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Jahromi SR, Martami F, Morad Soltani K, Togha M. Migraine and obesity: what is the real direction of their association? Expert Rev Neurother 2023; 23:75-84. [PMID: 36714917 DOI: 10.1080/14737175.2023.2173575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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.
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Affiliation(s)
- Soodeh Razeghi Jahromi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Martami
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Morad Soltani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Maghbooli M, Jameshorani M, Afshar S, Kamali K. The prevalence of metabolic syndrome parameters and their association with headache characteristics among migraineurs. CURRENT JOURNAL OF NEUROLOGY 2021; 20:190-201. [PMID: 38011412 PMCID: PMC9107570 DOI: 10.18502/cjn.v20i4.8344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
Background: Migraine is associated with metabolic syndrome (MetS). There are evidences that components of MetS are more prevalent among migraine patients than non-migraineurs. Since both migraine and MetS are associated with a high risk of cardiovascular events, it is likely that the parameters of MetS increase the occurrence of cardiovascular disease (CVD) in migraineurs. The present research project was conducted for the purpose of investigating the relationship between MetS parameters and different items of migraine headaches. Methods: This descriptive-analytical, cross-sectional study was performed on 240 migraineurs [according to International Headache Society (HIS) II criteria] within the 17+ age range. The participants were selected via consecutive and convenience sampling method. The evaluated parameters for each subject included 2 arms: migraine characteristics (intensity, frequency of attacks, subtype, duration, and treatment regimen) and indices of MetS according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) report criteria [high-density lipoprotein-cholesterol (HDL-C), triglyceride (TG), fasting plasma glucose (FPG), height, waist circumference (WC), systolic and diastolic blood pressure (BP), and body mass index (BMI)]. All data were analyzed in SPSS software. Results: Total prevalence of MetS was 16.25% (39 patients). There was a statistically meaningful relationship between hypertriglyceridemia and gender (P = 0.021), hypertriglyceridemia and prophylactic antimigraine regimen (P = 0.022), hyperglycemia and age group (P = 0.010), hyperglycemia and the intensity of headache (P = 0.048), hyperglycemia and prophylactic treatment (P = 0.001), systolic hypertension and migraine subtype (P = 0.004), systolic hypertension and the duration of migraine disease (P = 0.005), diastolic hypertension and migraine subtype (P = 0.002), WC and gender (P = 0.001), WC and the intensity of headache (P = 0.028), WC and prophylactic medication (P = 0.017), HDL and gender (P = 0.001), HDL and the prophylactic regimen (P = 0.023), and MetS and gender (P = 0.005). The prevalence of MetS was increased with increase in the severity of migraine headache. Conclusion: Due to the relative increase in the prevalence of MetS in patients with more severe migraine, an evaluation of the mechanisms of MetS is recommended in this population.
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Affiliation(s)
- Mehdi Maghbooli
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maryam Jameshorani
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Sabereh Afshar
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kourosh Kamali
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
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Papetti L, Moavero R, Ferilli MAN, Sforza G, Tarantino S, Ursitti F, Ruscitto C, Vigevano F, Valeriani M. Truths and Myths in Pediatric Migraine and Nutrition. Nutrients 2021; 13:2714. [PMID: 34444875 PMCID: PMC8399652 DOI: 10.3390/nu13082714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 12/19/2022] Open
Abstract
The link between migraine and nutrition can be explored from several points of view. Lifestyle and, in particular, aspects of nutrition can have a significant impact on the course of pediatric migraine. In addition, some dietary treatments, such as the ketogenic diet, and some active ingredients present in foods (nutraceuticals) may have a therapeutic effect on migraine. A diet that can control weight gain and obesity has beneficial effects on migraine severity. On the other hand, when we talk about the link between nutrition and headaches, it is also necessary to point out that some public information is actually fake news that has no scientific basis. The purpose of this review is to provide an update on the salient points linking pediatric migraine to nutritional principles, focusing on the relationship between weight and headaches, the therapeutic effect of food for medical purposes, the ketogenic diet as a migraine treatment, and the relationship between migraine and dietary habits.
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Affiliation(s)
- Laura Papetti
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
| | - Romina Moavero
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00165 Rome, Italy;
| | - Michela A. N. Ferilli
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
| | - Giorgia Sforza
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
| | - Samuela Tarantino
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
| | - Fabiana Ursitti
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
| | - Claudia Ruscitto
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, 00165 Rome, Italy;
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
| | - Massimiliano Valeriani
- Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (R.M.); (M.A.N.F.); (G.S.); (S.T.); (F.U.); (F.V.); (M.V.)
- Center for Sensory-Motor Interaction, Denmark Neurology Unit, Aalborg University, 9100 Aalborg, Denmark
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Gazerani P. A Bidirectional View of Migraine and Diet Relationship. Neuropsychiatr Dis Treat 2021; 17:435-451. [PMID: 33603381 PMCID: PMC7884951 DOI: 10.2147/ndt.s282565] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022] Open
Abstract
Migraine is a common headache with a large negative impact on health. Several endogenous and exogenous factors can influence the severity and frequency of migraine, for example, lifestyle factors including dietary factors. Consequently, lifestyle modifications and dietary considerations have been reported beneficial to moderate clinical features of migraine. Much effort has been invested in determining the lifestyle factors (eg, stress, exercise, sleep, and diet) that trigger migraine to develop recommendations and guidelines for prevention. Diet has also been investigated with a major focus on the content of the diet and to a lesser extent on the amount, pattern, and quality of diet. Identification of dietary factors in migraine has led to nutritional interventions with a major focus on elimination of triggers, and weight control strategies. Several so-called migraine diets have consequently been proposed, for example, the ketogenic diet. Some theories have considered epigenetic diets or functional food to help in altering components of migraine pathogenesis; however, these theories are less investigated. In contrast, evidence is being accumulated to support that some mechanisms underlying migraine may alter dietary choices, for example type, amount, or patterns. Since a causative relationship is not yet established in migraine-diet relationship as to which comes first, this concept is equally valuable and interesting to investigate. Only limited epidemiological data are available to demonstrate that dietary choices are different among patients with migraine compared with individuals without migraine. Differences are reflected on quality, composition, pattern, and the amount of consumption of dietary components. This view emphasizes a potential bidirectional relationship between migraine and diet rather than a one-way influence of one on the other. This targeted review presents examples from current literature on the effects of diet on migraine features and effects of migraine on dietary choices to draw a perspective for future studies.
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Affiliation(s)
- Parisa Gazerani
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet, Oslo, Norway
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Tarantino S, Papetti L, Di Stefano A, Messina V, Ursitti F, Ferilli MAN, Sforza G, Moavero R, Vigevano F, Gentile S, Valeriani M. Anxiety, Depression, and Body Weight in Children and Adolescents With Migraine. Front Psychol 2020; 11:530911. [PMID: 33192771 PMCID: PMC7655930 DOI: 10.3389/fpsyg.2020.530911] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022] Open
Abstract
Background: There is a lack of studies that explore the possible association between body weight, psychological symptoms, and migraine severity in pediatric populations. The purpose of the study was to explore: (1) the association between body weight and the frequency of migraine attacks, (2) the possible differences in anxiety and depression symptoms according to the frequency of attacks and body weight, and (3) the possible mediating role of anxiety and/or depression in the association between body weight and frequency of migraine attacks in children. Methods: One hundred and eleven children/adolescents with migraine were included (47 boys and 64 girls; mean age 11.7; ±2.4 years). The patients were classified as: (1) high frequency patients, reporting from weekly to daily episodes and (2) low frequency patients, with ≤3 episodes per month. According to their body mass index percentiles, the patients were divided in “Normal weight” (from ≥5 to <85 percentile), “Overweight” (from ≥85 to <95 percentile), and “Obese” (≥95 percentile). Given the low number of obese patients, the overweight and obese groups were considered together in the “Overweight” group. Anxiety and depression symptoms were assessed by the Self-Administered Psychiatric Scales for Children and Adolescents (SAFA). Results: Fifty-four patients were normal in weight (49.6%), while 56 patients (50.4%) were overweight. The overweight patients showed a higher frequency of migraine attacks (64.7%; p < 0.05). Patients with a high frequency of attacks reported higher scores in all SAFA-Anxiety subscales (SAFA-A Tot: F = 15.107; p = 0.000). Overweight patients showed a significantly higher score in the “Separation anxiety” subscale (F = 7.855; p = 0.006). We found a mediating role between the overweight and high frequency for total anxiety (z = 2.11 ± 0.03; p < 0.05) and social anxiety (z = 2.04 ± 0.03; p < 0.05). Conclusions: Our results suggest that, among the children suffering from migraine, the overweight status is associated with a higher frequency of attacks and separation anxiety symptoms. In particular, our study provides the first evidence of the role of anxiety in linking overweight and the frequency of migraine attacks in children and adolescents.
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Affiliation(s)
- Samuela Tarantino
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Laura Papetti
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alessandra Di Stefano
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Valeria Messina
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Fabiana Ursitti
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Michela Ada Noris Ferilli
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgia Sforza
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Romina Moavero
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Federico Vigevano
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Simonetta Gentile
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Massimiliano Valeriani
- Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Rossi HL, Raj NR, Marquez de Prado B, Kuburas A, Luu AKS, Barr GA, Recober A. Trigeminal Pain Responses in Obese ob/ob Mice Are Modality-Specific. Neuroscience 2019; 415:121-134. [PMID: 31295530 DOI: 10.1016/j.neuroscience.2019.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 12/19/2022]
Abstract
How obesity exacerbates migraine and other pain disorders remains unknown. Trigeminal nociceptive processing, crucial in migraine pathophysiology, is abnormal in mice with diet induced obesity. However, it is not known if this is also true in genetic models of obesity. We hypothesized that obese mice, regardless of the model, have trigeminal hyperalgesia. To test this, we first evaluated trigeminal thermal nociception in leptin deficient (ob/ob) and control mice using an operant thermal assay. Unexpectedly, we found significant hypoalgesia in ob/ob mice. Because thermal hypoalgesia also occurs in mice lacking the transient receptor potential vanilloid 1 channel (TRPV1), we tested capsaicin-evoked trigeminal nociception. Ob/ob and control mice had similar capsaicin-evoked nocifensive behaviors, but ob/ob mice were significantly less active after a facial injection of capsaicin than were diet-induced obese mice or lean controls. Conditioned place aversion in response to trigeminal stimulation with capsaicin was similar in both genotypes, indicating normal negative affect and pain avoidance. Supporting this, we found no difference in TRPV1 expression in the trigeminal ganglia of ob/ob and control mice. Finally, we assessed the possible contribution of hyperphagia, a hallmark of leptin deficiency, to the behavior observed in the operant assay. Ob/ob and lean control mice had similar reduction of intake when quinine or capsaicin was added to the sweetened milk, excluding a significant contribution of hyperphagia. In summary, ob/ob mice, unlike mice with diet-induced obesity, have trigeminal thermal hypoalgesia but normal responses to capsaicin, suggesting specificity in the mechanisms by which leptin acts in pain processing.
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Affiliation(s)
- Heather L Rossi
- Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA
| | - Nichelle R Raj
- Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Blanca Marquez de Prado
- Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Adisa Kuburas
- Department of Neurology, University of Iowa, Iowa City, IA, USA; Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA
| | - Anthony K S Luu
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | - Gordon A Barr
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Ana Recober
- Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA.
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Abstract
PURPOSE OF REVIEW Migraine is a common and highly disabling condition that is particularly prevalent among women and especially women of reproductive age. The tremendous rise in adiposity in the Western world has led to an epidemic of obesity in women. The particular effects of obesity on women with migraine of various ages are the focus of this review. RECENT FINDINGS Conflicting findings from various studies with different approaches and populations have made challenging definitive conclusions about associations between migraine and obesity. While the association between obesity and migraine frequency has been consistently demonstrated and obesity is considered a risk factor for progression from episodic to chronic migraine, the association between obesity and migraine prevalence is still somewhat debated and appears to be dependent on gender and age, with the most consistent effects observed in women younger than 55 years of age. Association between migraine and obesity is most commonly observed in women of reproductive age. The multimodal changes associated with age and hormonal change in women likely play a role in this relationship, as obesity does not appear to be related to migraine in women over 55 years of age. Future studies focusing on the migraine-obesity relationship in women should examine the effects of age, endogenous hormonal state, and exogenous hormones on migraine and obesity.
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Affiliation(s)
- Jelena M Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA.
- Montefiore Headache Center, Bronx, NY, USA.
| | - Julio R Vieira
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA
- Health Quest Neurology, Kingston, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA
- Montefiore Headache Center, Bronx, NY, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
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Gelaye B, Sacco S, Brown WJ, Nitchie HL, Ornello R, Peterlin BL. Body composition status and the risk of migraine: A meta-analysis. Neurology 2017; 88:1795-1804. [PMID: 28404807 DOI: 10.1212/wnl.0000000000003919] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/14/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the association between migraine and body composition status as estimated based on body mass index and WHO physical status categories. METHODS Systematic electronic database searches were conducted for relevant studies. Two independent reviewers performed data extraction and quality appraisal. Odds ratios (OR) and confidence intervals (CI) were pooled using a random effects model. Significant values, weighted effect sizes, and tests of homogeneity of variance were calculated. RESULTS A total of 12 studies, encompassing data from 288,981 unique participants, were included. The age- and sex-adjusted pooled risk of migraine in those with obesity was increased by 27% compared with those of normal weight (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.16-1.37, p < 0.001) and remained increased after multivariate adjustments. Although the age- and sex-adjusted pooled migraine risk was increased in overweight individuals (OR 1.08; 95% CI 1.04, 1.12, p < 0.001), significance was lost after multivariate adjustments. The age- and sex-adjusted pooled risk of migraine in underweight individuals was marginally increased by 13% compared with those of normal weight (OR 1.13; 95% CI 1.02, 1.24, p < 0.001) and remained increased after multivariate adjustments. CONCLUSIONS The current body of evidence shows that the risk of migraine is increased in obese and underweight individuals. Studies are needed to confirm whether interventions that modify obesity status decrease the risk of migraine.
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Affiliation(s)
- Bizu Gelaye
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Simona Sacco
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy J Brown
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Haley L Nitchie
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raffaele Ornello
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - B Lee Peterlin
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD.
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9
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Obesity and chronic pain: systematic review of prevalence and implications for pain practice. Reg Anesth Pain Med 2015; 40:91-111. [PMID: 25650632 DOI: 10.1097/aap.0000000000000218] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The combination of obesity and pain may worsen a patient's functional status and quality of life more than each condition in isolation. We systematically searched PubMed/MEDLINE and the Cochrane databases for all reports published on obesity and pain. The prevalence of combined obesity and pain was substantial. Good evidence shows that weight reduction can alleviate pain and diminish pain-related functional impairment. However, inadequate pain control can be a barrier to effective lifestyle modification and rehabilitation. This article examines specific pain management approaches for obese patients and reviews novel interventional techniques for treatment of obesity. The infrastructure for simultaneous treatment of obesity and pain already exists in pain medicine (eg, patient education, behavioral medicine approaches, physical rehabilitation, medications, and interventional treatment). Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies.
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Ornello R, Ripa P, Pistoia F, Degan D, Tiseo C, Carolei A, Sacco S. Migraine and body mass index categories: a systematic review and meta-analysis of observational studies. J Headache Pain 2015; 16:27. [PMID: 25903159 PMCID: PMC4385329 DOI: 10.1186/s10194-015-0510-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/03/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Several studies have assessed the associations between migraine and underweight, pre-obesity or obesity, with conflicting results. To assess the consistency of the data on the topic, we performed a systematic review and meta-analysis of the available observational studies. METHODS Multiple electronic databases were systematically searched up to October 2014 for studies assessing the association between migraine and body mass index categories (underweight, pre-obesity, or obesity). RESULTS Out of 2,022 records, we included 15 studies. When considering the 11 studies following the World Health Organization BMI cutoffs, we found an increased risk of having migraine in underweight subjects (pooled adjusted effect estimate [PAEE] 1.21; 95% CI, 1.07-1.37; P = 0.002) and in obese women (PAEE 1.44; 95% CI, 1.05-1.97; P = 0.023) as compared with normal weight subjects; additionally, pre-obese subjects had an increased risk of having chronic migraine (PAEE 1.39; 95% CI, 1.13-1.71; P = 0.002). When considering all the 15 studies, we additionally found an increased risk of having migraine in obese as compared with normal weight subjects (PAEE 1.14; 95% CI, 1.02-1.27; P = 0.017); additionally, obese subjects had an increased risk of having chronic migraine (PAEE 1.75; 95% CI, 1.33-2.29; P < 0.001). The pooled analysis did not indicate an increased risk of having migraine in pre-obese subjects. CONCLUSIONS The meta-analysis of the available observational studies suggested an association between migraine and obesity likely mediated by gender and migraine frequency. Further studies taking into account gender, migraine type, frequency, activity, and duration could provide more robust evidence.
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Affiliation(s)
- Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Patrizia Ripa
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Francesca Pistoia
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Diana Degan
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Cindy Tiseo
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Antonio Carolei
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
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Goulart AC, Santos IS, Lotufo PA, Benseñor IM. Gender aspects of the relationship between migraine and cardiovascular risk factors: A cross-sectional evaluation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cephalalgia 2015; 35:1103-14. [DOI: 10.1177/0333102415570494] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/27/2014] [Indexed: 11/15/2022]
Abstract
Background The relationship between cardiovascular risk factors (CVRF) and migraine is controversial and might be different in both genders. These associations were evaluated in Brazilian middle-aged men and women from the Longitudinal Study of Adult Health (ELSA-Brasil). Methods The cross-sectional relationship between our main outcome, which was migraine headache (definite, probable and overall), and CVRF was evaluated in the total sample and according to gender. We calculated frequencies and odds ratios (95% CI) for this relationship using binary and multinomial logistic regression analyses in crude, age-adjusted and multivariable models adjusted by potential confounders. Results Of 14,953 individuals who completed the data about headache and CVRF, the frequency of one-year migraine was of 29.5% (22.5% in women and 7.0% in men). In the multivariable-adjusted regression analyses, an inverse association between hypertension (OR, 0.53; 95% CI, 0.36–0.79), metabolic syndrome (OR, 0.65; 95% CI, 0.43–0.99) and definite migraine were confirmed for men, but not for women. In the opposite direction, a positive association between migraine headaches (definite, probable and overall) and dyslipidemia (overall migraine OR, 1.25; 95% CI, 1.13–1.38) was observed only for women, but not for men. Conclusions A gender influence on the relationship between migraine and CVRF was verified in the ELSA-Brasil.
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Affiliation(s)
| | - Itamar S Santos
- Hospital Universitário, Universidade de São Paulo, Brazil
- School of Medicine, Universidade de São Paulo, Brazil
| | - Paulo A Lotufo
- Hospital Universitário, Universidade de São Paulo, Brazil
- School of Medicine, Universidade de São Paulo, Brazil
| | - Isabela M Benseñor
- Hospital Universitário, Universidade de São Paulo, Brazil
- School of Medicine, Universidade de São Paulo, Brazil
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12
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Sacco S, Pistoia F, Degan D, Carolei A. Conventional vascular risk factors: their role in the association between migraine and cardiovascular diseases. Cephalalgia 2014; 35:146-64. [PMID: 25505017 DOI: 10.1177/0333102414559551] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Migraine, in particular migraine with aura, has been found to be associated with cardiovascular disease. However, the role of conventional vascular risk factors in the association is still debated. The aim of the present review is to address the association between migraine and conventional cardiovascular risk factors as well as to address their possible role in the association between migraine and cardiovascular disease. METHODS Data for this review were obtained through searches in multiple sources up to May 2014 using the terms "migraine" OR "headache" in combination with all the vascular risk factors of interest. RESULTS Data about the possible association between migraine and high blood pressure values are heterogeneous, hindering any final conclusion. Data addressing the possible association between migraine and diabetes mellitus indicate the lack of any association or in some cases a negative association between the two conditions. The body of evidence on the role of dyslipidemia in migraineurs is relatively homogeneous and, with few exceptions, reports an association between migraine and an unfavorable lipid profile; however, the difference in lipid levels between migraineurs and non-migraineurs is small and its clinical implication unclear. Regarding obesity, a trend has been observed of increased risk of migraine with increasing obesity, especially in young patients, albeit in the midst of conflicting data. Evidence about the association between cigarette smoking and migraine mostly indicates that migraineurs are more commonly smokers than non-migraineurs. On the other hand, the majority of the available studies report less alcohol use in migraineurs than in non-migraineurs. Finally, many of the available studies suggest a more frequent family history of cardiovascular disease in migraineurs as compared to non-migraineurs. Since most of the studies that supported the association between migraine and cardiovascular disease adjusted the analyses for the presence of several vascular risk factors, they cannot entirely explain this association. CONCLUSIONS Based on the available reported data, it seems unlikely that the higher risk of cardiovascular disease in migraineurs is mediated by any single vascular risk factor. For this reason the role of specific interactions among risk factors with the contribution of genetic, environmental, personality and psychological factors should be appropriately investigated.
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Affiliation(s)
- Simona Sacco
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Francesca Pistoia
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Diana Degan
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Antonio Carolei
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
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13
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Chai NC, Scher AI, Moghekar A, Bond DS, Peterlin BL. Obesity and headache: part I--a systematic review of the epidemiology of obesity and headache. Headache 2014; 54:219-34. [PMID: 24512574 DOI: 10.1111/head.12296] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2013] [Indexed: 01/04/2023]
Abstract
Individually, both obesity and headache are conditions associated with a substantial personal and societal impact. Recent data support that obesity is comorbid with headache in general and migraine specifically, as well as with certain secondary headache conditions such as idiopathic intracranial hypertension. In the current manuscript, we first briefly review the epidemiology of obesity and common primary and secondary headache disorders individually. This is followed by a systematic review of the general population data evaluating the association between obesity and headache in general, and then obesity and migraine and tension-type headache disorders. Finally, we briefly discuss the data on the association between obesity and a common secondary headache disorder that is associated with obesity, idiopathic intracranial hypertension. Taken together, these data suggest that it is important for clinicians and patients to be aware of the headache/migraine-obesity association, given that it is potentially modifiable. Hypotheses for mechanisms of the obesity-migraine association and treatment considerations for overweight and obese headache sufferers are discussed in the companion manuscript, as part II of this topic.
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Affiliation(s)
- Nu Cindy Chai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Obesity and headache/migraine: the importance of weight reduction through lifestyle modifications. BIOMED RESEARCH INTERNATIONAL 2014; 2014:420858. [PMID: 24800223 PMCID: PMC3996319 DOI: 10.1155/2014/420858] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/10/2014] [Indexed: 11/17/2022]
Abstract
The aim of this study is to determine a possible relationship between prevalence, frequency, and severity of migraine and obesity. All pertinent data from the literature have been critically examined and reviewed in order to assess the possible relationship between obesity and migraine, in particular migraine frequency and disability in children, as well as in adult population studies. Prevalence, frequency, and severity of migraine appear to increase in relation to the body mass index, although this evidence is not supported by all the studies examined. Data from literature suggest that obesity can be linked with migraine prevalence, frequency, and disability both in pediatric and adult subjects. These data have important clinical implications and suggest that clinicians should have a special interest for weight reduction of obese children suffering from migraine, prescribing and supporting intensive lifestyle modifications (dietary, physical activities, and behavioral) for the patient and the entire family.
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15
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Landy SH, Kaniecki RG, Taylor FR. Abstracts and Citations. Headache 2014. [DOI: 10.1111/head.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Peterlin BL, Rosso AL, Williams MA, Rosenberg JR, Haythornthwaite JA, Merikangas KR, Gottesman RF, Bond DS, He JP, Zonderman AB. Episodic migraine and obesity and the influence of age, race, and sex. Neurology 2013; 81:1314-21. [PMID: 24027060 DOI: 10.1212/wnl.0b013e3182a824f7] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the episodic migraine (EM)-obesity association and the influence of age, race, and sex on this relationship. METHODS We examined the EM-obesity association and the influence of age, race, and sex in 3,862 adult participants of both black and white race interviewed in the National Comorbidity Survey Replication. EM diagnostic criteria were based on the International Classification of Headache Disorders. Body mass index was classified as underweight (<18.5 kg/m(2)), normal (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), or obese (≥30 kg/m(2)). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for EM were estimated using logistic regression. Models were stratified by age (<50/≥50 years), race (white/black), and sex (male/female). RESULTS A total of 188 participants fulfilled criteria for EM. In all participants, the adjusted odds of EM were 81% greater in individuals who were obese compared with those of normal weight (OR 1.81; 95% CI: 1.27-2.57; p = 0.001), with a significant trend of increasing odds of EM with increasing obesity status from normal weight to overweight to obese (p = 0.001). In addition, stratified analyses demonstrated that the odds of EM were greater in obese as compared with normal-weight individuals who were 1) younger than 50 years of age (OR 1.86; 95% CI: 1.20-2.89; p for trend = 0.008), 2) white (OR 2.06; 95% CI: 1.41-3.01; p for trend ≤0.001), or 3) female (OR 1.95; 95% CI: 1.38-2.76; p for trend ≤0.001). CONCLUSION The odds of EM are increased in those with obesity, with the strongest relationships among those younger than 50 years, white individuals, and women.
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Affiliation(s)
- B Lee Peterlin
- From the Departments of Neurology (B.L.P., J.R.R., R.F.G.) and Psychiatry & Behavioral Sciences (J.A.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.L.R.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA; Genetic Epidemiology Research Branch (K.R.M., J.-P.H.), Intramural Research Program, National Institute of Mental Health, NIH, Department of Health and Human Services, Bethesda, MD; Brown Alpert Medical School (D.S.B.), Department of Psychiatry and Human Behavior/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI; and Intramural Research Program (A.B.Z.), National Institute on Aging, Biomedical Research Center, NIH, Baltimore, MD
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Affiliation(s)
- Marcelo E Bigal
- Head of the Merck Investigator Studies Program, Scientific Engagements and Education (MISP/SEE), Office of the Chief Medical Officer, Merck & Co., Inc., North Wales, PA, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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