Objective To test whether behavioral weight loss (BWL) intervention decreases headaches in women with comorbid migraine and overweight/obesity. Methods This randomized, single-blind trial allocated women [18–50 years old, 4–20 migraine days/month, Body Mass Index (BMI)=25.0–49.9 kg/m2] to 16 weeks of BWL, (n=54) that targeted exercise and eating behaviors for weight loss, or Migraine Education control (ME, n=56) that delivered didactic instruction on migraine and treatments. Participants completed a 4-week smartphone headache diary at baseline, post-treatment (16–20 weeks) and follow-up (32–36 weeks). The primary outcome was post-treatment change in migraine days/month, analyzed via linear mixed effects models. Results Of 110 participants randomized, 85 (78%) and 80 (73%) completed post-treatment and follow-up. Although BWL achieved greater weight loss [mean (95% CI) kg] vs. ME at post-treatment [−3.8 (−2.5, −5.0) vs. +0.9 (−0.4,2.2) p<.001] and follow-up [−3.2 (−2.0, −4.5) vs. +1.1 (−0.2,2.4), p<.001], there were no significant group (BWL vs. ME) differences [mean (95%CI)] migraine days/month at post-treatment [−3.0 (−2.0, −4.0) vs. −4.0 (−2.9, −5.0), p=.185] or follow-up [−3.8 (−2.7, −4.8) vs. −4.4 (−3.4, −5.5), p=.378]. Conclusion Contrary to hypotheses, BWL and ME yielded similar, sustained reductions in migraine headaches. Future research should evaluate whether adding BWL to standard pharmacologic and/or non-pharmacologic migraine treatment approaches yields greater benefits.

Objective/Background Obesity is related to migraine. Maladaptive pain coping strategies (e.g., pain catastrophizing), may provide insight into this relationship. In women with migraine and obesity, we cross-sectionally assessed: 1) prevalence of clinical catastrophizing; 2) characteristics of those with and without clinical catastrophizing; and 3) associations of catastrophizing with headache features. Methods Obese women migraineurs seeking weight loss treatment (n=105) recorded daily migraine activity for 1-month via smartphone and completed the Pain Catastrophizing Scale (PCS). Clinical catastrophizing was defined as total PCS score ≥30. The Headache Impact Test (HIT-6), Allodynia Symptom Checklist (ASC-12), Headache Management Self-Efficacy Scale (HMSE), and assessments for depression (CES-D) and anxiety (GAD-7) were also administered. Using PCS scores and Body Mass Index (BMI) as predictors in linear regression, we modeled a series of headache features (i.e., headache days, HIT-6, etc.) as outcomes. Results One-quarter (25.7%;95%CI=17.2%–34.1%) of participants met criteria for clinical catastrophizing: they had higher BMI(37.9±7.5 vs. 34.4±5.7 kg/m2, p=0.035), longer migraine attack duration(160.8±145.0 vs. 97.5±75.2 hours/month, p=0.038), higher HIT-6 scores(68.7±4.6 vs. 64.5±3.9, p<0.001), more allodynia(7.0±4.1 vs. 4.5±3.5, p<0.003), depression(25.4±12.4 vs. 13.3±9.2, p<0.001), and anxiety(11.0±5.2 vs. 5.6±4.1, p<0.001), and lower self-efficacy(80.1±25.6 vs. 104.7±18.9, p<0.001) compared to participants without clinical catastrophizing. The odds of chronic migraine were nearly 4-fold greater in those with (n=8/29.6%) versus without (n=8/10.3%) clinical catastrophizing (OR=3.68;95%CI=1.22–11.10, p=0.021). In all participants, higher PCS scores were related to more migraine days(β=0.331, p=0.001), longer attack duration(β=0.390, p<0.001), higher HIT-6 scores(β=0.425, p<0.001), and lower HMSE scores (β=−0.437, p<0.001). Higher BMI, but not higher PCS scores, was related to more frequent attacks (β=−0.203, p=0.044). Conclusions One-quarter of participants with migraine and obesity reported clinical catastrophizing. These individuals had more frequent attacks/chronicity, longer attack duration, higher pain sensitivity, greater headache impact, and lower headache management self-efficacy. In all participants, PCS scores were related to several migraine characteristics, above and beyond the effects of obesity. Prospective studies are needed to determine sequence and mechanisms of relationships between catastrophizing, obesity, and migraine.

No abstract