By B. Lee Peterlin, DO
Migraine, whether episodic or chronic, is co-morbid with obesity. The risk of migraine increases with increasing obesity status—from normal weight to overweight to obese. In addition, obesity increases the risk of someone with an episodic pattern of headaches transforming to a chronic pattern. Given that obesity is a potentially modifiable risk factor, migraine patients and clinicians treating migraineurs should be aware of this association, and consider each individual’s obesity status in regards to both life-style education and medication choices.
Life-style education, particularly in terms of promoting healthy weight, as well as in the consideration of appropriate diet and exercise routines, may be important tools in the management of migraine headaches. Lack of physical activity has been demonstrated to be associated with a 21-50% increased risk of headache attacks in adult (HR 1.209; p<.01) and adolescent (OR 1.5; 95%CI: 1.0-2.2) migraineurs. In addition, increasing data supports that aerobic activity may reduce headache frequency in episodic migraineurs. The data is not clear as to what diet, if any, may help to decrease headache frequency. The current evidence on diets has been methodologically limited or negative. However, this data suggests that a low fat, or ketogenic, diet may improve episodic migraine in overweight adults. Additionally, for those with chronic daily headache, a diet high in omega 3 and low in omega 6 may help. Whether it is the diet or the weight loss that is associated with these improvements remains to be determined. It is a good idea to talk with your doctor and nutritionist before you start an exercise or diet regimen.
Although more studies are needed to better characterize the influences migraine medications may have on a patient’s risk to gain or lose weight, it is important to be aware that many migraine medications can affect weight—with either weight gain or weight loss. Medications which may be used for migraine prevention and that may be associated with weight loss include: topiramate, zonisamide and protriptyline. Other potential migraine prevention agents where weight loss is mild or neutral may include duloxetine and venlafaxine. In contrast, verapamil, more so than propranolol and gabapentin, may be associated with weight gain or be weight neutral, whereas valproic acid, amitriptyline and flunarazine may be associated with substantial weight gain.
In summary, migraine patients should be encouraged to maintain a healthy weight, to exercise regularly, and to consume a healthy diet. When migraine prevention is warranted, work with your doctor to utilize medications that help to meet or maintain a healthy body composition and healthy life-style choices.
B. Lee Peterlin, DO
Director of Johns Hopkins Headache Research
Johns Hopkins School of Medicine, Baltimore, MD.