Severely obese individuals with migraine headache may have fewer and less intense headaches after losing a significant amount of weight through bariatric surgery, according to results of a small prospective, observational study.
"A number of population-based studies have shown that obesity is associated with migraine, but to our knowledge this is the first study to actually show that weight loss is associated with improvements in migraine," first study author Dale S. Bond, PhD, of The Miriam Hospital Weight Control and Diabetes Research Center in Providence, Rhode Island, told Medscape Medical News.
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," Dr. Bond said.
He noted that a reduction in inflammation, which is hypothesized to be involved in migraine pathophysiology, might also contribute to this phenomenon. "We also know that inflammatory mediators that are involved in migraine pathophysiology are also elevated in obese individuals," he explained.
Their findings were published March 29 in Neurology.
Migraine Eases After Surgery
Dr. Bond and colleagues assessed 24 severely obese migraineurs before and 6 months after bariatric surgery. Most of the study subjects were middle-aged women. The subjects had a mean body mass index (BMI) of 46.6 kg/m2 before surgery; 6 months after surgery, their mean BMI was 34.6 kg/m2. Subjects lost 49.4% of their excess weight, on average.
According to the investigators, the average number of headache-days was "markedly" reduced from 11.1 days before surgery to 6.7 days after surgery (P < .05). Nearly half (46%) of subjects experienced at least a 50% reduction in headache frequency.
The odds of achieving this milestone were higher in those who lost more weight, regardless of the type of surgery; 58% of subjects had laparoscopic adjustable gastric banding.
There was also a "substantial" decrease in headache severity (P < .05) and related disability (P < .01). Before surgery 12 subjects (50%) reported moderate to severe disability, but only 3 subjects (12.5%) reported this degree of disability 6 months after surgery.
"Remarkably," the investigators say, "headache improvements occurred postoperatively despite the fact that 70% of participants were still obese, suggesting that weight loss can help alleviate migraine in the absence of resolution of obesity."
Dr. Bond said his group is planning to look at whether losing small amounts of weight through behavioral weight loss treatments might also be effective. "If so, this would have even greater implications because only a very small proportion of obese individuals are actually going to have bariatric surgery. We'll also be able to look at whether changes in diet and exercise and sleep might also be associated," he said.
CPAP for Migraine?
In the same issue of Neurology, researchers from Germany and Switzerland report evidence from a small prospective study that hypoxia in the context of obstructive sleep apnea syndrome (OSAS) might be a trigger for migraine and can be improved by continuous positive airway pressure (CPAP).
Ulf Kallweit, MD, of University Hospital Zurich in Switzerland, and colleagues assessed 11 patients with OSAS and migraine headache before and 1 year after conventional CPAP therapy. Six patients had migraine, 4 had migraine with aura, and 1 had chronic migraine. Their mean BMI was 29.7 kg/m 2.
CPAP, which was used "regularly" (87%) by study subjects, was effective for OSAS, reducing the apnea-hypopnea index from a mean of 33.7 at baseline to 1.0 under CPAP. It also led to improvement in slow wave sleep and sleep efficiency.
With effective CPAP therapy, all patients reported an easing of migraine, with the average number of attacks decreasing from 5.8 to 0.1 per month. Ten patients were headache free for the last 3 months, and the patient with chronic migraine went from having daily headaches to 2 attacks per month during the last 6 months, the researchers report.
"CPAP seems to be even more effective than prophylactic pharmacotherapy (eg, topiramate)," Dr. Kallweit noted in an email to Medscape Medical News.
It's unclear whether the improvement in migraine was caused directly by better oxygenation or indirectly by improvements in sleep. On the basis of this study, Dr. Kallweit says it would be wise to "pay particular attention to symptoms of sleep apnea in migraineurs and, if appropriate, treat it." A larger trial is planned to confirm these findings, the researcher said.
Asked for his thoughts on this study, Dr. Bond said, "I'm not a sleep expert, but one of the hypothesized mechanisms of interactions between obesity and migraine is possibly sleep apnea."
The study by Dr. Bond and colleagues was supported in part by the National Institutes of Health (NIH). Dr. Bond serves on the editorial boards of Surgery for Obesity and Related Diseases and American Journal of Health Behavior and receives research support from the NIH. Dr. Kallweit discloses having served on an advisory board for Merck Serono.
Source - http://www.medscape.com/viewarticle/742227?src=mp&spon=14