Gastric bypass alleviates migraine headaches

Jun 17, 2011

Bariatric surgery can lead to total or partial alleviation of migraines in nearly 90% of morbidly obese patients diagnosed with migraine headaches, according to a new study presented here at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery.

Over an average follow-up of 3 years after gastric bypass surgery, more than 70% of patients never had another migraine. More than 18% had partial resolution, with migraine attacks dropping from 5 to 2 per month. These patients also experienced less painful migraines and took fewer medications. Eleven percent of patients had no change in migraine status.

“The incidence and severity of migraines was greatly reduced after bariatric surgery and weight loss, suggesting there are a number of people who are suffering from migraines who otherwise might not but for their excessive weight,” said Isaac Samuel MD, Associate Professor, University of Iowa Roy J and Lucille A Carver College of Medicine and Director, UI Obesity Surgery Program.

University of Iowa researchers reviewed the medical records of 702 patients who had Roux-en-Y gastric bypass (RYGB) surgery between March 2000 and September 2009 who had a diagnosis of migraine for which they were being medically treated. Eighty-one patients qualified for the retrospective study and data were collected from institutional electronic medical records or via telephone. The postoperative follow-up period ranged from 12 months to 8.5 years (patients followed up less than 12 months were excluded from the analysis).

The researchers noted that while gastric bypass generally improved or resolved migraine headaches among all study participants, those who developed their first migraines after becoming obese experienced the most improvement. About 80% had total resolution and 14% had partial improvement. Of the people who experienced their first migraine before the onset of obesity, 75% showed improvement after surgery (46% had total resolutions, 29% had partial improvement).

While many people with morbid obesity have additional medical issues associated with migraines, by analyzing the data, researchers showed that the improvement in migraine symptoms following surgery was independent of the improvement of their migraine-associated issues such as depression, anxiety, or sleep apnea. Women with migraines associated with their menstrual cycles had similar improvement of migraines, as did others in the study.

“The association between migraine headache and obesity is controversial,” added Dr Samuel. “Although some suggest that obesity is associated with migraine prevalence, others have only found a correlation between the frequency and severity of migraine headache and obesity. The effect of surgical weight loss on morbidly obese patients with migraines provides a unique opportunity to evaluate this association. The higher number of patients identified in this study cohort that developed migraines after obesity onset could suggest that obesity contributes to an increased risk of having migraines rather than merely exacerbating the symptoms.”

Other causes of headache in obese patients could include pseudotumor cerebri, or idiopathic intracranial hypertension, an increase in pressure around the brain that can feel like a migraine and may be caused by obesity, which also responds well to bariatric surgery. The UI retrospective study was unable to differentiate between the 2, and researchers relied on the doctor’s diagnosis of migraine.

Source: News Release
American Society for Metabolic & Bariatric Surgery
June 15, 2011