Improvement of migraine headaches in severely obese patients after bariatric surgery
JoseHaba-Rubio, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerlandjose.haba-rubio@chuv.ch
Mehdi Tafti and Raphael Heinzer
Submitted June 28, 2011
We read with great interest the article by Bond et al. who reported an improvement of migraine headaches in severely obese patients after bariatric surgery. [1] The authors speculated that obesity is associated with an increase of proinflammatory molecules implicated as pain mediators in neurovascular inflammation, which generates migraine pain.
In our opinion, the improvement of migraine headaches reported could be due, at least in part, to an improvement in obstructive sleep apnea syndrome (OSAS). Obesity is the principal risk factor for developing OSAS, as a 10% weight gain increases the risk of developing OSAS by six times. [2] The prevalence of OSAS in patients presenting for weight loss surgery is greater than 70% [3], and surgically induced weight loss significantly improves OSAS and parameters of sleep quality. [4]
In the same issue of Neurology, Kallweit et al. reported a decrease in migraine frequency in patients with OSAS effectively treated by CPAP. [5]. If the treatment of OSAS reduces migraine severity and weight loss improves OSAS, the improvement of migraine headaches found by Bond et al. could be due to improvement of OSAS after weight loss following bariatric surgery.
The pathophysiological hypothesis is that hypoxia in the context of OSAS might be a trigger for migraine, but the improvement of migraine could also be due to improvement in sleep quality and continuity induced by treatment of OSAS. We believe that particular attention should be paid to symptoms of sleep apnea in obese patients and future studies evaluating the relationship between obesity and migraine should include routine screening for OSAS.
References
1. Bond DS, Vithiananthan S, Nash JM, Thomas JG, Wing RR. Improvement of migraine headaches in severely obese patients after bariatric surgery. Neurology 2011;76:1135-1138.
2. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021.
3. Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg 2008;74:834-838.
4. Haines KL, Nelson LG, Gonzalez R, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery 2007;141:354-358.
5. Kallweit U, Hidalgo H, Uhl V, Sandor PS. Continuous positive airway pressure therapy is effective for migraines in sleep apnea syndrome. Neurology 2011;76:1189-1191.
Disclosure: Dr. Tafti served on the scientific advisory board for UCB Pharma (Belgium); received honorarium, travel funds, and research grants from UCB Pharma (Belgium) and the European Narcolepsy Network (EU-NN). Dr Heinzer received speakers' honoraria from Resmed Inc. and support from the Lancardis Foundation. Dr. Haba-Rubio reports no disclosures.
We read with great interest the article by Bond et al. who reported an improvement of migraine headaches in severely obese patients after bariatric surgery. [1] The authors speculated that obesity is associated with an increase of proinflammatory molecules implicated as pain mediators in neurovascular inflammation, which generates migraine pain.
In our opinion, the improvement of migraine headaches reported could be due, at least in part, to an improvement in obstructive sleep apnea syndrome (OSAS). Obesity is the principal risk factor for developing OSAS, as a 10% weight gain increases the risk of developing OSAS by six times. [2] The prevalence of OSAS in patients presenting for weight loss surgery is greater than 70% [3], and surgically induced weight loss significantly improves OSAS and parameters of sleep quality. [4]
In the same issue of Neurology, Kallweit et al. reported a decrease in migraine frequency in patients with OSAS effectively treated by CPAP. [5]. If the treatment of OSAS reduces migraine severity and weight loss improves OSAS, the improvement of migraine headaches found by Bond et al. could be due to improvement of OSAS after weight loss following bariatric surgery.
The pathophysiological hypothesis is that hypoxia in the context of OSAS might be a trigger for migraine, but the improvement of migraine could also be due to improvement in sleep quality and continuity induced by treatment of OSAS. We believe that particular attention should be paid to symptoms of sleep apnea in obese patients and future studies evaluating the relationship between obesity and migraine should include routine screening for OSAS.
References
1. Bond DS, Vithiananthan S, Nash JM, Thomas JG, Wing RR. Improvement of migraine headaches in severely obese patients after bariatric surgery. Neurology 2011;76:1135-1138.
2. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021.
3. Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg 2008;74:834-838.
4. Haines KL, Nelson LG, Gonzalez R, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery 2007;141:354-358.
5. Kallweit U, Hidalgo H, Uhl V, Sandor PS. Continuous positive airway pressure therapy is effective for migraines in sleep apnea syndrome. Neurology 2011;76:1189-1191.
Disclosure: Dr. Tafti served on the scientific advisory board for UCB Pharma (Belgium); received honorarium, travel funds, and research grants from UCB Pharma (Belgium) and the European Narcolepsy Network (EU-NN). Dr Heinzer received speakers' honoraria from Resmed Inc. and support from the Lancardis Foundation. Dr. Haba-Rubio reports no disclosures.