Weight Loss Decreases Headache Frequency in Children

BY ALICIA AULT
Elsevier Global Medical News

CHICAGO (EGMN) - Children with a higher body mass index who also suffer from headache appear to have a greater degree of improvement when they lose weight, said Dr. Andrew D. Hershey on June 8 at the annual meeting of the American Headache Society.

Dr. Hershey, director of the Headache Center at the Cincinnati Children's Hospital Medical Center, presented data from one component of a multicenter study being conducted by the society's Pediatric-Adolescent Headache section.

In the first stage of the study, reported in a poster at last year's meeting, researchers looked at 466 consecutive patients at seven centers around the United States and found that headache occurred more frequently in children who were obese than in those who were not. The second stage of the study aimed to determine if weight loss had any effect on headache frequency and disability.

The same centers looked at 913 consecutive patients (including the 466 in the first stage), evaluating them for height, weight, age, gender, body mass index (BMI) and BMI percentile, and for disability, using the Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire. BMI percentile, instead of BMI alone, is used in children to address the changes in BMI with growth, said Dr. Hershey.

A BMI percentile of 6-85 is considered healthy, 85-95 is at risk of obesity, and above 95 is obese. Among the 913 children evaluated, 20% (182 children) were considered obese and 37% (337) were considered at risk. As a component of their headache management plan, physicians discussed nutrition, healthy food choices, and exercise with patients and their parents. They did not specifically tell children to lose weight, said Dr. Hershey.

The children were assessed for headache frequency and disability at 3 and 6 months.

At baseline, the mean age was 12 years, the mean weight was 50 kg, and the mean height was 150 cm. The mean BMI was 21 kg/m2 and the mean BMI percentile was 64. The mean headache frequency was 13/month and the mean PedMIDAS score was 34.

At 3 months, 214 of the 913 children were evaluable; 15% were obese (31 patients). Slightly more than 100 children of the 214 lost weight. Dr. Hershey said that the children were obese or at risk of obesity but who had lost weight had a greater improvement in headache frequency and disability, compared with the group as a whole, but even more so than those who gained weight. Obese children who gained weight had an increase in headache frequency.

At 6 months, 174 children were evaluable and 16% were still obese; however, more than half had lost weight. Children who had lost weight had a greater reduction in headache frequency and a greater improvement in disability.

Dr. Hershey and his colleagues concluded that obese children with migraine have increase disability but that reductions in weight can decrease both headache frequency and disability. That argues for clinicians to increase nutritional and healthy lifestyle counseling when talking with pediatric patients, he said.

This study was sponsored by a grant from the American Headache Society. Dr. Hershey has advised pharmaceutical companies in the past, but this study was independent of pharmaceutical support, he disclosed.

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