(PO21-04-22) Effect of Dietary Fatty Acids on Sleep and Stress Among Adults With Migraine: Secondary Analysis of a Randomized Controlled Trial

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Presenting Author(s)

KF

Keturah R. Faurot, PhD, MPH, PA
– Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Co-Author(s)

MH

Mark S. Horowitz, MS
– National Institutes of Health
CR

Christopher E. Ramsden, MD, PhD
– National Institute on Aging
JM

John D. Mann, MD
– University of North Carolina at Chapel Hill
DZ

Daisy Zamora, PhD
– University of North Carolina at Chapel Hill

Disclosure(s):

Keturah R. Faurot, PhD, MPH: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: To determine whether dietary interventions that reduce headache also improve sleep and stress in adults with migraine.

Methods: We conducted a 16-week, three arm, parallel group, randomized, modified double blind, controlled trial in North Carolina. Participants were 182 adults (88% women, mean age 38y) with migraines on 5-20 days per month. The 3 diets were designed with EPA, DHA, and linoleic acid altered as controlled variables: H3 diet (n=61)—increase EPA+DHA to 1.5 g/day and maintain linoleic acid at around 7% of energy; H3L6 diet (n=61)—increase n-3 EPA+DHA to 1.5 g/day and decrease linoleic acid to ≤1.8% of energy; control diet (n=60)—maintain EPA+DHA at < 150 mg/day and linoleic acid at around 7% of energy. Sleep quality, stress rating, and the number of headache hours per day were pre-specified endpoints assessed daily with an electronic diary. Sleep quality was rated on a 1-4 scale, with higher score indicating better quality. Stress was rated on a 0-10 scale, with higher score indicating more stress. Longitudinal mixed models were used to estimate between-group differences at end of study. Mediation analyses examining headache hours as a mediator (paramed command in Stata 17) controlled for baseline BMI, age, sex, headache hours, and baseline values of the respective outcome.

Results: At baseline, mean sleep quality was 2.5 (SD 0.5) and stress rating was 3.0 (SD 1.6). In intention-to-treat analyses, the H3L6 group significantly increased sleep quality and reduced stress level relative to the control group (difference 0.2, 95% confidence interval 0.05 to 0.3; -0.6, -0.9 to -0.3, respectively). There was a similar trend in the H3 vs. control group, although only statistically significant for increased sleep quality (0.1, 0.02 to 0.2) but not for reduced stress rating (-0.3, -0.6 to 0.02). In mediation analyses, the reduction in headache hours per day explained ~60% of the effect of the combined interventions on sleep quality (natural indirect effect = 0.09, p=0.006). For stress, the reduction in headache hours per day explained ~45% of the effect of the combined interventions (natural indirect effect = -0.14, p=0.078).

Conclusions: The H3L6 intervention improved sleep quality and decreased stress. Findings suggest that these improvements occurred partially as a result of headache reduction.

Funding Sources: NCCIH