Losing weight helps decrease the incidence of migraines

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For migraine sufferers with obesity, losing weight can decrease headaches and improve quality of life, researchers from Italy and the US report. The results of their meta-analysis were presented at ENDO 2019, the Endocrine Society’s annual meeting in New Orleans.

“If you suffer from migraine headaches and are obese, losing weight will ameliorate the quality of your family and social life as well as your work and school productivity. Your overall quality of life will greatly improve,” said lead study author Dr Claudio Pagano, an associate professor of internal medicine at the University of Padova in Padova, Italy. “Weight loss in adults and children with obesity greatly improves migraine headache by improving all the main features that worsen migraineurs’ quality of life,” he added. “When people lose weight, the number of days per month with migraine decreases, as does pain severity and headache attack duration.”

To investigate the effects of weight loss achieved through bariatric surgery or behavioural intervention on migraine frequency and severity, Pagano and his colleagues at The Miriam Hospital/Brown Alpert Medical School, Providence, in the US reviewed the standard online medical research databases for studies that considered pain intensity, headache frequency, attack duration, disability; and BMI, BMI change, intervention (bariatric surgery versus behavioural), and population (adult versus paediatric).

In a meta-analysis of the 473 patients in the 10 studies that met the researchers’ inclusion criteria, they found that weight loss was linked with significant reductions in headache frequency, pain intensity and disability (all p<0.0001); as well as attack duration (p=0.01).

Migraine improvement was not linked with either degree of obesity at baseline or amount of weight reduction. Also, the effect on migraine was similar when weight reduction was achieved through bariatric surgery or behavioural intervention and was comparable in adults and children.

“Weight loss reduces the impact of conditions associated with obesity, including diabetes, hypertension, coronary heart disease, stroke and respiratory diseases,” Pagano said. “Obesity and migraine are common in industrialised countries. Improving quality of life and disability for these patients will greatly impact these populations and reduce direct and indirect healthcare costs.”

The mechanisms linking obesity, weight loss and migraine headache remain unclear, according to the authors, but they may include alterations in chronic inflammation, adipocytokines, obesity comorbidities, and behavioral and psychological risk factors.

Background: Migraine and obesity are highly prevalent and chronic diseases. Evidence has shown that obesity may influence frequency and severity of migraine attacks and is a risk factor for migraine progression. Several studies have suggested that weight loss, achieved via surgical and non-surgical means, may improve migraine.
Aim: To perform a meta-analysis on the effect of weight loss obtained by bariatric surgery or behavioral intervention on migraine frequency and indices of severity.
Methods: A search through Pubmed/Medline, ISI-web of knowledge and Google Scholar retrieved 10 studies (n=473) that were used for meta-analysis. Selected outcomes were Headache Frequency, Pain Intensity, Disability and Attack Duration while BMI, BMI change, type of intervention (bariatric vs behavioral), type of population (adult vs pediatric) were used for moderators and meta-regression analysis.
Results: Random effect meta-analysis shows that weight loss yields significant reductions in Headache Frequency (ES -0.65, 95% C.I. -0.88 to -0.42, p<0.0001), Pain Intensity (ES -0.81, 95% C.I. -1.19 to -0.44, p<0.0001), Disability (ES -0.61, 95% C.I. -0.77 to -0.45, p<0.0001) and Attack Duration (ES -0.35, 95% C.I. -0.62 to -0.08, p=0.01). Moderators and meta-regression analysis showed that improvement in migraine was not correlated either to the degree of obesity at baseline or the degree of weight reduction. In addition, the effect on migraine was similar when weight reduction was obtained with bariatric surgery or behavioral intervention and was comparable in adult and pediatric populations.
Conclusions: Weight loss improves parameters of migraine headache in patients who have obesity independently of the type of intervention and the amount of weight loss. The mechanisms underlying the link between obesity, weight loss and migraine headache are still largely unclear although it is possible that alterations in chronic inflammation, adipocytokines, obesity comorbidities (i.e. OSAS), and overlapping behavioral and psychological risk factors may play a role.

Angelo Di Vincenzo, Marco Beghetto, Roberto Vettor, Marco Rossato, Dale Bond, Claudio Pagano

The Endocrine Society material
ENDO 2019 abstract

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