Effects of Surgical and Non-surgical Weight Loss on Migraine Headache: a Systematic Review and Meta-Analysis
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Effects of Surgical and Non-surgical Weight Loss on Migraine Headache: a Systematic Review and Meta-Analysis Angelo Di Vincenzo 1 & Marco Beghetto 1 & Roberto Vettor 1 & Claudio Tana 2 & Marco Rossato 1 & Dale S. Bond 3 & Claudio Pagano 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The aim of this study was to perform a meta-analysis on the effect of weight loss obtained by bariatric surgery or behavioral intervention on migraine frequency and indices of severity. Materials and Methods A search through Pubmed/Medline, ISI-web of knowledge, and Google Scholar retrieved 10 studies (n = 473). Selected outcomes were Headache Frequency, Pain Severity, Disability, and Attack Duration while BMI, BMI change, type of intervention (bariatric vs. behavioral), and type of population (adult vs. pediatric) were used for moderators and metaregression analysis. Results Random effect meta-analysis shows that weight loss yields significant reductions in Headache Frequency (ES − 0.78, p < 0.0001), Pain Severity (ES − 1.04, p < 0.0001), Disability (ES −0.68, p < 0.0001), and Attack Duration (ES − 0.25, p = 0.017). Improvement in migraine was not correlated either to the degree of obesity at baseline or the degree of weight reduction. The effect on migraine was similar when weight reduction was obtained with bariatric surgery or behavioral intervention and was comparable in adult and pediatric populations. Conclusions Weight loss improves characteristics of migraine headache in patients who have obesity independently of the type of intervention and the amount of weight loss. The mechanisms underlying the link between obesity, weight loss, and migraine headache may include chronic inflammation, obesity comorbidities, and overlapping behavioral and psychological risk factors. Keywords Migraine . Obesity . Weight loss . Bariatric
Introduction Migraine is a neurological disease that typically involves a moderate-to-severe headache that is accompanied by multiple autonomic, affective, and sensory features. It is both highly prevalent, affecting 1 billion people worldwide, and debilitating, ranking as the second leading cause of disability globally [1–3]. Individuals who have migraine often experience additional disability due to comorbidities such * Claudio Pagano [email protected] 1
Department of Medicine, University of Padua, via Giustiniani 2, 35128 Padova, Italy
2
Department of Medicine and Surgery, University of Parma, Parma, Italy
3
The Miriam Hospital/Brown Alpert Medical School, Providence, RI, USA
as other pain conditions and psychological disorders. Further, migraine can undergo a process of transformation, whereby episodic attacks become more frequent and in some cases almost daily. Given the overall burden caused by migraine and the risk of additional burden due to progression from episodic to chronic migraine, it is critical to identify risk factors amenable to intervention to improve the management of this disease [4]. Obesity is increasingly r
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