Among patients with obesity and migraine, surgical or behavioral weight loss is associated with reduction of migraine frequency, pain severity, attack duration, and disability, according to a new meta-analysis published in Obesity Surgery.
Previous studies have shown that obesity is associated with increased migraine risk and might contribute to more frequent and severe migraine attacks among those with pre-existing migraine. Several studies have suggested that weight loss may have a beneficial effect on migraine. The goal of the current meta-analysis was to assess whether any benefit of weight loss on migraine is correlated with the degree of weight change and if different weight reduction strategies may elicit different effects.
The researchers searched the MEDLINE/PubMed, ISI-Web of Knowledge, Scopus, and Google Scholar databases from 2000 to the end of 2018 and screened 98 records, of which 90 were excluded and 8 articles, corresponding to 10 primary studies (473 patients), were included in the meta-analysis. The outcomes measured included headache frequency (10 studies), pain severity (6 studies), disability (4 studies), and attack duration (6 studies).
Weight loss was associated with a significant reduction in headache frequency (effect size [ES] -0.78; 95% CI, -1.13 to -0.43, P <.00001), pain severity (ES -1.04; 95% CI, -1.49 to -0.59, P <.0001), and headache disability (ES -0.68; 95% CI, -0.96 to -0.41, P <.0001), and there was a small but significant reduction in headache duration (ES -0.25, 95% CI, -0.45 to -0.04, P =.017).
Improvement in migraine was not correlated to either the degree of obesity at baseline or the degree of weight reduction.
There was no difference between bariatric and behavioral approaches for weight loss on headache frequency, pain severity, or headache disability. However, the effect of weight loss on headache duration was significant only for surgical weight loss and not for the behavioral approach.
The beneficial effects of weight loss on headache frequency and disability were similar in adult and pediatric populations, but the impact on attack duration was limited to the adult population.
The researchers acknowledged several limitations of the study, including the relatively small number of studies and patients, lack of control group in most studies, and no data on changes of circulating inflammatory and anti-inflammatory cytokines, energy balance behaviors, and psychological symptoms.
“This meta-analysis provides further evidence for the efficacy of weight loss as an important adjunctive treatment for individuals with migraine and obesity,” concluded the study authors. They do, however, note that “results showing similar benefit regardless of the weight loss method and amount of weight loss achieved justify additional research to determine mechanisms, beyond weight loss, that account for migraine improvements.”
Di Vincenzo A, Beghetto M, Vettor R, et al. Effects of surgical and non-surgical weight loss on migraine headache: a systematic review and meta-analysis [published online ahead of print, February 1, 2020]. Obes Surg. doi: 10.1007/s11695-020-04429-z