Understanding the link between obesity and headache- with focus on migraine and idiopathic intracranial hypertension

Abstract

Background Obesity confers adverse effects to every system in the body including the central nervous system. Obesity is associated with both migraine and idiopathic intracranial hypertension (IIH). The mechanisms underlying the association between obesity and these headache diseases remain unclear. Methods We conducted a narrative review of the evidence in both humans and rodents, for the putative mechanisms underlying the link between obesity, migraine and IIH. Results Truncal adiposity, a key feature of obesity, is associated with increased migraine morbidity and disability through increased headache severity, frequency and more severe cutaneous allodynia. Obesity may also increase intracranial pressure and could contribute to headache morbidity in migraine and be causative in IIH headache. Weight loss can improve both migraine and IIH headache. Preclinical research highlights that obesity increases the sensitivity of the trigeminovascular system to noxious stimuli including inflammatory stimuli, but the underlying molecular mechanisms remain unelucidated. Conclusions This review highlights that at the epidemiological and clinical level, obesity increases morbidity in migraine and IIH headache, where weight loss can improve headache morbidity. However, further research is required to understand the molecular underpinnings of obesity related headache in order to generate novel treatments.

Applying a biopsychosocial model to migraine: rationale and clinical implications

“…Regarding the first postulated explanation, we can provide the example of psychiatric comorbidities, epilepsy, or sleep disturbances [ 57 – 59 ]. Regarding the second postulated explanation, we can include obesity and inflammatory diseases [ 56 , 60 – 62 ]. Irrespectively of the presence or not of shared mechanisms, it is a fact that several treatments which are commonly used for migraine prophylaxis have been repurposed from other diseases.…”

The impact of obesity-related raised intracranial pressure in rodents

“…TRPV1 expression is modulated by inflammatory mediators, given that the TG is outside the blood brain barrier, this suggests that the circulating inflammatory milieu in obesity could be causative in the upregulation of TRPV1, given that our qPCR data suggests no increases in pro-inflammatory gene expression in the TG 22 , 43 . Although we investigated CGRP and TRPV1, other peptides such as PACAP and amylin are proposed to be involved in headache, thus future investigation into these in the context of DIO related cutaneous allodynia is warranted 18 . The direct cause of the molecular and therefore the cutaneous allodynia remains uncertain.…”

“…However, the increasing rate of obesity suggests that environmental and behavioral factors including dietary factors have been the major contributors to the obesity epidemic rather than rare genetic changes 17 . IIH patients are 92% female, suggesting that female gender may play a role in developing raised ICP in the context of obesity 18 . There is no evidence that IIH is a genetic disease, as such the source of the disease is likely behavioral and environmental.…”

Headache in the Workplace: Analysis of Factors Influencing Headaches in Terms of Productivity and Health

“…This leads us to believe that dietary strategies for weight loss may be able to ameliorate headache/migraine [ 69 ]. Epidemiological and clinical considerations demonstrate that obesity increases morbidity in migraine and headache, whereas weight loss can improve headache morbidity [ 70 ]. The association between migraine and dyslipidemia has been observed in case-control [ 71 ] and population studies [ 72 ].…”