Your patient may not know it, for those with obesity, headaches can be a result. It is essential to acknowledge the established medical associations between these conditions and to engage in the discussion with appropriate sensitivity.

Physiologic Link Between Weight and Headaches

From a clinical standpoint excess weight is a contributing factor to headaches.

“Fat is proinflammatory. The more you have, the more inflamed your brain gets,” said Jack Gladstein, MD, a professor of pediatrics and neurology at the University of Maryland School of Medicine, and the director of the Pediatric Headache Clinic at the University of Maryland Medical Center, both in Baltimore. “Losing weight helps lower your headache burden by decreasing inflammation. It also allows one to exercise, which is an important part of a headache treatment plan.”

How Occasional Headaches Differ From Chronic Headaches

When discussing headaches with your patients it’s helpful to discuss symptoms, frequency, and possible triggers.

Mild headaches that do not usually interfere with activities and do not have those signs are tension-type headaches, said Gladstein.

“They usually respond to over-the-counter medications, and people are not too bothered by them,” he said. It’s beneficial to note that studies cite how “little is known about the specific environmental or behavioral interactions that might trigger an attack in a prone individual,” however, research reveals that triggers range from foods, activities, behaviors, environmental conditions and many other causes.

Your patients may be able to take note of the specific activities that may trigger a headache, but obesity is likely not the cause of headaches that aren’t chronic, he said. “Occasional headaches are not caused by obesity,” said Gladstein. “Obesity makes headaches harder to treat and may give you more headaches. It doesn’t cause the headaches.”

Explaining Migraine Headaches to Patients

Migraine is defined as a severe headache with autonomic sign — nausea, vomiting, and light or sound sensitivity, said Gladstein.

“Migraines are an inherited disorder that gets better and worse depending on multiple factors,” he said. “One of the factors that increases your migraine burden is obesity. It is one of the modifiable things someone can do to manage their headache issue.”

The other factors are regular hydration, sleep, exercise, and meals.

Migraine headaches and idiopathic intracranial hypertension (IIH), are strongly associated to obesity through several mechanisms, said Cate Varney, DO, obesity medicine director, UVA Health, and an associate professor, University of Virginia School of Medicine in Charlottesville, Virginia.

First, she said, obesity creates a chronic low-grade inflammatory state.

“Adipose tissue isn’t benign, it releases inflammatory molecules that can make patients more susceptible to more frequent and intense headaches,” said Varney. “Additionally, obesity increases the risk of elevated intracranial pressure which can directly contribute to headaches.”

Headache specialists often recommend weight loss as part of the overall treatment plan for those with IIH, she said.

When talking to patients with obesity, remain nonjudgmental, recognize the difficulty of changing habits, and offer support, said Gladstein.

As you provide directives and information to your patients, keep in mind how each person with migraines has a different burden — frequency, severity, disability. “That burden decreases as one loses weight as an independent risk factor. Reasons may include less inflammation, more exercise, better eating choices, better self-image,” he said.

A Pharmaceutical Approach

Given that weight loss often takes months, a primary care provider could consider starting medication therapy that addresses both weight and headache control, said Varney.

The FDA-approved combination phentermine/topiramate (Qsymia), can yield around 8%-10% average weight loss when used with diet changes and exercise, Varney said. Topiramate alone, although not officially indicated for weight management, can support weight loss and has demonstrated effectiveness in reducing migraine frequency, especially in patients with chronic or episodic migraine.

Varney reported being an Eli Lilly advisory board member and speaker. Gladstein reported having no disclosures.