Experts Assess Link Between Misclassification of Obesity and Prevalence of Migraine

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The authors of a recent editorial explained that the higher prevalence of migraine in obese individuals may be due to a common etiological factor, because both conditions are linked to inflammatory processes.

Experts recently assessed the effects of misclassifications of obesity on the course of migraine, suggesting that the use of probiotics could act as a suitable therapeutic intervention for depression and other disorders related to neuroinflammation and the intensity of migraine attacks.

The authors of a recent editorial published by The Journal of Headache and Pain explained that the higher prevalence of migraine in obese individuals may be due to a common etiological factor, because both conditions are linked to inflammatory processes.

“A high inflammatory response promotes the sensitization of central neurons to harmful and non-harmful stimuli, with an increased risk of progression of migraine, and the increase in body fat mass of the obesity state can intensify the neurovascular inflammatory response in migraine, increasing headache and its frequency,” the authors stated.


The current parameters used to diagnose obesity are dated and limited, according to the authors. They explained that obesity in adults is defined using body mass index (BMI), which does not distinguish between total body fat (TBFat) and total body lean (TBLean), or bone mass. Additionally, the authors suggested that the cut-offs of BMI are arbitrary and, therefore, the diagnosis of obesity may be inaccurate when used as an index of the percentage of body fat (PBF).

The authors discussed that the diagnosis and treatment of obesity must include a general and nutritional history, an objective examination, measurement of energy expenditure at rest, and an evaluation of body composition.

“Furthermore, obesity is characterized by a state of chronic low-grade inflammation of the adipose tissue, which acts as a neuroendocrine organ, producing multiple molecules involved in energy homeostasis and inflammation, via the secretion of inflammatory cytokines,” the authors stated. “The adipocytes produce and secrete a large number of molecules of a protein nature, collectively called ‘adipokine.’”

The article suggested that adipocytokines may be involved in the correlation between obesity and migraine. Additionally, the authors noted that calcitonin gene-related peptide (CGRP), a neurotransmitter produced in peripheral sensory neurons and numerous sites of the central nervous system, can promote immune and inflammatory responses and is increased during acute migraine attacks. CGRP levels are also found to be increased in obese subjects, demonstrating the link between migraine and obesity.

In addition, the authors noted that anxiety disorders are strongly associated with migraine and that probiotics demonstrate a therapeutic potential deriving from modulation of gut composition. In the authors’ previous study in obese subjects, there were more significant improvements in migraine frequency after weight loss than after probiotics treatment.

“Restoring the integrity of the intestinal barrier with probiotics such disorders of the brain, involving depression, anxiety, frequency and intensity of migraine attack, have been reduced, with a bidirectional modulation of gut microbiota and brain function, through the decrease of inflammatory reactions,” concluded the authors.


Di Renzo L, Cammarano A, De Lorenzo A. The misclassification of obesity affects the course of migraine. J Headache Pain. 2018;19:63. doi: 10.1186/s10194-018-0895-6.