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Obesity increases risk of migraines

Yes, being obese can actually increase your risk of having more migraines headaches!

Obesity affects one and a half billion adults worldwide, with estimates of a third of adults in United States being obese. Obesity is associated with many health issues including heart disease, stroke, diabetes, and cancer, making obesity is a significant health problem.  Obesity also has a negative effect on quality of life due to increased back and joint pain. What may be surprising to some people is the fact that obesity is also associated with an increased risk of migraine headaches.

Studies have shown obesity is a strong risk factor for having migraines. Being overweight or obese is associated with a two-fold increased risk of having migraines. As the BMI increases so does the risk of having migraine headaches. Additionally, obesity is also associated with having greater than five times the risk of developing chronic migraines. By definition, a chronic headache is having >15 migraines a month, which are typically more difficult to treat.

The fact that obesity increases the risk of both chronic and episodic migraines has been shown in multiple studies.   The first was in 2003 by a study by Ann Scher.  This study showed that not only that the risk of having migraines increased with obesity, but also that compared to those with normal weight, individuals with episodic headaches who also had obesity at baseline were at increased odds of developing chronic migraine at follow up. These results have since been confirmed in several other studies.

What is the mechanism?

The cause of increased migraine in obesity is not exactly known, but most likely it is related to the pro-inflammatory properties of adipose tissue. Adipose tissue is more than just fat that piles up where we don’t want it; it is also a functioning active endocrine organ. Adipose tissue produces and releases pro-inflammatory cytokines including tumor necrosis factor and interleukin-1. Additionally, several hypothalamic peptides adiponectin and orexin, typically felt to be anti- inflammatory, are low in people who are obese.   This increased systemic inflammation has been implicated in the pathogenesis of migraine headaches.  Increased inflammation also is associated with increased central sensitization, which then lead to more frequent and harder to treat migraines.

Can weight loss help prevent migraines?

Currently the only studies on the effects of weight loss in adults were in people who underwent surgical treatment for weight loss. The two small clinical studies that looked at headache frequency after weight loss from bariatric surgery, found that at 6 months after surgery the frequency of migraine did indeed decrease from a pre-surgery average of four per month down to 1-2 per month. There was also an improvement in headache duration, pain severity, disability, and use of pain medications.

The only study looking at non-surgical intervention for weight loss to date was in adolescents. This study looked at whether a behavioral weight loss intervention would reduce migraine frequency. The behavior intervention consisted of encouragement of exercise program and dietary education of the adolescent and their parents. This study showed that a decrease in BMI was associated with a reduction in migraine frequency. With the greater decrease in BMI was a greater decrease in migraine frequency.

How can weight loss cause an improvement in migraine headaches?

Just as obesity is associated with pro-inflammation, weight loss is anti-inflammatory. Weight loss decreases pro-inflammatory cytokines (TNF and IL-1) and the peptides leptin.   Weight loss also increases anti-inflammatory peptides; Orexin A, and adiponectin. Thus with weight loss, there is less neurogenic inflammation resulting in less frequent migraines but also less central sensitization and decreased severity of those migraines.

Additionally, there are also the benefits of physical activity on prevention of migraines. Several studies have been published that have reported beneficial effects on both migraine frequency and severity. Also a study showed that exercise might be just as beneficial as topiramate in the prevention of migraines. Exercise is also felt to be anti-inflammatory and also increases the feel good, pain-reducing chemicals in your brain. In addition, people who exercise, tend to eat better, sleep better and have less stress which all can also decrease migraines.

WHY NOT GIVE IT A TRY?

Given that there is proven benefits seen with both exercise and weight loss in improvement in both frequency and severity of migraines, what is stopping you from giving it a try. I would love to help find an exercise and weight loss program that is right for you.

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Bibliography:

Evan, R. W. (2012, February). The Association of Obesity with Episodic and Chronic Migraine. Headache .

Lockett, D. C. (1992). The effects of aerobic exercise on migraine. Headache, 32 (1), 50-54.

Peterlin BL, R. A. (2010). Migraine and obesity: Epidemiology, mechanisms, and implications. Headache, 50, 631-648.

Varkey, E. e. (2011). Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalalgia, 31 (4), 1428-1438.

Verrotti, A. e. (2013). Impact of a weight loss program on migraine in obese adolescents. Euroean Journal of Neurology (20), 394-397.