Megan Brooks

June 20, 2011

June 20, 2011 — For morbidly obese adults who suffer from migraines, losing a substantial amount of weight through bariatric surgery can reduce the incidence and severity of the debilitating headaches, according to a study presented at the American Society for Metabolic and Bariatric Surgery 28th Annual Meeting in Orlando, Florida.

This suggests that "there are a number of people who are suffering from migraines who otherwise might not, but for their excessive weight," study presenter Isaac Samuel, MD, director of the obesity surgery program at University of Iowa Hospitals and Clinics in Iowa City, noted in a statement from the meeting.

Dr. Samuel and colleagues took a look back at 81 morbidly obese patients with migraine headaches who underwent Roux-en-Y gastric bypass. "No lap band patients were included in this series. We selectively included only gastric bypass patients," Dr. Samuel said in an interview with Medscape Medical News.

Most were women, with a presurgery body mass index (BMI) of 48 kg/m2. On average, they lost about 55% of their excess weight; their average BMI after Roux-en-Y gastric bypass surgery was 33 kg/m2.

Within about 6 months of surgery, 89% of patients reported significant improvement in migraine headaches; 57 of 81 patients reported complete resolution, 15 reported partial resolution, and only 9 reported no change.

Patients who developed their first migraines after becoming obese experienced the most improvement, with 48 of 51 (94%) showing clinical improvement (41 complete, 7 partial, and 3 no improvement).

Among 24 patients who developed migraines before becoming obese, 18 (75%) showed clinical improvement (11 complete, 7 partial, and 6 no resolution).

Improvement in migraine symptoms after gastric bypass was independent of improvement in depression, anxiety, or sleep apnea. Women with menstrual migraines had easing of migraines similar to other women in the study.

Observations "Not Surprising"

The link between migraine headache and obesity is "controversial," Dr. Samuel said. The fact that more patients in this cohort developed migraines after becoming obese "could suggest that obesity contributes to an increased risk of having migraines, rather than merely exacerbating the symptoms," he added.

Reached for independent comment, Alexander Mauskop, MD, director and founder of the New York Headache Center in New York City and board-certified neurologist, said that "there is a correlation between the frequency of migraines and obesity, so it is not surprising that treatment to lower the weight might help the headache as well. It just makes sense."

Support for the migraine-relieving effects of gastric bypass come from a study recently published in Neurology (2011;76:1135-1138), and reported at that time by Medscape Medical News.

The study involved 24 severely obese migraineurs who underwent bariatric surgery. After 6 months, and after losing an average of 49% of their excess weight, most experienced fewer and less intense headaches.

Although the study can't prove that weight loss is responsible for the easing of migraine, "we think weight loss is definitely playing a role," Dale S. Bond, PhD, from The Miriam Hospital Weight Control and Diabetes Research Center in Providence, Rhode Island, who worked on the study, told Medscape Medical News.

Dr. Bond and his colleagues plan to look at whether losing small amounts of weight through behavioral weight-loss treatments is also effective in relieving migraine headaches. "If so, this would have even greater implications because only a very small proportion of obese individuals are actually going to have bariatric surgery," he said.

Dr. Samuel said gastric-bypass-induced endocrine alterations are a possible mechanism for the apparent migraine-relieving effects of the surgery. Dr. Mauskop agreed. Changes in hormones are definitely a "possible" mechanism, he told Medscape Medical News.

Dr. Bond reports serving on the editorial boards of Surgery for Obesity and Related Diseases and the American Journal of Health Behavior, and receiving research support from the National Institutes of Health. Dr. Samuel and Dr. Mauskop have disclosed no relevant financial relationships.

American Society for Metabolic and Bariatric Surgery (ASMBS) 28th Annual Meeting: Abstract P-111. Presented June 15, 2011.


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