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The Mysterious Connection between Migraine and Obesity

Weight loss and anti-inflammatory diet may reduce headache frequency, severity.

Clinicians have long noted the connection between migraine and obesity. “Most neurologists have seen enough studies that show the link between obesity and migraine,” shared Sylvia Lucas, MD, PhD, clinical professor of neurology, specializing in headaches, at the University of Washington School of Medicine in Seattle. Indeed, previous studies have indicated that weight loss may reduce the frequency, severity, and duration of migraine attacks.1 A 2017 meta-analysis of weight and migraine found that the risk of migraine increased by 27% in those adults with obesity.2  

However, the many co-morbidities associated with both migraine and obesity can make it difficult to tease out the relationships between various factors. For example, both obesity and migraine are associated with inflammation, lack of physical activity, and psychological symptoms, such as depression and anxiety.3 Any effect of weight loss on migraine, therefore, could be due to any of these inter-related factors.

Shannon Hall, CRNP, practices neurology at the University of Alabama Birmingham Medical Center. She has observed a dramatic difference in her migraine patients when they lose weight. “I see so many patients who come back after bariatric surgery and have no more headaches. But we don’t know why,” she said. “There are just too many factors that could be playing a role.”

It was with these complications in mind that researchers, led by Claudio Pagano, at the University of Padua in Italy, undertook a meta-analysis to examine the impact of weight loss on migraine frequency and severity.3 In the process, the researchers also looked at the amount of weight change and the methods of weight reduction to see if those actions had any effect on headaches. Their findings led to potential clues about the mechanisms involved.

Reviewing the Impact of Weight Loss on Migraine Frequency, Severity

Studies considered eligible for the analysis included a wide variety of protocols, including retrospective, prospective observational, non-randomized, and randomized controlled trials. Studies that looked at diet, behavioral therapy, and bariatric surgery as a means of weight reduction were included. All studies reported on at least one of the following outcomes: headache severity, frequency, disability, or duration. Ten studies made the final cut for inclusion in the meta-analysis. A total of 581 patients (from the US, Italy, and Iran) were included in the review. Two of the studies were based on pediatric populations. Of the eight that were not, the average age was 40.3; six of these were all female, and the other two were 83% and 93% female.

In one study, the effect of weight loss on pain was more striking than the effect on duration. (Image: iStock)

The results showed associated weight loss with improvement in all four of the outcomes considered—migraine headache frequency, severity, duration, and related disability. The effect of weight loss on pain was more striking than the effect on duration. Frequency and disability fell in between. In addition, the outcomes did not vary much between behavioral or surgical interventions, nor between adults and children.

Another interesting finding was that effects did not appear to correlate with the degree of weight loss or the starting weight of the patients. This caused the researchers to speculate that weight loss itself was not the only mechanism involved in patients’ improvement. They suggested that a reduction of pro-inflammatory cytokines and an increase in anti-inflammatory cytokines due to energy restriction, quality of diet, or other factors might be a possible mechanism. Dr. Lucas agrees that inflammation may be the likely culprit. “We do know that if you’re obese, there is an almost constant release of cytokines,” she told PPM.

Most of the studies included in the University of Padua analysis reviewed lacked a control group, and the number of studies included was small. These limitations make it difficult to draw firm conclusions. However, the research does add to the growing body of evidence that weight loss may be a useful intervention for appropriate migraine patients.

Talking to Migraine Patients about Weight Loss and Diet

The concept that losing weight may improve the quality of life among those who live with migraine disease raises some questions for clinicians. For instance, Hall pointed out that when a patient has a BMI over 30, for instance, she will counsel that patient about weight loss, but it has to be done carefully.

Dr. Lucas agrees with this approach. “We’re sure not to start the conversation by talking about weight. That can offend patients. They want us to treat their headaches, not talk about losing weight,” she said. “People who are overweight are so stigmatized,” she added. “It’s hard to figure out a way to bring it up that is not insulting.”

The inflammatory connection may offer a helpful way to launch the dialogue. Explaining that inflammation can be a driver of headache, and that losing weight can reduce inflammation may be a gentler way to bring up weight loss. But it is possible, according to Dr. Lucas, to avoid the subject of weight entirely. “Clinicians need to focus not on weight, but on the need to bring down the inflammatory markers,” she explained. “An anti-inflammatory diet might do this.” In this approach, the diet is aimed at reducing inflammation, not pounds, and reducing headaches. The weight loss is just a happy side effect.

Last updated on: June 4, 2020
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