Prophylaxis: A Network Meta-analysis conducted an analysis of 40 randomized controlled studies, with a total of 6,616 participants, to determine the effectiveness and safety of different combined doses of EPA and DHA in preventing and treating migraine. They then compared their results with FDA-approved or guideline-recommended pharmacologic treatments. The findings of this analysis were published in Advances in Nutrition, the international review journal of the American Society for Nutrition.

Rather than conduct a standard scientific review of the evidence, the authors chose a network meta-analysis to “improve the power of multiple comparisons of treatment efficacy and possible superiority of individual pharmacologic interventions of different doses, thereby providing potential significant detailed evidence-based information to guide future clinical practice.”

The findings of this network meta-analysis provide “compelling evidence that high-dose prophylactic EPA/DHA supplementation can be considered a first-choice treatment for migraine prophylaxis since this treatment displayed the highest efficacy and highest acceptability for all studied treatments.” The authors also found that EPA and DHA supplements had a similar level of acceptability (i.e., the percentage of patients who dropped out of a clinical trial for any reason) in comparison with other pharmacologic treatments or a placebo. Finally, EPA and DHA supplementation was associated with fewer adverse health events compared to a placebo or other pharmacologic interventions.

According to the authors, “the most important result of the current network meta-analysis is that EPA/DHA supplementation is associated with a superior prophylactic effect on migraine frequency and severity compared to other FDA-approved and guideline-recommended medications.”

The authors did acknowledge certain limitations of their analysis. In particular, due to the small number of randomized controlled trials investigating the impact of EPA and DHA supplementation on migraine, “clinicians should avoid over-interpretation of the findings in the current network meta-analysis and apply them in a relatively conservative way.” On the other hand, the findings “provide a rationale for designing future large-scale randomized controlled trials to investigate optimal dosing of EPA/DHA supplementation in migraine patients.”

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