Does Obesity Impact Migraine Prevalence?

In individuals under the age of 50, both total body obesity (TBO) and abdominal obesity (AO) were associated with greater migraine prevalence and attack frequency, according to a study published in The Journal of Headache and Pain.

The prevalence of obesity has substantially increased in recent years, with the latest CDC data classifying 9% of the US population as severely obese and 42% as obese. Weight gain and obesity are also some of the leading risk factors for disease and death worldwide, and significantly contribute to increased risks of coronavirus disease 2019 (COVID-19) complications.

In addition to being associated with a host of other health problems “TBO, as measured by body mass index (BMI), has been associated with migraine prevalence, and with the progression from episodic to chronic migraine.”

However, researchers point out obesity defined by BMI cannot distinguish between fat and muscle mass or between abdominal and peripheral fat distribution.

As abdominal visceral fat is metabolically different from other body fat and may be an independent risk factor for medical complications, “AO may be of particular interest in migraine, as this adipose tissue produces multiple substances potentially involved in migraine pathophysiology, including markers of systemic inflammation,” authors wrote.

To better understand how obesity and body fat distribution are associated with migraine and tension-type headache (TTH), investigators conducted a cross-sectional study based on data from 33,176 Norwegian citizens.

Of the 18,191 women and 14,985 men included in the study (mean age of 54.4 years), 4290 (12.9%) had migraine, 4447(13.4%) had frequent TTH, and 24,439 acted as headache-free controls.

The third Nord-Trøndelag Health Study (HUNT3) took place between 2006 and 2008. Participants received 2 questionnaires which included more than 200 health-related questions.

After participants completed the 1st questionnaire (Q1), they were invited to participate in a medical examination and to fill out a second questionnaire (Q2), which included 14 questions specifically on headache.

Analyses revealed:

• TBO (BMI ≥ 30) was associated with increased odds of having migraine (OR 1.45; 95% CI, 1.32–1.59), both for women and for men, while effect size was larger in participants < 50 years of age (OR 1.74; 95% CI, 1.54–1.98), and not seen for those ≥50 years
• Obesity was associated with higher odds of having both migraine with aura (OR 1.51; 95% CI 1.33–1.71) and migraine without aura (OR 1.43; 95% CI, 1.26–1.62)
• Being overweight (BMI 25–30) was associated with higher odds for having migraine with aura (OR 1.25; 95% CI, 1.12–1.39) and migraine without aura (OR 1.15; 95% CI, 1.04–1.29)
• AO (waist circumference [WC] > 88 cm in women, > 102 cm in men) was associated with increased odds of having migraine (OR 1.29, 95% CI, 1.18–1.41), for women and men
• AO effect size was larger when considering only participants < 50 years (OR 1.89; 95% CI, 1.69–2.11), but there was also an association for participants ≥50 years of age (OR 1.26; 95% CI, 1.10–1.45)

Researchers also found weaker associations between obesity and TTH, in addition to a dose-response relationship between obesity categories and increased headache frequency in migraineurs.

“Regarding body fat distribution, the association between migraine and TBO was independent of AO, but not vice versa, suggesting that TBO may be a more important measure with regards to migraine prevalence and chronification,” authors wrote.

Metabolic and hormonal activity of adipose tissue, increased release of pro-inflammatory substances, and neuroinflammation and neuropeptides involving hypothalamic function are among various mechanisms that may explain the association between migraine and obesity.

Researchers noted the use of questionnaire-based headache diagnoses instead of clinical review poses a limitation to the study. They also cautioned the cross-sectional design of the study prohibits any conclusions about causality from being drawn and limits finding generalizations.

However, “these findings may have clinical implications for treatment of migraine and should be further investigated in population-based follow-up studies,” authors concluded.

Reference:

Kristoffersen ES, Børte S, Hagen K, et al. Migraine, obesity and body fat distribution- a population-based study. J Headache Pain. Published online August 6, 2020. doi:10.1186/s10194-020-01163-w