Obesity and Migraine
By Lee Peterlin, DO
Episodic and chronic migraine are associated with general or total body obesity in reproductive aged individuals – those individuals who also have the highest prevalence of migraine. In addition abdominal obesity may be associated with a greater risk of severe headaches and migraine in reproductive-aged women than men. Given that obesity is a potentially modifiable risk factor, migraine patients and clinicians treating migraineurs should be aware of the association of migraine with obesity in general and that the risk of migraine increases with increasing obesity and that weight gain and weight loss may impact headache frequency.
Both patients and clinicians treating obese migraine patients should consider life-style education - particularly in terms of promoting healthy diet and exercise routines. Lack of physical activity has been demonstrated to be associated with a 21% increased risk of headache attacks in adult migraineurs (HR 1.209; p<.01)21 and a 50% increased risk of migraine in adolescents (OR 1.5; 95%CI: 1.0-2.2).7 In addition, limited data suggest aerobic activity may reduce headache frequency in episodic migraineurs. Further although studies are needed to better characterize the influences migraine medications may have on energy balance and a patient’s propensity to gain or lose weight, migraine patients should be made aware of the potential influence medications may have on their weight.
Many migraine medications can affect weight either positively or negatively. Medications which may be used for migraine prophylaxis and be associated with weight loss include: topiramate, zonisamide and protriptyline.Other potential migraine prophylactic agents where weight loss is mild or neutral may include duloxetine and venlafaxine. In contrast, verapamil, more so than propranolol and gabapentin, may be associated with mild to moderate weight gain or be weight neutral, whereas valproic acid, amitriptyline and flunarazine may be associated with substantial weight gain.
In summary patients should be encouraged to exercise, consume a healthy diet, and avoid excessive weight gain; and when migraine prophylaxis is warranted they should work with their physician to utilize medications which will help them to meet or maintain healthy body composition goals.
Lee Peterlin, DO, Director of JHU Headache Research, Johns Hopkins Bayview Medical Center, Baltimore, MD.