WebMD Health News
Louise Chang, MD
June 15, 2011 -- Weight loss surgery can reduce or eliminate migraine headaches and reduce the risk of heart attack and stroke, according to new research.
Both studies were presented at the annual meeting of the American Society for Metabolic & Bariatric Surgery in Orlando.
''In the morbidly obese patient, there is a very good chance their migraine headache can improve or totally go away if you do a gastric bypass for their morbid obesity," says researcher Isaac Samuel, MD, associate professor of surgery at the University of Iowa Carver College of Medicine, Iowa City.
''Bariatric surgery has been shown to reduce the risk of heart attack, stroke or death by 25% to 50% compared to other surgical patients,'' says researcher John David Scott, MD, assistant professor of surgery at Greenville Hospital System University Medical Center in Greenville, S.C.
More than 15 million Americans are classified as morbidly obese. Either they have a body mass index (BMI) of 40 or above or a BMI of 35 or higher with an obesity-related disease such as type 2 diabetes.
About 220,000 bariatric surgeries are performed each year in the U.S., according to Society estimates. The cost is $11,500 to $26,000.
The link between obesity and migraines is debated, says Samuel.
Experts agree that obesity increases the severity and incidence of migraine, he says. "What they do not agree on is whether there is an increased risk of migraine in the obese population."
In his study, he looked at 81 patients, mostly women, with an average BMI of 48. Their average age was 40.
"All were on medications [for migraine]," he tells WebMD.
He separated the 81 people into two groups, according to when their migraines started. After excluding six due to unknown status, he evaluated 51 whose migraines developed after their obesity and 24 whose migraines occurred before their obesity. He followed the people for up to 8.5 years.
Of the 51 who developed migraines after obesity, 48 showed improvement after the surgery. Forty-one of these no longer had migraines.
Of the 24 who developed migraines before their obesity, 18 had improvement, including 11 who got rid of the migraines.
''If your migraine onset was after your obesity, the chances of total resolution are much higher," he tells WebMD.
Why the surgery reduces or wipes out the migraines is not known, he says.
He speculates that hormonal changes from the surgery could explain it.
Scott and his colleagues evaluated 9,140 patients to look at cardiovascular benefits. Of these, 4,747 had bariatric surgery, 3,066 had orthopedic surgery, and 1,327 had gastrointestinal surgery. Their ages were 40 to 79.
Other studies have compared gastric bypass patients with those who are also obese but did not have surgery. Scott says comparing bariatric surgery patients to other surgery patients removes some bias.
His study differs from others finding cardiovascular benefits in another way. "We looked at actual events -- heart attacks and stroke." Other studies have looked at risk factors such as high cholesterol, he says.
After five years, 84.8% of the weight loss surgery patients had survived without having a heart attack or stroke, while 72.8% of the orthopedic surgery patients did and 65.8% of the GI surgery patients.
Those who had weight loss surgery had a 28% risk reduction in heart attack, stroke, and death compared to those who had orthopedic surgery. The weight loss patients had a 52% reduced risk of heart attack, stroke, and death when compared to the GI surgery group.
The information is valuable for those pondering weight loss surgery, Scott tells WebMD.
''Bariatric surgery is not to be taken lightly," he says. Adding this new information to existing information should help in decision making, he says.
Among the risks of the surgery are vitamin and mineral deficiencies, dehydration, gallstones, and death.
Scott reports receiving speakers' fees from W.L. Gore & Associates, a medical materials manufacturer. He reports funding from Ethicon Endo-Surgery, which makes a gastric band for weight loss surgery.
The heart benefits found in the new study are ''not a huge surprise," says Richard Atkinson, MD, an obesity expert and clinical professor of pathology at Virginia Commonwealth University.
He notes that the difference in survival between groups is ''quite significant."
"It's a valuable study and it yet again shows the benefit of having significant weight loss after bariatric surgery [on death and heart attack and stroke]," he says.
Much less is known about how the surgery affects migraines, Atkinson says. "This is not an area that has been studied extensively."
The new findings, he says, "may provide clues to migraine's origins and what to do about them."
The migraine study results reflect what doctors hear from their patients after performing weight loss surgery, says Bruce Wolfe, MD, president of the American Society for Bariatric & Metabolic Surgery and professor at Oregon Health and Science University, Portland.
This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES:American Society for Metabolic & Bariatric Surgery annual meeting, Orlando, Fla., June 12-17, 2011.Isaac Samuel, MD, associate professor of surgery, University of Iowa Carver College of Medicine, Iowa City.Richard Atkinson, MD, clinical professor of pathology, Virginia Commonwealth University.John David Scott, MD, assistant professor of surgery, Greenville Hospital System University Medical Center, Greenville, S.C.Bruce Wolfe, MD, professor of surgery, Oregon Health & Science University, Portland; president, American Society for Metabolic & Bariatric Surgery.
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