|Year : 2021 | Volume
| Issue : 4 | Page : 288-292
Body mass index and its association with various features of migraine: A cross-sectional study from Saudi Arabia
Danah Aljaafari1, Noman Ishaque1, Ghadeer Al-Shabeeb1, Sukainah Alalwi1, Aishah Albakr1, Osama Basheir1, Reem A Alyoubi2, Fahd Alkhamis1, Majed Alabdali1
1 Department of Neurology, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
2 Department of Pediatric Neurology, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
|Date of Submission||24-Jun-2020|
|Date of Acceptance||14-Oct-2020|
|Date of Web Publication||3-Dec-2021|
Department of Neurology, College of Medicine, Imam Abdulrahaman Bin Faisal University, 2835, King Faisal Road, Dammam 34212
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Migraine is a highly prevalent condition, and prevalence of obesity is also increasing. Results of studies addressing association of body mass index (BMI) with migraine and its features are conflicting. In this cross-sectional study, we aim to assess association between BMI and various migraine features. Methods: This study was conducted in the Headache Clinic of King Fahd Hospital of University, Al Khobar, Saudi Arabia. Interviews were conducted by three consultant neurologists. Migraine was defined according to the International Headache Society and BMI was calculated as weight (kilograms)/height (m2). Results: Of total of 121 patients, 79% were female. Almost 87.6% of patients were taking prophylactic medications. Majority of patients had attack for more than 24 h (60.3%), pulsating character (81%), moderate-to-severe intensity (92.6%), associated with nausea and/or vomiting (75.2%), and photophobia/phonophobia (91.7%). About 29.8% of patients were normal weight, 28.1% were overweight, and 39.7% were obese and morbidly obese. There was insignificant association between various categories of BMI and features of migraine, that is, unilateral location (P = 0.385), pulsating character (P = 0.571), moderate-to-severe intensity (P = 0.187), nausea and/or vomiting (P = 0.582), and photophobia and/or phonophobia (P = 0.444). Conclusion: In our study, we did not find an association between BMI and various features of migraine.
| Abstract in French|| |
Introduction: La migraine est une maladie très répandue, et la prévalence de l'obésité est également en augmentation. Résultats des études portant sur l'association de l'indice de masse corporelle (IMC) avec la migraine et ses caractéristiques sont contradictoires. Dans cette étude transversale, nous visons à évaluer l'association entre IMC et diverses caractéristiques de la migraine. Méthodes: Cette étude a été menée à la Headache Clinic de l'hôpital King Fahd de l'Université, Al Khobar, Arabie Saoudite. Les entretiens ont été menés par trois neurologues consultants. La migraine a été définie selon l'International La Headache Society et l'IMC ont été calculés en poids (kilogrammes)/taille (m2). Résultats: Sur un total de 121 patients, 79 % étaient des femmes. Presque 87,6 % des patients prenaient des médicaments prophylactiques. La majorité des patients ont eu une attaque pendant plus de 24h (60,3%), caractère pulsatile (81%), intensité modérée à sévère (92,6 %), associée à des nausées et/ou vomissements (75,2 %) et photophobie/phonophobie (91,7 %). Environ 29,8 % des les patients avaient un poids normal, 28,1 % étaient en surpoids et 39,7 % étaient obèses et obèses morbides. Il y avait une association insignifiante entre diverses catégories d'IMC et caractéristiques de la migraine, c'est-à-dire localisation unilatérale (P = 0,385), caractère pulsatile (P = 0,571), modéré à sévère intensité (P = 0,187), nausées et/ou vomissements (P = 0,582) et photophobie et/ou phonophobie (P = 0,444). Conclusion: Dans notre étude, nous n'ont pas trouvé d'association entre l'IMC et diverses caractéristiques de la migraine.
Mots-clés: Indice de masse corporelle, fréquence, migraine, obésité, gravité
Keywords: Body mass index, frequency, migraine, obesity, severity
|How to cite this article:|
Aljaafari D, Ishaque N, Al-Shabeeb G, Alalwi S, Albakr A, Basheir O, Alyoubi RA, Alkhamis F, Alabdali M. Body mass index and its association with various features of migraine: A cross-sectional study from Saudi Arabia. Ann Afr Med 2021;20:288-92
|How to cite this URL:|
Aljaafari D, Ishaque N, Al-Shabeeb G, Alalwi S, Albakr A, Basheir O, Alyoubi RA, Alkhamis F, Alabdali M. Body mass index and its association with various features of migraine: A cross-sectional study from Saudi Arabia. Ann Afr Med [serial online] 2021 [cited 2022 Aug 15];20:288-92. Available from: https://www.annalsafrmed.org/text.asp?2021/20/4/288/331665
| Introduction|| |
Obesity and migraine are highly prevalent conditions in the general population.,,,, Obesity is a chronic, multifactorial disease with high prevalence in the general population and it is growing with time all over the world.,,, Saudi Arabia is the 15th most obese country with an overall obesity rate of 33.7% and the prevalence of overweight and obese population is increasing in Saudi Arabia over time., Obesity has been linked to pain disorders like migraine. On the other hand, migraine is a very common and disabling pain disorder with high prevalence in general population ranging from 5% to 35% in females and from 3% to 20% in males.,
Studies have focused on the association between obesity and migraine, but the results have been conflicting. Some studies have shown a relationship between obesity and various features of migraine including higher frequency, aura, and increased frequency of photophobia and phonophobia.,, Furthermore, obesity might have an association with various cardiovascular comorbidities seen with migraine.,,,, Positive association between migraine and obesity would be of great significance as it may lead to an increase in the prevalence of migraine and may be a possible target for preventive therapies of migraine.
In this study, we aim to evaluate the association between obesity as measured by body mass index (BMI) and various features of migraine.
| Methods|| |
Methods and sample design
This cross-sectional study was conducted in the Headache Clinic of King Fahd hospital of University Al Khobar, Eastern region of Saudi Arabia from June 2018 to June 2019. The research protocol was approved by the institutional review board.
Migraine patients aged between 18 and 40 years were identified in the Headache Clinic. Informed consent was obtained from subjects before the interview. A trained neurologist conducted the interview. Migraine was defined according to the criteria by the International Headache Society as “At least five headache attacks, lasting 4–72 h and at least two of unilateral location, pulsating quality, moderate or severe intensity and aggravation by or causing avoidance of routine physical activity.” Questionnaire included questions pertaining to use of any prophylactic medications, duration (classified into <24 h, 24–48 h, and from 48 to 72 h or longer), unilateral location, pulsating character, intensity, avoidance of physical activity during attack, associated nausea and/or vomiting, photophobia and/or phonophobia, status of smoking, exercise, use of any hormonal therapy, and presence of any chronic medical illnesses. BMI was measured according to the formula: BMI = weight (kg)/height (m2). Body weight and height were measured on subjects with light dress and without shoes. According to the World Health Organization classification, BMI was classified into five categories: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), obese (30–34.9), and morbidly obese (>35). Obese and morbidly obese patients were grouped together due to a very small number of morbidly obese patients.
Descriptive statistics were used to assess frequencies and distributions. Proportions were compared with either χ2 test or Fisher's test. P < 0.05 was considered statistically significant. All analyses were performed using SPSS version 21.0 (IBM Corp., Armonk, NY, USA).
| Results|| |
Patient's demographic characteristics and migraine features are given in [Table 1]. Of 121 patients, 96 (79.3%) were female. One hundred and six (87.6%) patients were taking prophylactic medications. Only 9.9% of patients were smoking at the time of enrollment, whereas 4.1% of patients were ex-smokers. The rest of the patients were nonsmokers. Only 29.8% of patients were doing exercise. Only 8.3% of patients were taking hormonal therapy. Regarding the history of chronic medical illness, 10.7% of patients had hypertension, 5% of patients had dyslipidemia, and 3.3% patients had hypothyroidism and diabetes each. Duration of headache was <1 day in 39.7% of patients, up to 48 h in 38% of patients, and up to 72 h or more than that in 22.3% of patients. Headache was unilateral in 67.8% of patients, of pulsating character in 81% of patients, and of moderate-to-severe intensity in 92.6% of patients. It was associated with nausea and/or vomiting in 75.2% of patients and photophobia and/or phonophobia in 91.7% of patients. Migraine led to avoidance of physical activity in 73.6%. Regarding categorization, according to the BMI, 2.5% of patients were underweight, 29.8% of patients were of normal weight, 28.1% of patients were overweight, and 39.7% were obese.
Association of BMI with demographic characteristics and various migraine features is given in [Table 2]. Females made up 77.8%, 82.4%, and 79.2% of 36 normal weight, 34 overweight, and 48 obese patients, respectively. However, gender was not found to bear a significant association with different categories of BMI (P = 0.911). Prophylactic medications for migraine were being used by 83.3% of normal weight, 88.2% of overweight, and 89.6% of obese patients, but there was no significant association between use of prophylactic medication for migraine and various categories of BMI (P = 0.749). Similarly, duration of acute attack of migraine was not found to be significantly associated with different categories of BMI (P = 0.450). Unilateral location of migraine was found in 75% of normal weight, 64.7% of overweight, and 625.5% of obese patients, but the association between two was not significant (P = 0.385). Close to two-third of patients with a pulsating character of headache were either overweight or obese; however, the association was not found to be significant (P = 0.571). Again, 66% of patients with moderate-to-severe intensity of migraine were either overweight or obese, but the association of BMI with intensity of migraine was not found to be significant (P value = 0.187). About 68% of all patients with migraine who experienced nausea and/or vomiting were overweight or obese, but the association between nausea and/or vomiting and BMI was not significant (P = 0.582). Although 111 patients of 121 patients reported that they experienced photophobia and/or phonophobia during the attack, the association of photophobia and/or phonophobia with BMI was not statistically significant (P = 0.444). Association of BMI with avoidance of daily life activities during migraine attack was also found to be insignificant (P = 0.9). About 86% of patients were nonsmokers and only 9.9% of patients were smokers and insignificant association was found between smoking status and BMI (P = 0.496). Only one-third of patients were doing exercise, the association between BMI and exercise was insignificant (P = 0.706). Only 8.3% of patients reported use of hormones and association of hormonal use and BMI was found to be insignificant (P = 0.819). Nearly two-third of patients were free of any other medical illness, hypertension was the most prevalent condition in rest of the patients; however, BMI did not have a significant association with a history of medical illness (P = 0.113).
|Table 2: Body mass index and various patient characteristics and features of migraine|
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| Discussion|| |
In this clinic-based cross-sectional study, we did not find any significant association between BMI and various features of migraine including duration, laterality, intensity, nausea/vomiting, and photophobia/phonophobia.
There is considerable uncertainty about nature of the obesity/headache relationship and whether it is specific to migraine or chronic daily headache or headache in general. Association of BMI with migraine has been studied previously, but the results are conflicting. Some studies did not find an association between BMI and migraine, whereas other studies have suggested an association between obesity and higher migraine frequency as well other migraine features such as severity and photophobia and/or phonophobia.
Similar to our study, Mattsson did not find a significant association between obesity and migraine in 684 females aged 40–74 years. Similarly in a cross-sectional analysis of 11 datasets by Keith et al., migraine prevalence was not related to obesity, obese women had increased risk of headache (but not specifically migraine) as compared to those with normal BMI. Téllez-Zenteno et al. did not find association between BMI and severity and disability caused by migraine. Also, Winter et al. in their large prospective study about middle-aged women, they did not indicate a consistent association between migraine incidence and overweight, obesity or relevant weight gain. In another recent study, any proportion of BMI was not associated with migraine, severity of pain in migraine, and duration of migraine. Bigal et al. reported that although preventive therapy for migraine was effective, efficacy of preventive therapy for migraine did not differ with respect to different categories of BMI.
Some studies have suggested that obesity is a comorbid with chronic pain syndromes including fibromyalgia and back and neck pain. Therefore, there was interest in the association between obesity and migraine. Several mechanisms supported that there may exist a possible link between BMI and headaches. Concentrations of calcitonin gene-related peptide levels, which are elevated in obese individuals, are a very important mediators of migraine/chronic migraine.,,, Furthermore, migraines, like obesity, have been reported as a risk factor for cardiovascular disorders as well as stroke.,, Finally, preventive medications for migraine may also be a contributing reason for changes of BMI., Some studies have suggested that obesity in patients with migraine is associated with aura, high-frequency migraines, greater severity, and with an increased frequency of photophobia and phonophobia and also with transformation of episodic migraine to chronic migraine.,,,,, J-shaped association has been suggested between BMI and higher frequency of migraine. It is also suggested that individuals with episodic headache and obesity are five times more likely to develop a chronic daily headache.,,,,
Main strengths of our study are (1) to our knowledge, this is the first study from Middle East region addressing association of BMI and migraine features. (2) Our study is mainly focused on the association of BMI with various features of migraine. (3) Most of our patients had moderate-to-severe intensity of migraine, hence most suitable population to assess the association of migraine and BMI.
Limitations of our study are small sample size and we did not assess the association of BMI with disability caused by migraine.
| Conclusion|| |
Although a large number of migraine patients might be overweight and obese, BMI does not bear association with migraine or its various features.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
National Center for Chronic Disease Prevention and Health Promotion. Overweight and Obesity: U.S. Obesity Trends 1985-2006; April 24, 2008.
World Health Organization. Global Strategy on Diet, Physical Activity, and Health: Obesity and Overweight; April 24, 2008.
Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med 2004;164:249-58.
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004;291:2847-50.
Lipton RB, Bigal ME. The epidemiology of migraine. Am J Med 2005;118 Suppl 1:3S-10S.
Al-Othaimeen AI, Al-Nozha M, Osman AK. Obesity: An emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey. East Mediterr Health J 2007;13:441-8.
Alqarni SS. A review of prevalence of obesity in Saudi Arabia. J Obes Eat Disord 2006;2:2.
Bigal ME, Liberman JN, Lipton RB. Age-dependent prevalence and clinical features of migraine. Neurology 2006;67:246-51.
Winter AC, Berger K, Buring JE, Kurth T. Body mass index, migraine, migraine frequency and migraine features in women. Cephalalgia 2009;29:269-78.
Bigal ME, Liberman JN, Lipton RB. Obesity and migraine: A population study. Neurology 2006;66:545-50.
Bigal ME, Lipton RB. Obesity is a risk factor for transformed migraine but not chronic tension-type headache. Neurology 2006;67:252-7.
Kurth T, Slomke MA, Kase CS, Cook NR, Lee IM, Gaziano JM, et al
. Migraine, headache, and the risk of stroke in women: A prospective study. Neurology 2005;64:1020-6.
Stang PE, Carson AP, Rose KM, Mo J, Ephross SA, Shahar E, et al
. Headache, cerebrovascular symptoms, and stroke: The Atherosclerosis Risk in Communities Study. Neurology 2005;64:1573-7.
MacClellan LR, Giles W, Cole J, Wozniak M, Stern B, Mitchell BD, et al
. Probable migraine with visual aura and risk of ischemic stroke: The stroke prevention in young women study. Stroke 2007;38:2438-45.
Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA 2006;296:283-91.
Kurth T, Gaziano JM, Cook NR, Bubes V, Logroscino G, Diener HC, et al
. Migraine and risk of cardiovascular disease in men. Arch Intern Med 2007;167:795-801.
Peterlin BL, Rapoport AM, Kurth T. Migraine and obesity: Epidemiology, mechanisms, and implications. Headache 2010;50:631-48.
Mattsson P. Migraine headache and obesity in women aged 40-74 years: A population-based study. Cephalalgia 2007;27:877-80.
Keith SW, Wang C, Fontaine KR, Cowan CD, Allison DB. BMI and headache among women: Results from 11 epidemiologic datasets. Obesity (Silver Spring) 2008;16:377-83.
Téllez-Zenteno JF, Pahwa DR, Hernandez-Ronquillo L, García-Ramos G, Velázquez A. Association between body mass index and migraine. Eur Neurol 2010;64:134-9.
Winter AC, Wang L, Buring JE, Sesso HD, Kurth T. Migraine, weight gain and the risk of becoming overweight and obese: A prospective cohort study. Cephalalgia 2012;32:963-71.
Huang Q, Liang X, Wang S, Mu X. Association between body mass index and migraine: A survey of adult population in China. Behav Neurol 2018;2018:6585734.
Bigal ME, Gironda M, Tepper SJ, Feleppa M, Rapoport AM, Sheftell FD, et al
. Headache prevention outcome and body mass index. Cephalalgia 2006;26:445-50.
Bic Z, Blix GG, Hopp HP, Leslie FM. In search of the ideal treatment for migraine headache. Med Hypotheses 1998;50:1-7.
Power C, Miller SK, Alpert PT. Promising new causal explanations for obesity and obesity-related diseases. Biol Res Nurs 2007;8:223-33.
Martelletti P, Stirparo G, Giacovazzo M. Proin flammatory cytokines in cervicogenic headache. Funct Neurol 1999;14:159-62.
Liang X, Wang S, Qin G, Xie J, Tan G, Zhou J, et al
. Tyrosine phosphorylation of NR2B contributes to chronic migraines via increased expression of CGRP in rats. Biomed Res Int 2017;2017:7203458.
Recober A, Peterlin BL. Migraine and obesity: Moving beyond BMI. Future Neurol 2014;9:37-40.
Mohamed-Ali V, Pinkney JH, Coppack SW. Adipose tissue as an endocrine and paracrine organ. Int J Obes Relat Metab Disord 1998;22:1145-58.
Sachdev A, Marmura MJ. Metabolic syndrome and migraine. Front Neurol 2012;3:161.
Young WB, Rozen TD. Preventive treatment of migraine: Effect on weight. Cephalalgia 2005;25:1-1.
Horev A, Wirguin I, Lantsberg L, Ifergane G. A high incidence of migraine with aura among morbidly obese women. Headache 2005;45:936-8.
Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 2003;106:81-9.
Rossoni de Oliveira V, Camboim Rockett F, Castro K, da Silveira Perla A, Chaves ML, Schweigert Perry ID. Body mass index, abdominal obesity, body fat and migraine features in women. Nutr Hosp 2013;28:1115-20.
Ornello R, Ripa P, Pistoia F, Degan D, Tiseo C, Carolei A, et al
. Migraine and body mass index categories: A systematic review and meta-analysis of observational studies. J Headache Pain 2015;16:27.
Bigal ME, Tsang A, Loder E, Serrano D, Reed ML, Lipton RB. Body mass index and episodic headaches: A population-based study. Arch Intern Med 2007;167:1964-70.
Bigal ME, Lipton RB, Holland PR, Goadsby PJ. Obesity, migraine, and chronic migraine: Possible mechanisms of interaction. Neurology 2007;68:1851-61.
[Table 1], [Table 2]