Association Between Obesity and Migraine in Women

DOI: https://doi.org/10.1007/s11916- 017- 0634- 8

Abstract-Summary The particular effects of obesity on women with migraine of various ages are the focus of this review.

While the association between obesity and migraine frequency has been consis- tently demonstrated and obesity is considered a risk factor for progression from episodic to chronic migraine, the association between obesity and migraine preva- lence is still somewhat debated and appears to be dependent on gender and age, with the most consistent effects observed in women younger than 55 years of age.

Association between migraine and obesity is most commonly observed in women

of reproductive age.

The multimodal changes associated with age and hormonal change in women likely play a role in this relationship, as obesity does not appear to be related to migraine in women over 55 years of age.

Introduction Migraine, prevalence, frequency, and severity have been linked to obesity in adults, with the most significant effects seen in women of reproductive age [356].

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There is likely a multitude of factors influencing the relationship between obesity and migraine including gender, age, adipose tissue type, body fat distribution and deposition, hormonal milieu, and inflammation.

As the effect of obesity on migraine appears to be gender and age specific, here, we consider the role of obesity in migraine pathogenesis with a specific emphasis on women, who are disproportionately affected by migraine.

Our review examines the migraine and obesity relationship as a function of mul-

timodal changes associated with age and sex in women.

Epidemiology of Migraine and Obesity Relationship in Women In another NHANES study, Peterlin and others showed that the positive association between obesity and prevalence of migraine/severe headache was limited to those 55 years of age and younger [357].

Peterlin and others using the large National Comorbidity Survey Replication showed that compared to normal weight individuals, obese individuals had more than 80% greater risk of having low frequency episodic migraine (EM); however, this association was only significant in those younger than 50 years of age [358].

The above studies suggest that there is a relationship between obesity and migraine prevalence, although this relationship is most evident in women of repro- ductive age.

Studies in all female migraine populations have had contradictory findings with Mattson reporting no association between migraine and obesity in Swedish women aged 40–74 [359], while Winter and others reported increased risk of CM in obese participants from the Women’s Health Study (WHS) [360].

Migraine and Obesity Relationship in Women Studies that have stratified the migraine-obesity relationship by age and gender have reported association in men and women aged 55 years or less [356, 357], but not in older individuals [361–363].

Studies focusing only on younger women have found about 40% increased risk

of migraine in obesity [364, 365].

In studies with only older women, no association was found when evaluating the relationship between migraine and BMI in Swedish women older than 40 years of age [359], while the study by Keith and others using 11 publicly available data sets including WHI data limited to post-menopausal women aged 50–78 years found a negative association between migraine and obesity [366].

Slight, this negative association was significant and underscores the differential

effects of women’s age in the migraine-obesity relationship.

There appears to be a separate association between migraine and obesity specific for women younger than age 55 years which is independent of a BMI, but rather associated with a different measure of adipose tissue deposition—AbO [357].

How hormonal changes induced by aging in women may affect the obesity-

migraine relationship is yet unclear.

2.3 Comorbidities

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Potential Mechanisms Involved in the Migraine-Obesity Relationship in Women Changing patterns of adiposity with aging in women with migraine have so far not been evaluated as possible mechanisms of the migraine-obesity relationship.

As the circulating plasma levels of estrogens in menopausal women are very low (even in cases of high adipose tissue content), the majority of estrogen affecting the CNS is presumed to be locally produced in the brain [367].

Estrogens are overall broadly defined as anti-inflammatory [367], making it thus challenging to understand why while aging, menopause, and the resultant increase in adiposity contribute to inflammation (both peripheral and neuroinflammation), which is thought to be the primary mechanism by which obesity affects migraine, migraine itself improves with aging and menopause in vast majority of women.

The mechanisms involved are unknown at this time, it stands to reason that estro- gen metabolism and its bi-directional interaction with adipose tissue play a complex role in migraine-obesity relationship with respect to gender and age.

Is There an Obesity Paradox in Migraine in Older Populations? According to this paradox, overweight and obese individuals with already estab- lished chronic disease have a better prognosis than lean patients with the same chronic diseases.

Majority of current evidence suggests that different types of pain and obesity are significantly related to each other, the obesity paradox has been observed in rheu- matoid arthritis and sacroiliac joint pain where female gender and low BMI are associated with worse prognosis [368].

In case of migraine which tends to peak in the fourth decade of life and starts decreasing in the fifth decade, the observed migraine-obesity relationship is more likely to be due to the patterns of migraine activity rather than chronic illness.

While obesity does not appear to be related to migraine prevalence in women aged over 55 years, there is an increase in headache frequency during menopausal transition that appears to be at least in part affected by obesity.

Conclusion The absence of concordance among multiple studies suggests that the relationship between obesity and migraine is more complex than simply an increase in adiposity and accompanying increase in inflammation.

Future studies focusing on the migraine-obesity relationship should examine the effects of weight gain, preventive medication, and/or exogenous hormones on migraine and obesity.

Additional parameters of obesity such as AbO waist, waist circumference, or BMI as well as the metabolic status should be considered in studies examining asso- ciation of migraine with disease in various age groups and stages of menopausal transition.

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Acknowledgement A machine generated summary based on the work of Pavlovic, Jelena M.; Vieira, Julio R.; Lipton, Richard B.; Bond, Dale S. 2017 in Current Pain and Headache Reports.

Interrelations between migraine-like headache and persistent post-traumatic headache attributed to mild traumatic brain injury: a prospective diary study