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Migraines and obesity

Bypass patients report improvement in migraines

Patients report a total or partial alleviation of migraines following Roux-en-Y gastric bypass
The association between migraine headache and obesity is controversial
Study suggests that obesity contributes to an increased risk of having migraines
Isaac Samuel

Patients who suffered from migraines reported a total or partial alleviation of migraines following Roux-en-Y gastric bypass, according to a new study,  ‘Roux-en-Y gastric bypass achieves substantial resolution of migraine headache in the severely obese: 9-year experience in 81 patients., presented at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery. 


“The incidence and severity of migraines was greatly reduced after bariatric surgery and weight loss,” said Dr Isaac Samuel, Associate Professor, University of Iowa (UI) Roy J and Lucille A Carver College of Medicine and Director, UI Obesity Surgery Program. “This suggests there are a number of people who are suffering from migraines who otherwise might not but for their excessive weight.”


UI researchers reviewed the medical records of 702 patients who had Roux-en-Y gastric bypass (RYGB) surgery between March 2000 and September 2009 who had a diagnosis of migraine for which they were being medically treated. A total of 102 had a history of migraine prior to surgery. Exclusion of patients followed for less than 12 months resulted in a study population of 81 patients. Data were collected from these remaining patients from institutional electronic medical records or via telephone. The post-operative follow-up period ranged from 12 months to eight and a half years (patients followed up less than 12 months were excluded from the analysis). 


The patients had a mean age of 40, and women accounted for 90% of the study group. Preoperative BMI averaged 48, and duration of obesity averaged 22.6 years. The patients had a median follow-up of 38.6 months. The group had postoperative BMI of 33, and excess weight loss averaged 55%. On average, the patients had a migraine history of 19.2 years, a frequency of 5.7 episodes per month, and associated aura in 25 (31%) patients. All of the patients were receiving migraine therapy at surgery, the vast majority serotonin agonists (56 of 81).


“The incidence and severity of migraines was greatly reduced after bariatric surgery and weight loss” Isaac Samuel

During follow-up, 72 of the 81 patients reported improvement in migraine symptoms, which was associated with a mean excess weight loss of 56%. In contrast, the nine patients who reported no improvement had a mean excess weight loss of 42%. Further examination of the association between weight loss and migraine improvement showed that excess weight loss averaged 58% in the 57 patients who had complete resolution of migraine, compared with 51% in the 15 patients with partial resolution.


Other causes of headache in obese patients could include pseudo-tumour cerebri, or idiopathic intracranial hypertension, an increase in pressure around the brain that can feel like a migraine and may be caused by obesity, which also responds well to bariatric surgery. The UI retrospective study was unable to differentiate between the two, and researchers relied on the doctor’s diagnosis of migraine.


“The association between migraine headache and obesity is controversial. Although some suggest that obesity is associated with migraine prevalence, others have only found a correlation between the frequency and severity of migraine headache and obesity,” concluded Samuel. “The effect of surgical weight loss on morbidly obese patients with migraines provides a unique opportunity to evaluate this association. The higher number of patients identified in this study cohort that developed migraines after obesity onset could suggest that obesity contributes to an increased risk of having migraines rather than merely exacerbating the symptoms.”


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