For MIGRAINES, consuming fish oil concentrate effectively reduces the frequency and severity of headaches by decreasing platelet aggregation, stabilizing blood flow, and inhibiting inflammatory mediators. There is good evidence that blood vessel instability–smooth muscle layers that overreact and contract or relax too readily, and platelets that clump more readily–leads to the over-constriction and dilation of blood vessels that cause migraine pain.

What are migraines?

Migraines are a common chronic inflammatory neurological condition frequently characterized by intense, debilitating headaches. Migraines can cause throbbing in one particular area that can vary in intensity. Visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch, and smell, and tingling or numbness in the extremities or face are also common symptoms. Ocular migraines may involve flashing lights or visual disturbances without a headache. The underlying process of migraines involves nerve inflammation and dysfunction of the vascular endothelial cells. Much evidence confirms the role of inflammation in the pathogenesis of migraines.

In the U.S., almost 1 out of 4 people has some degree of a migraine, and a third of women under 45 years are affected by migraine headaches. During the active phase of the disease, neuronal activity is increased which leads to the release of proinflammatory peptides from nerve terminals. Several studies confirm the role of inflammation in the development and progression of a migraine.

What causes migraines?

Vascular instability and neurological dysfunction are both likely to play roles in causing migraines. Inflammation can trigger vasodilation–where blood vessels dilate and blood rushes in with a drop of pressure; or vasoconstriction–where blood vessels are narrowed, blood flow slows, and pressure inside arteries and veins increases. Sudden narrowing and then dilation of blood vessels is common with migraines.

Inflammation and oxidative damage can also injure neurons by increasing free radicals. An imbalance of neurotransmitters including GABA, serotonin, and acetylcholine affects blood flow. Likewise, hormones are linked with either vasodilation or vasoconstriction, and imbalances of cortisol, melatonin, testosterone, and estrogen can disturb brain blood flow and aggravate migraines.

Although the exact cause of a migraine headache can vary, evidence points to inflammation having a primary role in the pathogenesis of this neurological disease. Other contributing factors include:

• Increased levels of glutamate in the body. There is substantial evidence indicating a role for glutamate in migraine. Levels of glutamate are higher in the brain and possibly also in the peripheral circulation in migraine patients, particularly during attacks.
• Magnesium deficiency disorders.
• Monoaminergic pathway disorders: inherited neurological disorders involving defects in the metabolism of dopamine, norepinephrine, epinephrine, and serotonin.
• Mitochondrial disorders.
• Calcitonin gene-related peptide (CGRP): this molecule controls the onset and progression of high blood pressure and hypertensive states and has long been postulated to play an integral role in migraines.
• Neurogenic inflammation or pain, originating in a nerve or nerve tissue.
• Hormonal changes including menstrual cycle, pregnancy.
• Psychological factors like anxiety and chronic stress.
• Lifestyle and diet habits.

What are omega-3 fatty acids?

 Omega-3 fats are an integral part of every cell membrane throughout the body and are required for membrane cell receptors to function. All cells are wrapped in a membrane that functions as a selective barrier to regulate the passage of nutrients and waste in and out of the cell. The membrane is made of fatty acid phospholipids and cholesterol. Each new cell will try its best to form its membrane with generous and optimal amounts of omega-3 fats. If these are lacking, the cell membrane will include saturated or other fats. But cell membranes deficient in omega-3 lipids are impaired: they are less fluid and less able to function as a vital barrier. They fail at keeping electrolytes, water, and vital nutrients within the cell; and they cannot efficiently communicate with other cells or fully receive regulating hormones such as insulin. Homeostasis, the process that should maintain stable conditions within tissues, is then compromised.

The key fact is that our bodies cannot make omega-3 fatty acids, so they are essential nutrients that we must consume to reap wide-ranging health benefits for many body systems. The term ‘omega-3’ refers to the chemical structure of the long-chain fat and the location of its double bonds. The main food sources of omega-3 fats include oily fish in the animal kingdom such as salmon, mackerel, trout, and sardines, and organic cold-pressed flaxseed oil in the vegetable kingdom. Dietary intake of fish oil, rich in EPA and DHA, increases the content of long-chain fatty acids in phospholipids of blood cell membranes, particularly those involved in the inflammatory response such as neutrophils, lymphocytes, and monocytes.

How does fish oil reduce inflammation in migraines?

The main fatty acids used in the brain and nerve system are long-chain polyunsaturated fatty acids (PUFAs) such as those in fish oil concentrate. PUFAs, with similar mechanisms of anti-inflammatory drugs, help reduce the severity of inflammatory diseases and pain that originates in a nerve or nerve tissue. A high-potency omega-3 oil concentrate promotes the biochemical pathway that creates inflammation-calming mediators and beneficial prostaglandin 2 series anti-inflammatory leukotrienes.

Because omega-3 fatty acids are important components of cell membrane phospholipids and have potent anti-inflammatory actions, intake of these fatty acids is related to decreased concentration of C-reactive protein, proinflammatory eicosanoids, cytokines, chemokines, and other inflammation biomarkers.¹

The science behind fish oil and migraines

During the active phase of migraine headaches, neuronal activity is increased which leads to the release of pro-inflammatory peptides from nerve terminals. This underscores the role of inflammation in the development and progression of migraines.

The omega-3 fatty acids found in a concentrate of fish oil inhibit the production of inflammation-causing mediators called cytokines from macrophages. Glial cells in the brain, which are part of the brain’s supportive tissue around neurons, produce inflammatory cytokines that act specifically through receptors in the brain. The functional consequences of brain cytokine action or neuroinflammation are migraines with aura.² Investigators in a recent 2019 study used integrated whole-brain PET/MRI to compare 10 migraine sufferers with aura to 16 healthy control persons and found elevations in the markers of glial activation.

“We found that people who have migraines with aura show neuroinflammation in the brain in areas that process pain and also areas involved in the generation of cortical spreading depression,” senior author Nouchine Hadjikhani, MD, PhD, associate professor of radiology, Harvard Medical School. She continued, “Although these findings don’t directly translate into clinical practice at the moment, they are one more proof that migraine is a real neurological disorder that leaves traces in the brain.” The study suggests treatments like fish oil concentrate that target neuroinflammation and glial cell activation may be effective for the treatment and prevention of migraine.³

Studies have also shown the effects of omega-3 fatty acids on oxidative stress and nitric oxide in microglial cells. In a 2015 study, PUFAs significantly reduced the production of reactive oxygen species and nitric oxide in active microglia and offered neuroprotective effects.⁴

In a study conducted on 27 adolescent patients with migraine, it was shown that 2 months of supplementation with 1g of omega-3 fatty acids significantly decreased the frequency of headaches and patients also reported a 74% reduction in the duration of their headaches. These patients, suffering from frequent migraines for at least 1 year, participated in a randomized, double-blind, cross-over study including a 1-month washout period, and 2 months of placebo. The marked improvement experienced by the patients taking omega-3 oils indicates the important role of these crucial fats in migraine relief.⁵

We prefer to use a pure fish oil concentrate in our clinic that gives much higher absorption of omega-3 fats, compared to standard fish oil pills which are often poorly assimilated. With a concentrate, more of the essential omega-3’s pass through the gut and into the bloodstream than with regular whole fish oil, and the concentrate has no fishy after-taste. Because of its ultra-high absorption, fewer capsules are needed to obtain good tissue levels of omega-3 fats. Two or three pure fish oil concentrate capsules daily are as effective as two tablespoons of whole fish oil, which equates to 8 to 10 regular fish oil capsules.

Recommendation: Concentrate of omega-3 fish oil 1,000 to 2,000mg daily, with any meals, or as directed by your healthcare provider.

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