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Q
Does Obesity Cause Migraines?

I've heard that migraine headaches may be due to obesity. Can you tell me whether that is true? Does it mean that if you lose weight, the headaches will go away?

A
Answer (Published 9/9/2013)

Migraine is recurrent, vascular (throbbing) headache that affects up to 17 percent of women and six percent of men; it can be severe and disabling. Untreated, these headaches can last for hours and sometimes as long as three days. We don’t know for sure what puts you at risk of migraine, but obesity is clearly associated with some cases. Most recently, researchers from Johns Hopkins recruited 3,862 adults to examine this issue, and concluded that people with a high body mass index (BMI) indicating overweight or obesity were 81 percent more likely to have episodic migraines (those that occur 0 to 14 days per month) than were people with a lower body mass index. The study found that this association with weight was particularly true among women under 50 (their episodic migraine risk was three times higher than men’s). It also showed that as BMI went up, so did the chance of developing migraine. The study was presented at the International Headache Congress in June 2013.

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These findings don’t prove that obesity causes migraine. Instead they identify obesity as a major risk factor for the headaches. Nor did it show how obesity leads to migraine. One possibility is that medications used to prevent the headaches, particularly amitriptyline or valproic acid, can lead to weight gain. And there is a theory that the headaches may be due to inflammatory proteins secreted by body fat. As to the question of whether losing weight would lessen the frequency and severity of migraine or eliminate it altogether, study leader Barbara Lee Peterlin, director of headache research at Hopkins, was quoted in news reports as saying two small studies showed that some migraine patients had fewer headaches after weight-loss surgery, but more research is needed to confirm those findings.

In an article Dr. Peterlin wrote for the American Headache Society’s website, she noted that obese individuals who have episodic headaches have a greater risk of developing chronic headache (those occur on at least 15 days per month for a period of three months or more) than migraine patients who are not obese. Addressing the subject of weight loss, Dr. Peterlin wrote that not much data exists on the role of weight loss and exercise in reducing the frequency of migraine. However, she noted that one small pilot study suggests that aerobic exercise may decrease headache frequency, while another found that weight loss via a low fat diet could help decrease both frequency and intensity. Her advice? If you’re obese and have episodic migraine, avoid gaining weight and try to lose. If you succeed, you’ll certainly be healthier in general and maintaining a reasonable BMI may help reduce the frequency of your headaches.

Andrew Weil, M.D.

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