The Effect of Bariatric Surgery on Migraines: a Systematic Review and Meta-analysis

Introduction Recent research has demonstrated an association between obesity and migraine headaches. Furthermore, studies have demonstrated that migraine improvement can occur with significant weight loss. Given that bariatric surgery is the most effective intervention for obesity and obesity-related comorbidities, there is potential for bariatric surgery to improve migraine symptoms. The objective of this study was to conduct a systematic review and meta-analysis to determine the effect of bariatric surgery on migraine headaches. Methods A comprehensive literature search from database inception to December 2018 was conducted for studies examining the effect of bariatric surgery on migraines. Patients of all ages who had a history of migraines undergoing primary bariatric surgery were included. Primary outcomes included migraine frequency, severity, and disability. Results Four studies were included (n = 159). Frequency of migraines was markedly reduced after bariatric surgery, with fewer symptomatic days suffered by patients per month post-operatively (mean difference [MD] - 5.56 days, 95%CI 0.14 to 10.99, p = 0.04). The degree of migraine headache-related disability as measured by the Migraine Disability Assessment Scale (MIDAS) was also significantly lower following bariatric surgery (MD - 14.72, 95%CI 10.08 to 19.36, p < 0.001). The severity of migraine headache pain before and after surgery was reduced with borderline statistical significance (MD - 3.53, 95%CI - 0.12 to 7.17, p = 0.06). Conclusion Migraine severity, frequency, and headache-related disability were improved 6 months after bariatric surgery. However, this systematic review was limited by a low number of studies and larger high-quality, randomized trials are needed to determine the effect of bariatric surgery on migraine headaches.