Headaches and obesity

Fortini, Ida; Felsenfeld Junior, Bernardo Dror

doi:10.1590/0004-282X-ANP-2022-S106

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Arquivos de Neuro-Psiquiatria

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HEADACHE • Arq. Neuro-Psiquiatr. 80 (5 Suppl 1) • May 2022 • https://doi.org/10.1590/0004-282X-ANP-2022-S106 copy

Headaches and obesity

Obesidade e cefaleia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Obesity and headache disorders are two very common conditions in the general population that have been increasing in incidence over the last decades. Recent studies have shown a significant relationship between obesity and headaches, particularly migraine, with an important role in whether the disease is chronic. On the other hand, no such association was found with tension-type headaches. Studies showing an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine. Moreover, a secondary headache for which obesity is a strong risk factor is idiopathic Intracranial Hypertension (pseudotumor cerebri), with several studies showing the impact of weight reduction/bariatric surgery in the treatment of the disease. In conclusion, since obesity is a modifiable risk factor, it is important for physicians treating patients with headaches, and particularly migraine, to be aware of the association between these two disorders.

Keywords:
Body Mass Index; Obesity; Headaches; Migraine without Aura; Pseudotumor Cerebri

Authors/ year of publication	n	Population included	Gender	Median age (range)	BMI	Primary outcome	Results
Brown et al. 20001111. Brown WJ, Mishra G, Kenardy J, Dobson A. Relationships between body mass index and wellbeing in young Australian women. Int J Obes Relat Metab Disord. 2000 Oct 4;24(10):1360-8. https://doi.org/10.1038/sj.ijo.0801384 https://doi.org/10.1038/sj.ijo.0801384...	12.855	Headache/ Mig X Controls without headache	F	20 (18-23)	BMI < 17 BMI 18-24.9 BMI 25-24.9 BMI 25-29.9 BMI 30-34.9 BMI: 35-39.9 BMI > 40	OR headache or Mig	OR headache or Mig in women with BMI 25-30: 1.12 BMI >30 (OR 1.47) X normal BMI
Scher et al. 20031212. Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain. 2003 Nov;106(1-2):81-9. https://doi.org/10.1016/s0304-3959(03)00293-8 https://doi.org/10.1016/s0304-3959(03)00...	1932	Episodic headache X CDH	F and M	40 (18-65)	BMI < 25 BMI 25-30 BMI ≥30	Prevalence of headache OR X CDH X incidence of CDH OR in patients with prior EM	OR CDH 5 X > in EM patients with BMI ≥ 40 (OR 5.28)
Bigal et al. 20062525. Bigal ME, Tsang A, Loder E, Serrano D, Reed ML, Lipton RB. Body mass index and episodic headaches: a population-based study. Arch Intern Med. 2007 Oct 8;167(18):1964-70. https://doi.org/10.1001/archinte.167.18.1964 https://doi.org/10.1001/archinte.167.18....	30.215	No headache, <14 headache days (non Mig), CDH, EM X Controls	F and M	30 (18-89)	BMI <18.5 - n = 941 BMI 18.5- 24.9† (n = 15,501) BMI 25-29.9 (n = 9,258) BMI 30-34.9 (n = 3,133) BMI ≥35 (n= 1,382	OR of EM X No Mig, No headache or CDH	BMI 25-29.9 (OR 1.4, IC 95% 1,1 -1,8) X normal BMI BMI ≥ 30: (OR 1,3, IC 95% 1,1-1,6) IMC ≥ 40 (OR 1,8 IC 95% 1,4-2,2)
Ford et al. 20081717. Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart J-A. An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology. 2010 Aug 24;75(8):712-7. https://doi.org/10.1212/WNL.0b013e3181eee244 https://doi.org/10.1212/WNL.0b013e3181ee...	7601	Severe headache or Mig X No severe Mig or severe headache	F and M	46 (20-85)	BMI <18.5 - (n = 121) BMI 18.5-24.9† (n = 2313) BMI 25-29.9 (n = 2784) BMI ≥30 (n= 2383)	OR Mig	OR 1,37 of Mig or severe headache in patients with BMI ≥ 30 X normal BMI
Peterlin et al. 2010 1414. Peterlin BL, Rosso AL, Rapoport AM, Scher AI. Obesity and migraine: the effect of age, gender and adipose tissue distribution. Headache. 2010 Jan 4;50(1):52-62. https://doi.org/10.1111/j.1526-4610.2009.01459.x https://doi.org/10.1111/j.1526-4610.2009...	15.631	Severe Mig or headache X no severe headache or severe Mig	F and M	38 (20-55)	1) BMI ≥30 (n = 4,585) BMI <30† (n = 11,046) 2) AO (n = 6,631) No AO (n = 9,000) AO: AC ≥88 cm for women and AC ≥102 cm for men	OR Mig	OR Mig or severe headache with BMI ≥ 30 X BMI nl Women OR: 1.39. Men OR: 1.39
Robberstad et al. 2010 1717. Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart J-A. An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology. 2010 Aug 24;75(8):712-7. https://doi.org/10.1212/WNL.0b013e3181eee244 https://doi.org/10.1212/WNL.0b013e3181ee...	5847	Mig, TTH, headache without classification X Controls with no Mig or headache	F and M	<18 (13-18)	Weigh excess (based on BMI pediatric by sex and age) - n = 891	OR Mig	OR Mig > adolescents with BMI > 25
Vo et al. 20111818. Vo M, Ainalem A, Qiu C, Peterlin BL, Aurora SK, Williams MA. Body mass index and adult weight gain among reproductive age women with migraine. Headache. 2011 Apr;51(4):559-69. https://doi.org/10.1111/j.1526-4610.2010.01833.x https://doi.org/10.1111/j.1526-4610.2010...	3733	Mig X Controls	F	<40 (18-40)	BMI < 18.5 (n = 160) BMI 18.5-24.9† (n = 2623) BMI 25-29.9 (n =612) BMI ≥ 30 (n= 338)	OR EM	OR 1.81 of EM in patients with BMI ≥ 30 X normal BMI
20 20. Yu S, Liu R, Yang X, Zhao G, Qiao X, Feng J, et al. Body mass index and migraine: a survey of the Chinese adult population. J Headache Pain. 2012 Oct;13(7):531-6. https://doi.org/10.1007/s10194-012-0470-5 https://doi.org/10.1007/s10194-012-0470-...	5029	EM X Controls CDH excluded	F and M	43 (18-46)	BMI < 18.5 (n = 262) BMI 18.5-<23† (n =2,469) BMI 23-<25 (n =1,064) BMI 25-<30 (n = 1,044) BMI ≥ 30 (n = 190)	OR EM	OR EM 2.10 in patients with BMI ≥ 30 X normal BMI
Peterlin et al. 20131919. Peterlin BL, Rosso AL, Williams MA, Rosenberg JR, Haythornthwaite JA, Merikangas KR, et al. Episodic migraine and obesity and the influence of age, race, and sex. Neurology. 2013 Oct 8;81(15):1314-21. https://doi.org/10.1212/WNL.0b013e3182a824f7 https://doi.org/10.1212/WNL.0b013e3182a8...	3862	EM X no headache	F and M	< 46.6 (18-50+)	BMI < 18.5 (n = 129) BMI 18.5- 24.9† (n =1424) BMI 25-29.9 (n =1306) BMI ≥ 30 (n= 1004)	OR EM	OR EM 1.81 in patients with BMI ≥ 30 X normal BMI
Kristoffersen er at. 20201616. Kristoffersen ES, Børte S, Hagen K, Zwart J-A, Winsvold BS. Migraine, obesity and body fat distribution - a population-based study. J Headache Pain. 2020 Aug 6;21(1):97. https://doi.org/10.1186/s10194-020-01163-w https://doi.org/10.1186/s10194-020-01163...	33.176	Mig, TTH X Controls	F and M	No headache 56.7 (SD 15.6) Mig 46.2 (SD 12.9) TTH 49.3 (SD14.0)	BMI < 18.5 BMI 18.5 - 24.9 BMI 25 - 29.9 BMI ≥ 30 Waist circumference (AO)	OR Mig OR TTH	TBO and AO: associated with a higher prevalence of Mig X headache-free controls (OR 1.45) and OR 1.29 95% respectively), particularly for individuals < 50 years of age (OR 1.74 and OR 1.89). Similar results in MO and MA. Weaker associations were observed between obesity and TTH. TBO associated with Mig prevalence and attack frequency independent of AO.

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[1] Correspondence:
Ida Fortini; Email: idafortini@gmail.com