Effect of Bariatric Surgery on Migraine Headache: A Systematic Review and Meta-Analysis

Migraine is a common, disabling neurological disorder, and obesity has been associated with an increased frequency of migraine, chronicity, and severity. Bariatric surgery is the most effective treatment for substantial weight loss in morbidly obese patients. We conducted a systematic review and meta-analysis (per PRISMA 2020 guidelines; registered in PROSPERO (CRD420251175413)) to assess whether bariatric procedures influence migraine frequency and severity in patients with obesity.

We searched PubMed, Scopus, and Embase for studies on obese patients with a history of migraine who underwent bariatric surgery (including sleeve gastrectomy, Roux-en-Y gastric bypass, or gastric banding) and reported pre- and postoperative migraine outcomes. Six studies (n=1899 patients) met the inclusion criteria. Data on migraine frequency, intensity, and disability before and after the surgery were extracted. Outcomes were pooled using a random-effects meta-analysis, and study quality was assessed using the Newcastle-Ottawa scale.

Across the six included studies (n=1899), a variety of bariatric procedures were performed (sleeve gastrectomy, Roux-en-Y bypass, and gastric banding). The pooled results showed a consistent and significant reduction in migraine frequency following surgery. All pooled effect estimates favored the postoperative state, indicating fewer monthly headache days after weight loss surgery. Individual studies have also reported a reduction in migraine pain severity and disability after surgery. The magnitude of headache improvement was correlated with weight loss. Mechanistic insights suggested that postoperative weight loss led to hormonal changes (e.g., lowered calcitonin gene-related peptide levels) and reductions in pro-inflammatory cytokines (such as IL-6 and TNF-α), all of which may contribute to the observed migraine relief.

This systematic review indicates that bariatric surgery substantially reduces migraine frequency and severity in obese patients. Migraine improvement likely arises from the multifactorial effects of massive weight loss, including neuroendocrine modulation and decreased systemic inflammation, rather than bariatric surgery per se. Given the high comorbidity between obesity and migraine, weight-loss surgery should be considered as a therapeutic option to alleviate the migraine burden in obese individuals.