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Weight and Migraines Are Weirdly Linked, New Study Suggests

Looks like migraines are as discriminating as your Tinder dates.

Migraines are often characterized as bad headaches but are more accurately described as a disabling set of neurological symptoms which can include throbbing pain, light and noise sensitivity, and even vomiting that can lay a grown person flat for days at a time. Jennifer Reitman, a California publisher, describes the pain of her migraines, as, "like your head is on fire," and adds with a laugh, "I always joke and say it's the one time if someone broke into my house with a gun I would beg them to kill me."

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Now, scientists have learned new information about these brain-bashers that might lead to new treatment approaches: Migraines discriminate by weight.

Researchers at Johns Hopkins University School of Medicine performed a meta-analysis, published recently in Neurology. "The most exciting and important part is that it is the largest study of unique individuals on this topic," says lead study author B. Lee Peterlin, an associate professor of neurology (her team used the data of 12 prior studies and totaling 288,981 participants). The analysis found that being over- or underweight contributes to an increased risk of migraine. Obese people have a 27 percent increased risk of migraine over people of normal weight. Interestingly, severely underweight people also had an increased risk of migraine—it was 13 percent higher than that of average-weight people. So essentially, migraines have a Goldilocks and the Three Bears vibe—you're safer from them if you're "just right."

While this isn't the first study to correlate obesity and migraines, Peterlin says that those results included people of normal body weight, and did not specifically look at those who are underweight too. To get a more accurate picture, Peterlin separated participants by body mass index (a measure of body fat based on height and weight). The obesity measure was defined as a BMI of 30 or higher. The underweight measure was a BMI of less than 18.5.

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The link between obesity and increased migraine risk is further validated by prior clinical trials that show those with chronic migraine who have bariatric surgery (and subsequently lose weight as a result) see a reduction in monthly frequency and headache severity in three to six months after surgery. Additionally, research shows that exercise trials have helped alleviate the length and severity of migraines, though it is unclear if this is a result of the exercise itself, or the related weight loss.

Stephanie Garcia of Portland, Oregon, has struggled with migraines for 15 years. She would often wake in the middle of the night or early morning of the hours with extreme sensitivity to light and noise, and sometimes ringing in the ears bad enough to disrupt her sleep patterns. With these symptoms, she says, "I can tell at that point that a migraine is coming on." Over the past year, Garcia has also experienced "extreme weight loss and difficulty with weight gain," and says she has noticed a minor but notable increase in headaches and/or migraines in the past year.

Sometimes she can get ahead of a migraine with an opiate painkiller, to "take the edge off," but for many migraineurs, by the time the migraine arrives, it's already too late. Reitman doesn't bother to take any medication; she knows she'll just have to ride it out for three to five hours. "Then when they're over and you get a break, you're shot, you're done. It's not like you pop off the couch and go about your day, you're so exhausted from the pain of it, your day is over," she says.

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The new analysis also points to an interrelationship between BMI, age, and sex: Risk of migraine in those with obesity is greatest in people under the age of 55, and also greater for women than men. Regardless of controlling for age and sex though, the the risk of migraines remains increased in the over- and underweight.

The next step for researchers is understanding why and how weight has an impact on migraines. According to Peterlin, fat is an integral part of the endocrine system—it actually secretes hormones. "Adipose tissue [loose tissue made up of fat cells] is an organ, and like other endocrine organs such as thyroid, too much or too little can cause problems," Peterlin says.

Indeed, prior research of hers has shown that adipocytokines, proteins secreted almost exclusively by fat cells, are increased during acute migraine attacks. Also, age and sex differences account for differences in fat distribution, and metabolic function of those adipocytes—for instance, a young, prepubescent female will have significantly different fat distribution than a middle-aged obese man—though further research is needed to fully understand the mechanics of how and why.

The relationship between hormones and fat cells may also offer an explanation for why women going through perimenopause and menopause complain of frequent migraines, even if they've never had them before. Reitman was getting migraines as often as twice a month for three to five hours at a time until she completed menopause. They'd begin with an aura, at which point she says she had about ten minutes before the pain began. "I quickly try to get myself ready for everything I need: a bucket, a can of coca cola, an eye mask or wet compress. I get so sick to my stomach from the pain that I vomit."

Peterlin feels the primary value of her research lies in that it can empower migraine sufferers and their practitioners to make some lifestyle changes that may reduce migraines. "[Since] obesity is common and migraine is common, this is something both patients can actively work on themselves, and doctors can educate patients on," she says.

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