Struggling with weight and migraine?
Have you been told that losing weight would improve your migraine, but don’t know where to start?
I hear you! As a registered dietitian with migraine, I know how complicated this topic can be. In this comprehensive article, I will explain how weight impacts migraine and help you understand the best path forward for you.
Let’s dive in!
What is migraine?
Migraine is a chronic neurological disease. It is a type of headache disorder, although not everyone with migraine experiences head pain.
People with migraine have “attacks”, which are a flare-up of symptoms possibly including head pain, light sensitivity, nausea, and many others. These attacks come in 4 phases: prodrome, aura, attack, and postdrome.
[Read more about the phases of a migraine attack]
Migraine attacks begin after being exposed to a trigger, which is an internal or external event that causes abnormal activity in the brain. Some common migraine triggers include:
- Weather changes
- Bright lights
- Strong smells
- Skipped meals
- Food sensitivities
- Hormonal changes
- Menstrual cycle
Migraine is treated from two angles: prevention and relief. A good migraine treatment plan will address both prevention and relief with a combination of medication and holistic strategies.
Weight and Migraine:
Now we’ll break down how to determine your weight status and how migraine and weight may be correlated.
Body Mass Index
The Body Mass Index (BMI) determines your weight category using a calculation based on your height and weight.
To calculate your BMI, follow one of the following formulas.
BMI = weight (kg) ÷ height (m)2
BMI = weight (lb) ÷ height (in)2 x 703
Example: If you weigh 150 lbs and are 5’8 (68 in), the calculation would be…
BMI = 150lbs ÷ 68in ÷ 68in x 703
Total BMI = 22.8
Body Mass Index Breakdown
- Underweight: <18.5
- Normal weight: 18.5-24.9
- Overweight: 25-29.9
- Obese: 30
Migraine’s Impact on Weight
The disability of living with migraine can make weight management difficult. It is frustrating but unsurprising that migraine may result in unwanted weight gain or weight loss.
The discomfort, fatigue, and pain of frequent attacks may impact both diet and exercise. It can be challenging (or impossible!) to find the energy to exercise and prepare nutritious meals.
It is also worth noting that many medications prescribed for migraine management may come with side effects of unwanted weight changes.
Weight’s Impact on Migraine
Weight may be correlated with the risk of migraine and severity of migraine, particularly in pre-menopausal women.
- With a BMI ≥ 30, or obese weight status, there is a 27% increased risk of migraine (1).
- With a BMI < 18.5, or underweight weight status, there is a 13% increased risk of migraine (1).
There is more data on the correlation between obesity and migraine. One of the possible mechanisms is the inflammation evident in both conditions.
Calcitonin gene-related peptide (CGRP) is an inflammatory marker with a known relationship to migraine. CGRP and other inflammatory markers are increased in people with excess body fat, which may exacerbate migraine (2).
Orexin-A is a neuropeptide (chemical messenger) that regulates appetite, wakefulness, and arousal. A deficiency of orexin-A may be seen in both women with obesity and when perceiving pain, which is relevant to migraine attacks (2).
Can weight loss improve migraine?
Weight loss has the potential to decrease or alleviate migraine.
Behavioral Weight Loss
A behavioral weight loss program results in a decrease in migraine attack frequency, duration, and severity (3). This program includes restricted calorie, low fat diet, regular home-based exercise, and behavioral modification.
While this method of weight loss results in migraine improvement, the amount of weight lost does not seem to impact results.
Weight Loss Surgery
Bariatric surgery is a group of procedures used for weight loss. To qualify for weight loss surgery, you may need to meet certain BMI and medical guidelines. This surgery is not a “quick fix” for weight loss, as it requires major permanent diet and lifestyle changes and comes with many risks.
People with migraine who undergo this surgery may have an alleviation in migraine even before significant weight is lost (4).
This method may alleviate migraine with even higher success than behavioral weight loss (4). This is thought to be related to the changes in hormones and appetite mediators that are impacted by the surgical procedure.
Can weight loss worsen migraine?
Weight loss has the potential to aggravate or worsen migraine.
Whether it’s keto, paleo, vegan, gluten-free, or an elimination diet like Whole 30, there are a variety of “fad” diets people pursue for weight loss.
(Psst! I’ve written an entire article about diets for migraine.)
Many diets limit calories or eliminate certain foods. This is bad news for people with migraine because when not meeting nutritional needs or when our diet is imbalanced, this will cause blood sugar fluctuations, which may trigger more migraine attacks.
Fasting is voluntary refraining from eating or drinking. Some people use fasting as part of their diet plan, but people with migraine should use caution.
Low blood sugar, dehydration, and caffeine withdrawal may all occur when fasting or skipping meals, which are known migraine triggers. In fact, over 85% of people with migraine report skipping meals or fasting as a known trigger (5).
Movement has many health benefits and is an important part of any weight loss efforts.
While regular, consistent exercise may be an excellent tool for migraine treatment and prevention, vigorous exercise may also be a migraine trigger (6). Exercise can be difficult for people with migraine because of it being a possible trigger or aggravating factor that worsen an attack.
How to safely lose weight:
The weight loss strategies described below are safe, effective, and dietitian-approved.
The “MyPlate” eating pattern is a strategy to create balanced eating habits. It is a graphic tool to use as a formula for each of your meals.
The features of the MyPlate are as follows:
- ½ of your plate – fruits and vegetables
- ¼ of your plate – grains or starchy vegetables
- ¼ of your plate – protein choices
- Move towards low-fat dairy options or choose a fortified substitute
- Limit added sugars, saturated fats, and sodium
[Learn more about MyPlate]
For each meal, you plug in your choice of foods for each food group, making this a versatile and individualized eating pattern.
Getting a balance of each food group will leave you feeling satiated and satisfied after each meal, aiding with weight loss. In this plan, you are also to fill half your plate with fruits and non-starchy vegetables, which are lower calorie options.
While restrictive diets can be difficult to follow, the MyPlate eating pattern encourages variety. This diet strategy is realistic and easy to maintain for all ages and lifestyles.
Being mindful of portion sizes when eating is an effective weight loss strategy. There are some simple but effective ways to decrease portion sizes to promote weight loss, without feeling deprived.
Mindful eating is a great way to naturally practice portion control. Make each meal or snack an experience of its own, reduce distractions like eating while driving or watching television. Fully appreciating and acknowledging the food you eat will bring more satisfaction and reduce excess intake.
Meals can be challenging because it can be easy to consume large portions when there’s an abundance of food. When cooking meals, prepare your plate for the meal and immediately pack up the leftovers to enjoy later. When dining out, portions are usually quite large, so you may be able to put half of the meal in a carry-out container or split a meal with a friend.
More strategies to practice portion control include:
- Use smaller plates and bowls
- Enjoy single-serving sized snacks
- Don’t eat out of large containers, place what you plan to eat in a separate container
- Eat slowly, fully chewing your food
- Keep a food diary
Movement has many health benefits and is an important part of any weight loss efforts. Regular, consistent exercise may be an excellent tool for migraine treatment and prevention (6).
Exercise can be difficult for people with migraine because of it being a possible trigger or aggravating factor that worsen an attack. This can make people with migraine hesitant to begin an exercise regimen.
To avoid triggering a migraine attack, consider the following:
- Stay hydrated
- Have a light snack before and after exercise
- If outside, protect yourself from the sun with sunglasses and hats
- Warm up and cool down each session
- Begin a routine of lower-intensity movement to build your tolerance
It’s also important to discover movement routines that can be adapted to how you’re feeling (or how intense your symptoms are) day-to-day. Something like walking, biking, swimming, dancing, or yoga can be modified for more symptomatic and painful days.
To promote health and weight loss, it isn’t all just diet and exercise!
Consistent sleep, especially 6-8 hours per night, will improve health overall and increase the likelihood of you sticking with behavioral changes to promote weight loss (7).
Some ways to get better sleep include:
- Reduce blue light in the evening (use glasses or filters if continuing to use electronics)
- Create a cool, dark, quiet sleeping environment
- Avoid caffeine in the afternoon or evening
- Keep a regular bedtime and waking time
- Establish a bedtime routine to help you wind down
Both sleep deprivation and stress cause people to prefer energy-dense (high-calorie) foods and boosts the positive emotional response to these foods (8). It is said that stress stacks the odds “against” people pursuing weight loss and that stress may be a barrier for weight loss (8).
Stress management is very personalized, everyone has different preferences. Some strategies to manage stress include:
- Talk with a professional or loved one
- Create art – draw, paint, apply makeup
- Engage in another hobby
Other approaches to improve migraine:
Feeling discouraged with the emphasis on weight loss?
You can still get the benefits of the healthy habits described earlier (and listed below) from a weight-neutral lens.
- Balance – follow the MyPlate for 3 meals per day and enjoy nutritious snacks
- Portion control – use mindful eating, minimizing distractions, to naturally control potions
- Gentle movement
- Consistent sleep
- Stress management
When establishing these habits, look for “non-scale victories” to stay motivated. Some ideas to look out for include:
- Increased energy
- Improved sleep
- Hitting a fitness goal
- Better lab values on blood tests
- Less migraine attacks
Migraine triggers are internal or external events that cause a migraine attack.
Common triggers include:
- Environmental changes – bright lights, loud sounds, storms
- Lifestyle changes – stress, exercise, irregular sleep
- Hormonal changes – PMS, pregnancy, menopause
- Diet changes – missed meals, dehydration
Through tracking your migraine attacks, you may discover your unique set of migraine triggers. You will start to notice trends like yawning as a prodrome symptom, irregular sleep as a consistent trigger, and more. This helps you know what to look for and what triggers you may be able to avoid.
[Read more about migraine tracking]
Simply learning more about your migraine can improve your migraine health! This is likely because increased knowledge may help you better manage migraine (3).
Migraine is a complex, personalized disease with a large variety of triggers, treatments, and reliefs. It’s exciting that learning some of the basics can improve outcomes. If you’re reading this, you’re already down this path!
Migraine is a disabling neurological disease, with symptoms that can make weight management difficult like extreme pain and fatigue.
Obesity and migraine appear to be correlated, both conditions aggravating each other.
Pursuing weight loss does improve migraine health, although some weight loss methods like fad diets and high intensity exercise may worsen migraine.
There are safe and effective ways to pursue weight loss including balanced meals, portion control, and gentle exercise.
However, focusing on weight-neutral healthy habits, trigger management, and migraine education can lead you to similar results in your migraine health.
Interested in pursuing weight loss to manage migraine? Apply for coaching with the Migraine Nutritionist.