Short-Term Changes in Migraine Burden After Roux-en-Y Gastric Bypass: A Prospective Cohort Study

Obesity has been associated with increased migraine frequency and disability, and bariatric surgery may reduce migraine burden. However, the relationship between postoperative weight loss magnitude and migraine improvement remains incompletely defined.

In this prospective single-arm before-after study, 52 adults with severe obesity and clinically established migraine underwent Roux-en-Y gastric bypass (RYGB). Migraine-related outcomes were assessed preoperatively and at 3 months postoperatively using the Migraine Disability Assessment (MIDAS), the Migraine-Specific Quality of Life Questionnaire (MSQ; raw summed score), migraine frequency, and pain severity measured by visual analog scale (VAS). Paired t-tests were used to compare pre- and postoperative outcomes. Associations between age, weight reduction, and changes in migraine outcomes were evaluated using Pearson correlation coefficients.

At 3 months, significant reductions were observed in body weight (- 28.9 kg; p < 0.001) and BMI (- 10.9 kg/m²; p < 0.001). Migraine frequency decreased from 15.4 ± 7.0 to 5.0 ± 5.6 episodes (p < 0.001), and pain severity decreased from 7.2 ± 1.4 to 3.7 ± 2.8 (p < 0.001). MIDAS scores declined from 94.0 ± 24.5 to 34.9 ± 35.9 (p < 0.001), with a marked shift toward lower disability grades. MSQ impairment scores decreased from 52.6 ± 9.1 to 31.2 ± 10.9 (p < 0.001), indicating improved migraine-related quality of life. Effect sizes were large across outcomes. Changes in migraine-related outcomes were strongly intercorrelated but were not significantly associated with age or the magnitude of weight loss.

Roux-en-Y gastric bypass was associated with substantial short-term reductions in migraine frequency, severity, disability, and quality-of-life impairment in adults with severe obesity. Improvements were not correlated with weight loss magnitude or age. These findings suggest that migraine burden may improve following metabolic surgery performed for standard obesity indications, while highlighting the need for controlled studies with longer follow-up.