CHICAGO — Patients who gain at least 5% of body weight while taking prophylactic migraine medications experienced changes in clinical markers that could indicate increased risk of cardiovascular disease, said Dr. Marcelo Bigal at the annual meeting of the American Headache Society.
“Given that migraine and being overweight or obese are independent risk factors for cardiovascular disease, and obesity is a risk factor for migraine transformation and greater pain during migraine attacks, weight gain—including that associated with medical treatment—may have particularly important health implications in migraine patients,” said Dr. Bigal, of the Albert Einstein College of Medicine, New York.
He and his colleagues compared weight change with clinical markers of cardiovascular disease risk and headache treatment response in migraineurs participating in a large trial of topiramate and amitriptyline for migraine prophylaxis. The 331 patients were randomized to either topiramate 100 mg/day or amitriptyline 100 mg/day for 26 weeks. Most of the patients (67%) stayed at a steady weight. Weight gain occurred in 16% and weight loss in 17%. Most of those who lost weight (91%) were taking topiramate, and most of those who gained weight (87%) were taking amitriptyline.
There were no significant differences in medication response by weight change category. Patients with weight gain and loss had similar reductions in the mean frequency of monthly migraine episodes (−2.7 vs. −3.0).
However, weight change did influence the clinical markers of cardiovascular disease risk. Those who gained weight experienced significant elevations in mean diastolic blood pressure, glucose levels, heart rate, total cholesterol, and LDL cholesterol, compared with those who lost weight.
Patients who gained weight also had increases in their levels of C-reactive protein (CRP), gaining a mean of 1.8 mg/L. Patients who lost weight had a decline in CRP of 1.9 mg/L. Although the difference was not statistically significant, Dr. Bigal noted, it may be clinically meaningful. “CRP values of less than 1 mg/L predict low cardiovascular risk, values of 1–3 mg/L predict average risk, and values greater than 3 mg/L predict high risk [according to Centers for Disease Control and Prevention and the American Heart Association]. Given that migraine is itself is a risk factor for cardiovascular disease, weight gain in migraine patients may have particularly important health implications.”
The study was sponsored by Ortho-McNeil Janssen Scientific Affairs L.L.C. Dr. Bigal is a consultant for the company.