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Women with a History of Pediatric Migraine Gain More Weight as Adults

Monday, March 14, 2011

Migraine and obesity have been found to be associated in several large population-based studies. Previous studies have yielded somewhat controversial results regarding the association between episodic migraine and obesity which may be in part attributed to differences in methodology.  Another possible explanation is that the link between migraine and obesity may be different in men and women depending on their age and distribution of adipose tissue.  A large prospective population-based study found that the risk of progressing from episodic headaches to chronic daily headaches in a year was five times higher in obese than normal weight individuals.  While many studies had investigated the risk of migraine and migraine characteristics among obese subjects, nobody had investigated the risk of weight gain among migraineurs.

Recently, Vo et al. (see article) have studied the possible association between pediatric migraine and adult life weight gain.  The authors analyzed the data from the Omega Study, a prospective cohort study designed to identify risk factors of adverse pregnancy outcomes.  A cohort of 3733 women of reproductive age (³18 years) were included in this study.  History of physician-diagnosed migraine, self-reported weight, height, and other demographic information were obtained from structured questionnaire and review of medical records.

Eighteen percent of the women in the study reported a history of physician-diagnosed migraine.  Women with a body mass index (BMI) ³ 30 had 1.48-fold increased odds of migraine (OR=1.48; 95% CI 1.12-1.96).  Furthermore, these odds were even higher for women who were severely obese (BMI 35-39.9, 2-fold higher) and morbidly obese (BMI ³ 40, 2.75-fold higher), suggesting that there is a correlation in the severity of both disorders and consistent with previous literature.  While there was no difference in BMI at age 18 in both groups, those with a history of pediatric migraine (diagnosed before age 18) were more likely to have a higher pre-pregnancy BMI at the time of the study and therefore greater adult weight gain.  Pediatric migraineurs were 1.67-fold more likely to gain at least 10 kg (22 lb) after age 18 than non-migraineurs after adjusting for confounders.

This is an important study that reveals an association between pediatric migraine and adult weight gain.  This is the first study to address the risk of adult weight gain in subjects who experienced migraine during childhood/adolescence.  Furthermore, the results also confirm the association between migraine and obesity in reproductive age women.  These findings suggest that there may be a bi-directional relationship between the two disorders.  Future prospective studies to confirm this finding will be important.  Those studies should consider the possible effects that migraine medications and differences in lifestyle may have on weight. 

The mechanisms underlying the association between migraine and obesity remain elusive.  Multiple mediators have been proposed such as inflammatory and prothrombotic factors, CGRP, orexins, adipocytokines, serotonin, and the autonomic nervous system among others.  Additionally, there are multiple regions of the brain involved in migraine as well as in body weight and energy balance regulation.  Both migraine and obesity are complex disorders and they are likely to interact in an intricate fashion.  A better understanding of these interactions are crucial for the identification of novel therapeutic targets for both disorders.

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