But not everyone whose relatives have migraine have it themselves. So there must be other influences that determine whether or not a given person develops migraine. One of the possible influences that researchers are looking at is body weight. Although there isn’t enough evidence to say that obesity causes migraine, there is strong correlational evidence, according to Dale Bond, PhD, professor of psychiatry and human behavior at The Miriam Hospital and Brown Alpert Medical School in Providence, Rhode Island. Dr. Bond was one of 32 migraine experts featured at the 6th Annual Migraine World Summit, held March 17 to 25, 2021. He discussed the latest research on body weight and migraine, as well as possible strategies for reducing migraine risk, in his presentation, “How Weight Affects Migraine Disease.” “What the research seems to show is that obesity both increases risk for having migraine, and obesity also might be an exacerbating factor, so people with existing migraine who also have obesity might be at greater risk for having attacks that are more frequent and severe,” says Bond. Here’s what the latest research says about obesity and migraine.
1. Migraine Risk Associated With Obesity May Change With Age
It appears that the migraine risk associated with obesity decreases with age. A meta-analysis published in May 2017 in Neurology, which included 12 studies and total of 288,981 participants, found that after controlling for age and sex, having obesity (defined as a body mass index, or BMI, of 30 or higher) increased the risk for migraine by 27 percent. The authors found that the association decreased in people after the age of 50. This confirms findings in an earlier study published in Headache journal, which found that having obesity increased the prevalence and odds of migraine in men and women ages 20 to 55, but had no effect on the risk in individuals older than 55.
2. People Who Are Underweight Also Appear to Be at Higher Risk for Migraine
There is a modest increased risk for migraine in people who are underweight, according to Bond. The same 2017 meta-analysis that show a higher risk of migraine in people with obesity also found that people who had a BMI of less than 18.5 — generally considered the lower end of “normal” — had a 13 percent greater risk for migraine compared with people of normal weight. “The risk in terms of weight status seems be greater for those who have obesity versus those who are underweight,” Bond comments.
3. Having Obesity May Increase Your Risk for Chronic Migraine
Chronic migraine is when a person has 15 or more days per month of headache with migrainous features, according to the Migraine Research Foundation. The risk of progressing from episodic migraine (fewer than 15 migraine days per month) to chronic migraine is between 1.5 and 3 percent per year. Overuse of acute migraine medication, depression, and increasing headache day frequency are all associated with an increased risk of developing chronic migraine, according to an analysis published in Headache journal in March 2019. Obesity might also belong on that list. “There’s been some epidemiologic research that suggests that obesity might increase progression from episodic to chronic migraine,” says Bond. One of the common theories is that obesity is a low-grade systemic inflammatory state that might exacerbate the neurovascular response of migraine, he says. “That might be one mechanism by which obesity contributes to increased frequency of attacks, as well as increased risk for chronic migraine,” says Bond.
4. Obesity and IBS Together Linked to Migraine Risk
People with migraine are more likely to have irritable bowel syndrome (IBS) and vice versa, but there isn’t evidence that one condition causes the other. A study published in the Polish Journal of Neurology and Neurosurgery found that 23 to 53 percent of people with IBS experienced frequent headaches, and that 10 to 20 percent of the population had both migraine and IBS. There is research that suggests that having both obesity and a gastrointestinal disorder increases the likelihood of migraine, says Bond. “For example, when obesity is comorbid with irritable bowel syndrome, those individuals seem to be at higher risk for migraine than when obesity is not present,” he says.
5. If You Have Obesity, Losing Weight Can Reduce Migraine Days
According to research presented in 2019 at ENDO, the Endocrine Society’s annual meeting, people with obesity and migraine who lost weight experienced a reduction in the number of migraine days per month and had decreases in migraine pain severity and the length of their attacks. The “why” behind the link between obesity, weight loss, and migraine is still unclear. The study authors suggest it may be a combination of factors, including chronic inflammation, other chronic diseases that tend to occur along with obesity, and behavioral and psychological risk factors.
6. Some Weight Loss Methods May Make Your Migraine Worse
There are some things that a person with migraine may want to avoid when starting a weight loss program, says Bond. “We want to make dietary changes gradually rather than all at once, because some individuals may have dietary triggers that they might not be aware of,” he says. Weight loss methods such as intermittent fasting, an eating pattern in which a person restricts their eating to certain hours of the day, are probably not a good idea for people with migraine. Fasting can lower a person’s blood glucose level, which may trigger a migraine attack, says Bond. Reducing your sugar intake may help with weight loss, but replacing it with an artificial sweetener such as aspartame may be counterproductive, since some people report that artificial sweeteners trigger migraine attacks for them, according to Migraine Again. In addition, some research has shown that they are not helpful in achieving weight loss.
7. For Most People With Migraine, Exercise Won’t Trigger an Attack
Exercise often gets a “bad rap” in the migraine community, says Bond. Vigorous exercise might be a trigger in a small subset of people with migraine, but overall, the benefits of physical activity far outweigh the risk for people with migraine, he says. If exercise sometimes brings on a migraine attack for you, Bond suggests investigating potential environmental triggers that may be contributing. Heat, humidity, bright artificial lights in the exercise studio, and bright sunlight can all make an attack more likely, according to the American Migraine Foundation. If you don’t drink enough before and during your activity, exercise may also cause dehydration, which can also increase your risk for an attack, according to Bond. “Particularly on the hot days, try exercising in the early morning to avoid that heat and humidity,” he suggests.
8. Regular Exercise Can Have Many Benefits for People With Migraine
In addition to its benefits in controlling weight, regular exercise can help with stress reduction, and improving sleep, according to the Centers for Disease Control and Prevention (CDC). It may also reduce migraine symptoms and prevent migraine attacks through physiological mechanisms, for example, by reducing inflammation and improving cardiovascular health, Bond says. “In terms of aerobic exercise, we would generally tell our patients to start with walking — it’s easy, it’s safe, it’s cheap, and it’s practical — and to do that regularly,” says Bond. But exercise doesn’t necessarily have to be aerobic to have benefits for migraine, says Bond. “For example, hatha yoga might be particularly efficacious for someone with migraine, because it actually works on some of the mechanisms we see, such as neck pain and stiffness, anxiety, catastrophizing about pain, and stress reduction,” he says.
9. Small Changes May Be the Best Approach to Losing Weight
The most effective way to lose weight is to make good eating habits a permanent lifestyle change rather than a temporary phase, says Bond. Start with small changes, such as swapping out a high-fat salad dressing for a low-fat option, he suggests. “Over time, these small changes are going to accumulate and are going to have an impact on weight. Once you start gaining confidence with making some of those smaller changes, you’ll feel more confident making larger, more systemic changes to your diet,” says Bond. In addition to adopting a walking routine, Bond suggests looking for opportunities throughout the day to move more and sit less. “When you couple exercise with dietary changes, you get more bang for your buck,” he says. Check with your doctor before you embark on a weight loss plan, but typically, a safe rate of weight loss would be 1 to 2 pounds per week, says Bond.
