Migraine and obesity: what is the real direction of their association?

ABSTRACT

Introduction

In recent decades, studies have addressed the issue of how migraine and obesity are related and have suggested obesity as a risk factor for migraine headache. However, the exact direction of this relationship remains under debate. In this review, the authors summarize the evidence that have suggested migraine as a risk factor for obesity and overweightness.

Areas covered

This article reviews the results of the previous research published on PubMed and Scopus databases (from 2000 to 2020) concerning the association between migraine and obesity to determine the actual direction of their association. Special attention has been given to the common mechanistic pathways involved in the pathophysiology of migraine and obesity.

Expert opinion

The majority of research conducted thus far has considered obesity as a risk factor for migraine. However, because of the cross-sectional design of available research, we cannot be certain of the proposed direction of this association. There is evidence supporting the hypothesis that obesity can serve as a consequence of migraine through the effects of neuropeptides, inflammatory mediators, adipokines, gut microbiota and modifications in eating behavior and lifestyle. However, the real direction of the relationship between migraine and obesity should be further investigated in large prospective studies.

KEYWORDS:

• Appetite
• headache disorders
• obesity
• overweight
• mechanism
• migraine
• neuroinflammation
• neuropeptides

Article highlights

• The classic perception of obesity merely as a risk factor for migraine development requires reconsideration.

• Migraine can contribute to weight gain and obesity through the effects of neuropeptides, inflammatory mediators, adipokines, gut microbiota and modifications in eating behavior and lifestyle.

• There is a probable vicious cycle between migraine and obesity as becoming obese following migraine could exacerbate migraine-related symptoms and contribute to migraine chronification.

• Successful weight reduction by obese migraine patients is more challenging because of their modified lifestyle, medication-related weight change and comorbidities.

• In order to properly ascertain the relationship between obesity and migraine, further large prospective studies should be undertaken.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737175.2023.2173575.

Additional information

Funding

This paper was not funded.