[Updated: 2 August 2018] According to the US Centre for Disease Control (the CDC) more than 35% of US adults are obese and over 34% are overweight.[1] This weight issue is three times more common today than in the previous generation. Weight is clearly something that affects most of us but does fat or obesity cause migraine? Several scientific studies have looked at the interaction between obesity and migraine and found a relationship between them. [2] [3] [4] [5] More frequent and severe attacks are associated with people who are overweight. [2] [3] [4] [5]

Contents

The BMI weight standard

The body mass index (BMI) is the standard used to determine an individual’s weight-related health risk. It is a calculation of weight-to-height ratio. Based on height, the BMI provides a guide for an individual’s weight. They are considered guides as the BMI does not take into account muscle or bone mass or fat distribution around the body. A BMI index in people varies from 15 (borderline starvation) to over 40 (morbidly obese). Individuals are generally classified under the following categories:

Underweight:            Under 18.5

Normal weight:          18.5-24.9

Overweight:               25-29.9

Obesity:                      30-34.9

Morbidly Obese:        35 or more

To calculate your BMI. BMI = Weight(kg)/Height(m)2 Limitations of the BMI which mean it is less accurate in bodybuilders, weightlifters, high-performance athletes, pregnant women, the elderly or people under 18 years.

Waist Circumference is an Indicator of Disease Risk

Waist circumference is another important measure which compliments the BMI. Weight carried around the stomach is a greater health risk than weight on the hips or thighs. Weight circumference is also a better estimate of visceral fat, the type of fat which coats the organs and is more problematic. The waist circumference thresholds that indicate an increase of risk of disease are listed below by gender: For women:

  • your risk is increased at 80 cm or more
  • your risk is high at 88 cm or more

For men:

  • your risk is increased at 94 cm or more
  • your risk is high at 102 cm or more

To calculate your risk, click here to use this free online calculator. If your measurements indicate an increased risk it can directly contribute to the following:

  • type 2 diabetes
  • high blood pressure
  • sleep apnea
  • osteoarthritis
  • cardiovascular risk

But what about headache and migraine?

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Migraine and Obesity

A recent 2017 peer-reviewed published study found a direct link in the reduction of excess weight with a significant reduction in migraine frequency. [4] Study participants were females with 4-20 migraine days per month with a BMI between 25 and 49.9. The study found that the average number of migraine days had fallen by almost half at the followup period. [4] What did they do? Participants received a 16-week behavioral weight loss program which included 3 components:

  1. A standard calorie and fat-restricted diet with goals of 1,200-1,500 calories per day and 33-42 grams of fat per day.
  2. A gradual progression up to a goal of 250 mins per week of moderate-intensity, home-based exercise (i.e. 50mins, 5 days per week).
  3. Behavioral modification strategies such as self-monitoring (diet, exercise, weight), goal setting, stimulus control and problem-solving to modify eating and physical activity.

A separate large population study found that obesity is associated with the frequency and severity of migraine attacks. The higher the weight and BMI group of the individual, the higher the attack frequency and severity. It did not find that obesity was a risk factor for developing the migraine disorder or disease. [2] In other words, being overweight or obese doesn’t cause migraine, but if you have migraine it can make it significantly worse. If you do have migraine and you’re overweight then the results suggest if you lower your weight to a normal BMI group or even one BMI group downward (eg. from obese to overweight) then the frequency and severity of your attacks is likely to improve as well.

Chronic Daily Headache and Obesity Chronic daily headache (CDH) are headaches occurring on 15 or more days per month.[3] The most common types of CDH are transformed migraine and chronic tension-type headache. Transformed migraine occurs in those with migraine whose attacks increase in frequency. Chronic tension-type headache evolves from episodic tension-type headache. [3] A study looking at the factors associated with the onset and remission of CDH in a population found that obesity was associated with a five-fold increased risk of developing CDH.[5] A second study also found a clear relationship between the prevalence of chronic daily headache and transformed migraine according to BMI. Below you can see how weight similarily influences the likelihood of Transformed Migraine as weight increases.

Both charts above show a clear trend indicating that the heavier the BMI weight category you fall into, the higher the likelihood of CDH and transformed migraine.

The trend in transformed migraine is significant. This trend was not found in chronic tension-type headache which was also evaluated in the same research study.

How Does Obesity Affects Migraine Frequency & Severity?

We know that obesity doesn’t cause migraine but it does correlate with the frequency and severity of attacks. How exactly? Researchers aren’t precisely sure, but there are several reasonable theories proposed:

1. Inflammation

The interrelationships between headache frequency and obesity are complex. Obesity itself is a pro-inflammatory state. Biomarkers of inflammation inside the body are elevated in those individuals who are obese. [6] There are several proposed mechanisms by which obesity may contribute to higher levels of inflammation. Inflammation is an important consideration for migraine which is associated with neurovascular inflammation. [7] Some experts may reason then that the more inflammation in someone with migraine the more likely frequent and/or more severe attacks.

2. CGRP

CGRP or calcitonin gene-related peptides are molecules that keep coming up in migraine discussions and treatments. CGRP is a neuropeptide which plays an important role in a migraine attack. CGRP itself is released during a migraine attack. Interestingly there are several potential links between this molecule, obesity, and migraine which suggest a relationship. [8] Studies have shown that levels of CGRP are elevated in obese individuals. Particularly in women. [9] This biological link hasn’t yet been fully studied so this still remains hypothetical, however, CGRP inhibitors have been shown to be effective in treating migraine. This suggests to researchers that CGRP may also be playing an extra important role in migraine and obesity.

3. Dietary choices

In some cases obesity may be due to a separate medical illness or as a side effect from commonly prescribed migraine medications. In other cases our weight is a reflection of our dietary habits, food choices, and lifestyle. Overweight individuals are more likely to consume higher levels of processed foods than those whose weight sits in the normal BMI range. Processed foods contain numerous amounts of excitotoxins, chemicals, and artificial ingredients which may contribute to inflammation and overstimulate the sensitized migraine brain. This could potentially contribute to more attacks. More scientific research is needed in this area before this can become more than a hypothesis but it could be a piece of the obesity and migraine puzzle. Read more about potential triggers here.

4. Exercise

At higher levels of the BMI, it becomes more difficult to exercise. Exercise is less about weight loss and more about fitness and strength. Even large amounts of regular exercise cannot offset a diet full of processed food, artificial preservatives, additives and sugar. Studies have shown that regular cardiovascular exercise can help protect against migraine and is as effective as a commonly prescribed migraine preventative Topiramate.[10] Despite the evidence, exercise may still represent a challenge for overweight patients with migraine. They may have exertional headache where a headache is triggered by extra effort or overheating. This can make regular cardio exercise more difficult to practice. For the majority of patients, regular exercise is great for brain health, sleep, stress and migraine prevention. If you are overweight and wish to begin exercising check first with your doctor and start small, then build up gradually. Despite best intentions, jogging 5 miles after an extended period of no exercise is a recipe for disaster.

Conclusion

Research mentioned in this article suggests that addressing obesity results in fewer and less severe attacks. This applies to both adults and children and for those with chronic or episodic migraine. Benefits can accrue from either weight loss from diet/exercise changes or from surgical weight loss procedures. Clinical trials with control groups and robust methodologies are still lacking for a definitive statement about obesity and migraine reduction however the link is clear. Have you had trouble losing weight whilst juggling migraine? Let me know in the comments.

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Article References

[1] NIH Website ‘ Obesity and Overweight’ https://www.nichd.nih.gov/health/topics/obesity/conditioninfo/pages/risk.aspx Accessed 4 Dec 2017.

[2] Bigal, Marcelo E., Joshua N. Liberman, and Richard B. Lipton. “Obesity and migraine A population study.” Neurology 66.4 (2006): 545-550.

[3] Bigal, Marcelo E., and Richard B. Lipton. “Obesity is a risk factor for transformed migraine but not chronic tension-type headache.” Neurology 67.2 (2006): 252-257.

[4] Bond, Dale S., et al. “Behavioral Weight Loss Intervention for Migraine: A Randomized Controlled Trial.” Obesity 26.1 (2018): 81-87.

[5] Scher, A. I., et al. “Factors associated with the onset and remission of chronic daily headache in a population-based study.” Pain 106.1 (2003): 81-89.

[6] Lee, Yong-Ho, and Richard E. Pratley. “The evolving role of inflammation in obesity and the metabolic syndrome.” Current diabetes reports 5.1 (2005): 70-75.

[7] Bigal, Marcelo E., and Richard B. Lipton. “Obesity is a risk factor for transformed migraine but not chronic tension-type headache.” Neurology 67.2 (2006): 252-257.

[8] Recober, Ana, and Peter J. Goadsby. “Calcitonin gene-related peptide (CGRP): a molecular link between obesity and migraine?.” Drug news & perspectives 23.2 (2010): 112.

[9] Bigal, Marcelo E., and Richard B. Lipton. “Obesity is a risk factor for transformed migraine but not chronic tension-type headache.” Neurology 67.2 (2006): 252-257.

[10] Varkey, Emma, et al. “Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls.” Cephalalgia 31.14 (2011): 1428-1438.