Bariatric Surgery For Migraines?

Among the many aches and pains commonly associated with excess weight, the increased prevalence and severity of migraines in patients with obesity is perhaps the least well known.

Not only do migraines appear to be more common in patients with excess weight but there is also evidence that people with severe obesity are likely to have more severe migraines than individuals with normal weight.

There are a number of plausible psychological and physiological mechanisms that could explain this relationship. The former include the finding that pathological pain processing, catastrophising and sensitivity has been associated with excess weight. The latter is supported by recent evidence that pro-inflammatory molecules that are increased in obese individuals can act as pain mediators in neurovascular inflammation.

These finding certainly raise the question whether weight loss can reduce the frequency and/or intensity of migraines.

This question was now addressed by Dale Bond and colleagues from Providence, Rhode Island, in a paper just published in NEUROLOGY.

The researchers prospectively assessed 24 patients (88% female, BMI 47) who had migraine according to the ID-Migraine screener before and 6 months after bariatric surgery.

Post-surgical weight loss was associated with a significant reduction in number of headache days from 11 to 7 in the 90 days preceding each assessment. Patients, who lost the most weight, also had the greatest odds of experiencing a more than 50% reduction in headache days. Furthermore, the number of patients reporting moderate to severe disability due to migraines decreased from 12 (50.0%) before surgery to 3 (12.5%) after surgery. While patients also reported significant improvement in depression (average PHQ-9 scores reduced from 8.8 to 4.3), the changes in mood were not predictive of the improvements in migraines.

This study certainly supports the hypothesis that migraine frequency and severity in severely obese patients reduces with surgical weight loss.

On the other hand, before jumping to overly enthusiastic conclusions, it may be prudent to note that this study did not assess or discuss the possibility that the lifestyle changes associated with surgery may simply have reduced exposure to many of the nutritional and lifestyle triggers of migraines (e.g. certain foods such as fruits, onions, chocolate, nuts, cheese, sugar, caffeine, alcohol or red wine as well as stress or physical exertion).

I guess it would take a prospective trial with careful assessment of these migraine triggers (or at least a control group of weight-stable patients who make the same dietary and lifestyle changes) to determine how much of this finding is explained by weight loss rather than simply by lifestyle change following surgery.

Nevertheless, I do wonder if any of my readers have observed similar changes in headache frequencies with changes in body weight or environmental triggers unrelated to weight loss.

AMS
Edmonton, Alberta

Bond DS, Vithiananthan S, Nash JM, Thomas JG, & Wing RR (2011). Improvement of migraine headaches in severely obese patients after bariatric surgery. Neurology, 76 (13), 1135-8 PMID: 21444898