Obesity in children and adolescents is a significant public health problem at the current time. Data from 2003 to 2006 demonstrated that 16.3% of children and adolescents had a body mass index at or above 95% for age, fulfilling criteria for overweight (≥95th percentile).1
According to recent epidemiologic studies, 31.1% of adult men and 33.2% of adult women fulfill criteria for obesity.2
Rates appear to be increasing over time, with poor dietary choices and an increasing sedentary lifestyle playing a significant role. Obesity has been linked to numerous other medical conditions in the pediatric and adult populations, including psychologic issues, hypertension, diabetes mellitus, sleep issues, benign intracranial hypertension, and secondarily increased long-term risk of cerebrovascular and cardiovascular disease.3–5
In the adult headache population, obesity appears to be a risk factor for transformation from episodic to chronic migraine headaches.6
This correlation has not been noted between obesity and chronic tension-type headache in adults. Increased body mass index has been noted to negatively affect migraine frequency in adults with episodic migraine.7
One small study reported greater comorbidity between obesity and migraine with aura, specifically in women.
Information regarding effects of obesity and pediatric headache are more limited. A study by Hershey et al8
found a positive correlation between body mass index and headache frequency and disability, evaluating children and adolescents 3 to 18 years of age enrolled from 7 outpatient pediatric headache clinics. Overall, prevalence of obesity was 17.1%, which is similar to population norms (17.5%), but as body mass index percentile increased, so did headache frequency and disability. The population-based norms referenced in this study date from a 2006 study that included older data than population-based norms referenced in our study. Weight loss appeared to improve headache frequency and disability over time.
A bidirectional relationship was noted with a recent study by Pinhas-Hamiel et al.9
They noted an almost 4-fold excess risk of headaches was present in girls being followed at a pediatric obesity clinic compared to non-overweight population-based controls. This relationship was not noted in boys. In their prospective study, 7.7% of normal-weight girls had headaches compared to 20.3% of overweight girls. Blood pressure elevation was not independently related to headaches.
The relationship between chronic daily headache and obesity in children and adolescents has not been well delineated. In particular, the relationship between chronic daily headache with medication overuse and child/adolescent obesity has not been evaluated. To address these issues, we retrospectively studied headache patients from our multidisciplinary headache clinic evaluating body mass index and headache type diagnosed according to International Classification of Headache Disorders–Second Edition
criteria, comparing the incidence of obesity within our headache patients and population-based norms. Patients with medication overuse associated with chronic daily headache can be inherently difficult to manage. To fulfill the revised International Classification of Headache Disorders–Second Edition criteria for medication overuse headache, these individuals medicate their chronic daily headache with simple or combination analgesics equal to or greater than 15 days per month for at least 3 months or use triptans, opioids, or ergot combination analgesics equal to or greater than 10 days per month for 3 months.10