Obesity and headache disorders, including migraine, are common and increasingly prevalent conditions. Studies suggest a significant relationship between obesity and headaches, particularly migraine, where weight plays an important role in whether the disease is chronic. Obesity is also a strong risk factor for idiopathic intracranial hypertension (IIH), a secondary headache disorder.
The Overlap Between Obesity and Headaches
Obesity and headaches, migraine in particular, are frequent conditions. Headache is one of the most frequent reasons for consultation in neurology clinics. Studies suggest an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine.
Measuring Obesity
Total body obesity (TBO) is often estimated using body mass index (BMI), while abdominal obesity (AO) is estimated using abdominal circumference (AC).
Obesity Prevalence and Impact
In the US, the prevalence of overall obesity (BMI ≥30) increased significantly between 1999 and 2008. Obesity carries a substantial personal and financial burden and is comorbid with several clinical conditions, such as insulin resistance, type 2 diabetes, hypertension, dyslipidemia, heart disease, cancer, mood and sleep disorders, reproductive problems, liver disease, and pain syndromes.
Research on Obesity and Headaches
Several studies have explored the relationship between obesity and headaches.
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Early Studies
Brown et al. conducted a population-based cross-sectional study looking at the association between obesity and headaches of any type. Scher et al. conducted a prospective longitudinal study and found that self-reported obesity at study start (BMI ≥30) was more common in individuals with chronic daily headache (CDH) than with episodic headache (EH). Keith et al. conducted a cross-sectional analysis and found that the risk of headache in general was higher in obese people and that the risk of headaches was higher with an increasing degree of obesity. Robberstad et al. conducted a population-based study of adolescents.
Obesity and Migraine Risk
Another cross-sectional study confirmed the obesity-migraine relationship and established that migraine risk increased with increasing obesity. Peterlin et al. examined the association of episodic migraine (EM) and obesity and the influence of age, race, and gender. They reported that obese individuals had an increased risk of EM compared to those of normal weight. A Chinese study found that individuals with BMI ≥ 30 had a higher prevalence of migraine and that those with morbid obesity were more than twice as likely to have migraine compared to those with a normal BMI.
Abdominal Obesity
Most population-based studies of obesity and migraine were based on BMI rather than AO. Abdominal visceral fat is metabolically different from other body fats and appears to be an independent risk factor for clinical complications.
TBO and AO
A recent large population-based study examined the relationship between obesity and headaches using data from the HUNT3 study. Both TBO and AO were associated with a higher prevalence of migraine when compared to controls without headache, particularly for individuals < 50 years of age. Overall, weaker associations were seen between obesity and CTT. In addition, some migraine features are affected in the overweight population, and a dose-response relationship was found between obesity levels and increased headache frequency in individuals with migraine. TBO was associated with migraine prevalence and attack frequency independent of AO.
Chronic Migraine
In a cross-sectional analysis, the probability of chronic migraine (CM) in patients with obesity v. controls (obese patients without headaches or with ≤108 headaches/year) v. A cross-sectional study showed that participants with CM were more likely to be obese than those without headaches.
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Tension-Type Headache
Few data are available regarding the association of tension type headache (TTH) and obesity, but three population-based studies have evaluated this association.
Idiopathic Intracranial Hypertension (IIH)
IIH (pseudotumor cerebri) is characterized by a progressive headache associated with increased intracranial pressure (ICP), normal cerebrospinal fluid (CSF) chemistry, and absence of other causes of increased ICP.
IIH and Obesity
The association between obesity and IIH is much more robust in women. Although IIH can occur in people of normal weight, both high BMIs and larger percentage weight gains are associated with a progressively higher risk of IIH.
Potential Mechanisms Linking Obesity and Headaches
Although several hypotheses have been postulated in recent years, the association between migraine and obesity remains unclear.
Hypothalamic Involvement
Feeding regulation is carried out by several hypothalamic nuclei and their connections. The hypothalamus has a primary role in the pathophysiology of migraine. Therefore, it is hypothesized that pathological modulation of the hypothalamus in migraineurs may result in hyperphagia and weight gain. Several hypothalamic peptides, proteins, and neurotransmitters involved in eating contribute to the pathophysiology of migraine.
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Lifestyle Factors
A number of lifestyle factors may be important confounders that could explain the possible relationship between migraine and obesity, such as smoking, physical activity level, altitude, blood pressure, stress, sleep alterations, and medication use.
Biomarkers
Of the various biomarkers that may be important in the relationship between obesity and migraine, and also with insulin resistance (IR) and diabetes, we highlight a few below.
Serotonin
Interictal plasma serotonin levels are low in migraine patients and increase transiently during attacks. Low interictal serotonin states in migraine patients lead to increased urge to eat.
Adipokines
Adipokines (ADP) participate in energy homeostasis, immunity and inflammation. Women have higher levels of ADP than men.
Orexins
Animal and human data demonstrate the role of orexins in pain processing. OXA levels are shown to be elevated in the CSF of patients with CDH.
Leptin
Produced mainly by adipocytes, but also by various other tissues, including in the brain, leptin is inhibited by testosterone and increased by ovarian steroids. Leptin is associated with satiety, but obese people generally exhibit high circulating concentrations, suggesting a state of leptin resistance in obese states.
Bidirectional Relationship
Migraine and obesity may be associated in different ways, sharing genetic, biochemical, and environmental factors, as well as influencing central and peripheral mechanisms. The existence of a unidirectional association between migraine and obesity (i.e. obesity leading to increased migraine attacks) is clear. However, it is possible that the relationship between the two disorders could be bidirectional with migraine being a risk factor for exacerbating the development of obesity.
Medication-Induced Weight Gain
Medications used for migraine prophylaxis such as beta-blockers, antiepileptic drugs, calcium channel blockers, and tricyclic antidepressants are known to cause weight gain.
CGRP
Obese women have been shown to have elevated plasma levels of CGRP compared to controls. In preclinical studies, a relationship between CGRP and obesity has been demonstrated.
Insulin Resistance and Metabolic Syndrome
Insulin resistance (IR) is a condition characterized by a subnormal physiological response to normal insulin concentrations. Metabolic syndrome (MS) is a condition characterized by a set of metabolic abnormalities (hyperglycemia, hypertension, dyslipidemia, abdominal obesity, and pro-inflammatory state). Patients with CM have more IR than patients with EM and controls.
Diabetes
On the contrary, there seems to be a lower risk of DM2 in women with migraine compared to women without a history of migraine. However, the biological mechanisms underlying the protective effect of diabetes on the risk of migraine attacks are unknown.
IIH and Metabolic Dysregulation
IIH is a condition of systemic metabolic dysregulation with neuro-ophthalmological manifestations in which there is an excess of androgens, as in polycystic ovary syndrome. There is insulin resistance and hyperleptinemia in IIH.
Weight Loss and Headache Improvement
The World Health Organization lists migraine as one of the 10 most disabling medical illnesses on earth. Studies have shown that fat tissue secretes molecules to other body parts and systems. With obesity, the extra fat cells cause the body to make inflammatory proteins and keep the body in a constant state of inflammation. The American Migraine Foundation also notes that the risk of chronic migraine increases with weight gain.
Weight Loss Surgery and Migraines
A study in 2011 addressed the impact of weight loss surgery on obese patients with migraine headaches. The more weight patients lost, the greater the improvement in their headache symptoms.
Benefits of Weight Loss
“Weight loss reduces the impact of conditions associated with obesity, including diabetes, hypertension, coronary heart disease, stroke and respiratory diseases,” said lead study author Claudio Pagano, M.D., Ph.D.
Weight Loss-Related Headaches
Weight loss can cause headaches. There are a few reasons why you might get a headache after you lose weight.
Detox Headaches
The body stores toxins in fat cells, which are released into the bloodstream when fat is burned. You can prevent detox headaches through hydration, nutritional supplements. However, the right supplements depend on your metabolic function and genetics. That is why it is important that rapid weight less be done under doctor supervision.
Blood Pressure Changes
As you lose weight, your blood pressure may drop. If this happens, it will decrease the blood flow to the brain. This results in headaches or migraines for many people. This can be dangerous. Calorie intake needs to be adjusted and your lab results need to be reviewed to insure you are not putting your health at risk.
Dehydration
Weight loss can cause headaches when you fail to hydrate properly. When you lose weight, especially at a rapid pace, you lose water weight as fat breaks down. If you do not drink enough water to keep up with the level of dehydration caused by your weight loss efforts, you will experience headaches since dehydration is one of the most common causes of headache pain.
Calorie Intake Changes
Weight loss can cause headaches when your calorie intake changes rapidly. Another possible reason for headaches or migraines after losing weight is that your body is adjusting to the change in your caloric intake. If your blood sugar drops, you may experience hypoglycemia, a condition of low blood sugar that is often accompanied by headaches, fatigue and irritability. Sometimes this can even cause a person to lose consciousness. Again, this is another reason rapid weight loss should be done under the supervision of an experienced professional.
Other Causes of Headaches
Many people can get a headache if they miss a meal or aren't getting enough to eat. But if you are losing weight without trying, this needs to be checked out by your doctor. Possible causes can include uncontrolled Type 1 diabetes, depression, an eating disorder, or even cancer.
Tension Headaches
A tension headache is one of the most common types of headaches, and the exact cause is not known. Factors that may contribute to tension or stress headaches are lack of sleep, increased stress (referred to as a stress headache), skipping meals, dehydration, medical diseases or conditions, anxiety, or changes at home, work, or school.
Meningitis
Meningitis is inflammation of the membranes that cover the spinal cord and brain. Symptoms include fever, headache, and a stiff neck.
Sleep Apnea
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. OSA is diagnosed and evaluated through patient history, physical examination, and polysomnography.
Concussion
A concussion is a short-lived loss of brain function that is due to head trauma. Symptoms of a concussion include headache, nausea, dizziness, dazed feeling, irritability, and visual symptoms.
Dietary Considerations for Weight Loss and Headaches
A healthy diet is a must when you're trying to lose weight. Weight loss requires consumption of restricted calories. Many reduce their calorie consumption to a level that it starts affecting their overall health in various ways. Even when trying to lose weight, it is extremely important to add enough calories and nutrients to your diet. Usually, people trying to lose weight experience frequent headaches due to insufficient calorie intake.
Insufficient Calorie Intake and Headaches
For effective weight loss, one must consume fewer calories than your body burns. But if you are not getting the right kind of nutrition you may feel fatigued and experience headaches and dizziness due to many reasons.
Electrolyte Imbalance
When you consume insufficient calories or unbalanced diet you may experience electrolyte imbalance in the body. This means inappropriate levels of sodium and potassium (particularly in this situation) which leads to headaches more often.
Dehydration
Many foods also provide water to your body. The total body water levels decrease on a weight loss diet. It further leads to dehydration. So, it's always better when you follow a restrictive diet plan you must drink plenty of fluids.
Hypoglycemia
In some cases, long hours of fasting or skipping meals can contribute to Hypoglycemia (low blood sugar levels). In this condition, you may face headaches, tiredness and dizziness. In order to avoid hypoglycemia, you can enjoy small and frequent meals. This strategy will help you lose weight and prevent headaches. Also, add enough protein to your diet as it helps to keep you feel full for longer.
Intermittent Fasting
Intermittent fasting is commonly practiced these days for weight loss. It usually involves fasting for 12-14 hours. But this diet plan is not suitable for everyone as each body has its own requirements. Sometimes due to long hours of fasting blood pressure numbers fall and contribute to headaches as well.
Balanced Diet
If someone wants to achieve their target weight goals it is always better to follow a balanced diet. Also, try to include more and more liquids to your weight loss diet plans. You should also focus on macro and micro-nutrients. It's always better to take advice from professionals before following any random weight loss diet.
Lifestyle Recommendations for Migraine Management
It’s crucial for people with migraine to stay active, whether by taking walks, practicing yoga or playing a sport. A lack of exercise increases the risk of having migraine attacks. Small amounts of exercise may not result in weight loss, but regular exercise does reduce stress and anxiety and has been shown to result in fewer and less painful headaches.
Dietary Approaches
Physicians have been debating which diets can help people with migraine, partially fueled by conflicting research findings. In some cases, it’s not completely clear whether the diet or the weight loss associated with these diet changes helps decrease headache frequency. While there’s no such thing as “The Migraine Diet,” some studies hint that there may be benefits from low-fat and high-protein diets, as well as diets high in specific fats. Current data suggest that a low-carb, or ketogenic, diet high in omega-3 and low in omega-6 fats can help. These types of foods may improve episodic migraine in overweight adults. Further research is needed to confirm these findings.
Medication Considerations
Many migraine medications can affect weight and may cause either weight gain or loss. Remember, when you are prescribed a medication for your migraine, you should feel comfortable asking your doctor about its side effects.
Bariatric Surgery
Currently, migraine is not a reason to pursue weight-loss surgery, also known as bariatric surgery. But if you qualify for other reasons and have the procedure, studies suggest that you may end up with fewer and less intense migraine attacks. Both gastric bypass and lap banding show promise in reducing migraine frequency.