PL-111 Roux-en-Y gastric bypass (RYGB) achieves substantial resolution of migraine headaches in the severely obese

Background: Migraine headaches (MH) are common and more severe in the morbidly obese. We analyzed the impact of RYGB on MH in the morbidly obese. Methods: We analyzed our database of 702 morbidly obese patients that underwent RYGB between 2000-09. We identified patients with physician-diagnosed MH actively on medication. Results: Data are Mean SEM (range). Out of 102 patients with preoperative MH, 21 were excluded due to short follow-up of less than 12 months, while the remaining 81 were followed-up for 38.6 3 (16-103) months. These 81 patients were 90% female and had BMI of 48 1 (37-85) kg/m and age 40 1 (18-62) years. Following significant surgical weight loss, clinical improvement of MH was seen in 89% of patients within 5.6 0.9 (1-36) months (p 0.00001; Chi-Sq test), with 57 reporting complete resolution and 15 reporting partial resolution (9 experienced no change). We then compared patients that developed MH after obesity onset (MHAO Group) to those who had MH before obesity onset (MHBO Group), where 6 patients were excluded as indeterminate. The MHAO Group had 51 patients where 48 showed clinical improvement (41 complete, 7 partial and 3 no resolution). The MHBO Group had 24 patients where 18 showed clinical improvement (11 complete, 7 partial and 6 no resolution). Interestingly, the MHAO Group showed a significantly greater rate of complete resolution of MH after RYGB compared to the MHBO Group (p 0.0057; Chi-Sq test). Conclusion: Weight loss following RYGB substantially resolves migraine headaches, especially when obesity onset precedes the development of migraine. Whether RYGB-induced endocrine alterations also contribute to improvement of migraine remains to be determined.