Addressing Comorbid Migraine in Obese Patients

Morbidly or severely obese individuals develop migraine disorders significantly more often than patients who carry less weight.

Obese patients are at higher risk for both episodic and chronic migraines, and that risk increases as they gain more weight. Researchers have suggested that pathophysiological abnormalities, such as changes in hypothalamic activation and modulation of shared neurotransmitters and proteins, and/or lifestyle choices may be the cause.

Limited, uncontrolled research has shown bariatric surgery reduces headache frequency and pain intensity. In an article published in Future Neurology, 2 authors discussed researchers’ efforts to date and areas of treatment that appear promising. In fact, several studies have demonstrated partial resolution of migraine symptoms as patients lost weight.

The study authors pointed out that none of the studies included a control group, so they reminded readers that larger controlled studies evaluating bariatric surgery for migraine prevention are still needed. Many obese patients who have migraines are poor candidates for bariatric surgery or do not desire the procedure. In this population, studies assessing other weight-loss strategies like diet and exercise are also needed, the authors said.

The article advocated for clinicians to proactively advise patients on the increased risk of migraine among those who are obese. It also recommended choosing medications carefully when patients are obese, as many medications’ side effects include weight gain or loss.