Higher BMI Correlates With Increased Migraine Severity, Comorbidities

Results of a questionnaire-based study show higher body mass index (BMI) is associated with worse migraine symptoms and comorbidities.

New research indicates a body mass index (BMI) equal to or greater than 30 is associated with increased migraine chronification, headache days per month, and headache severity, compared with migraineurs with normal BMI. The abstract will be presented at the American Academy of Neurology’s 73rd Annual Meeting, being held virtually April 17-22, 2021.

Previous studies have found individuals classified as obese tend to have an increased risk of migraine chronification, in addition to an increased risk of headache comorbidities. For example, one study conducted in 2020 found that in individuals under the age of 50, both total body obesity and abdominal obesity were associated with greater migraine prevalence and attack frequency.

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 COVID-19 complications. According to the CDC, an adult BMI of 30 or higher is considered “within the obesity range.”

In order to quantify BMI in migraineurs and better understand its impact on migraine characteristics and comorbidities, researchers recruited those referred to a large tertiary headache clinic at the University of Washington.

Prior to their first visit, all participants (N = 3611) completed a detailed intake questionnaire on topics, including headache characteristics, sleep, depression, anxiety, stress, and other information. Patients’ BMI and diagnosis of migraine based on International Classification of Headache Disorders, 3rd Edition, criteria were also recorded.

Analyses revealed:

  • BMI was higher among those with chronic migraine
  • Patients with a BMI ≥ 30 compared with normal BMI reported more headache days per month and greater headache severity
  • Patients with a BMI ≥ 30 reported a higher perception of stress scores (P <.0001) that correlated with higher anxiety and had higher scores on Patient Health Questionnaire (PHQ) 4 (P <.0001) that correlated with depression compared with patients with a normal BMI
  • Patients who reported sleep problems had a higher BMI than patients not reporting sleep problems

“Our data support our expectation that BMI ≥ 30 compared to normal BMI correlates with increased migraine chronification, increased headache days per month, and increased headache severity,” the researchers concluded. “BMI ≥ 30 compared to normal BMI also significantly correlates with measures of migraine comorbidities, such as anxiety, depression, and difficulty with sleep.”

Findings suggest that normalizing BMI may be protective against migraine chronification and might help improve associated comorbidities.


O’Fallon G, Dyess M, Haley H, et al. Body mass index and the brain in pain: influence of BMI level on migraine patients seen at a large tertiary headache center. Presented at: American Academy of Neurology 73rd Annual Meeting; April 17-22, 2021; Virtual. Accessed April 13, 2021. https://index.mirasmart.com/AAN2021/PDFfiles/AAN2021-002621.html

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