Bariatric surgery not only helps severely obese patients shed excess pounds, it might also alleviate the pain of migraine headaches.
A new study has found that severely obese patients who underwent either Lap-Band surgery or gastric bypass saw both the number and the severity of their migraines drop after the surgery -- even if they still remained obese after the surgery.
Severe obesity brings with it plenty of health woes, as sufferers know all too well, including type 2 diabetes, high blood pressure, joint pain and mobility issues. For reasons still not quite understood, many patients, particularly women, also develop migraines.
Why obesity causes or aggravates migraines has not been well studied. It could be that inflammation triggers the headaches, or the estrogen released by fat cells plays a role.
Until now, no one has studied whether bariatric surgery can alleviate migraines in those with obesity.
This study was a small one, focusing on 24 severely obese patients who suffered from migraines. Most were female (88 per cent), with an average BMI of 46.6 prior to surgery. (BMI or body mass index is a measurement of obesity based on an individual's weight and height. A BMI over 40 is considered "morbid obesity.")
Just over half the patients underwent laparoscopic gastric banding surgery; the other half chose gastric bypass. After six months, the patients had lost an average of 66 pounds. The average BMI was 34.6 – a significant improvement, but still within the definition of obesity.
Psychologist Dale S. Bond of the Miriam Hospital in Providence, R.I., and Brown University led a team who assessed the patients for migraines using a standard migraine questionnaire given before the surgery and then six months later.
Nearly half of patients reported at least a 50 per cent reduction in frequency of "headache days," regardless of the type of surgery they had.
The frequency of the headaches fell from about 11 headache days per 90 days, to 6.7 days per 90 days. Patients who lost the most weight had the greatest odds of experiencing a more than 50 per cent reduction in headache days.
Not only were there fewer headaches, the ones they did experience were less severe.
The number of patients reporting "moderate to severe disability" from their migraines fell from 12 (50 per cent) before surgery, to 3 (12.5 per cent) six months after.
The researchers point out that what's interesting is that the headaches fell in both number and severity for so many of the patients even though 70 per cent of the participants were still considered obese six months after surgery.
"These findings suggest weight loss can help alleviate migraines even though an individual's obesity has not been fully resolved," Bond said in a news release.
The research appears in the journal Neurology.
It's possible that mood changes resulting from people feeling better about themselves may have contributed to some of the reduction in migraines. But the researchers note that while patients also reported significant improvement in depression, not everyone who saw their depression lift saw their migraines improve.
The researchers note that one of the weaknesses of their study is that the results were based on the patients' recall of their headaches. They said future studies should be started before surgery, requiring patients to keep a headache diary for a few months before and after the surgery.
Nor did the study look at whether diet and exercise changes may have played a role in the results. Certain foods such as chocolate, caffeine and wine are common migraine triggers, as are stress and physical exertion.
Bond added that future studies should also look at whether smaller weight loss interventions also produce similar improvements in migraines.
Even with the many documented health benefits of bariatric surgery, it's worth noting that obtaining the surgery in Canada is not simple.
Gastric bypass is expensive, typically ranging in price between $15,00 and $20,000. While all provincial health insurance programs pay for the surgery, the procedure is not available in all provinces. so wait times are long, ranging from several months to as long as five years or more.
Wait times for lap-band surgery are shorter, as the procedure is offered at private clinics for about $5,000 per patient. But not all patients are good candidates for the surgery, and the weight loss can be slower and less substantial.
