Obesity and Anxiety Roles in Headache Treatment

Regarding Obesity and Headaches

Over the last thirty years there has been an observation that there are more obese people with bad headaches than obese people in the general population.  The cause and effect has not been so clear. Some studies have contradicted others.

The questions raised (but are yet unanswered):

  1. Are people more obese because they are in pain and can’t be as active as others?
  2. Does being obese make headaches worse?
  3. Do medications to prevent headaches make people more obese?
  4. Is there something about the genetics of headache disorders that makes someone have the tendency of obesity? The truth is probably a mixture of factors.

A new study is underway to look at weight loss as a migraine treatment. This is the first study of its kind has been done.  The results will not be known until sometime in 2016.

Anxiety and Headaches

The chances of having an anxiety disorder and bad headaches is much higher than anxiety in the general population. Somewhere between 51% and 58% of patients with migraine have significant anxiety problems.  Once again we don’t know the causal relationship between the two.

It is possible that anxiety disorders leads to having headaches (unlikely). It is more likely that anxiety and migraine are two faces of a similar genetic, complex, neurological disorder where all the senses are heightened. It is also possible that having frequent headaches, especially if they start at an early age, makes someone more anxious.

The one thing we do know is having a significant anxiety disorder greatly complicates headache treatment and makes it less-likely the patient can get better unless they address the underlying anxiety first.  The reason for that is multi-factorial. I will discuss some of the complexities that anxiety brings to headache treatment.

1) The anxious patient is far more likely to believe that they suffer from some-yet-discovered dreadful disease.  They have multiple tests done including many head scans. So rather on focusing on things that we know work to help them get better, they go from rabbit hole to rabbit hole “looking for the cause,”  with the expectation that once the cause is found it can be cured. It is really hard for them to accept that they have migraine . . . common, yes, but can be a dreadful disease in its own right.

2) The anxious patient is far more likely to have pharmacophobia.  This is the irrational fear of medications. While we try all means to mitigate the effects of headache disorders, diet, exercise, massage, acupuncture and the others, there is no question that medications work the best. This only makes sense because medications are real and the only thing (despite what popular marketing cliches say) that works at the root of the cause of headaches.

The anxious patient fears medications to the point that they won’t even try to take them. If they do, they fear side effects and will stopped them at the fist sign of side effects, either real or perceived.  It takes at least three weeks of being on a therapeutic dose of a medication before it can work.  We usually start with baby, sub-therapeutic doses to try and limit side effects.  So if these small doses are stopped, the patient never has the chance to get better.

Of course side effects can be real, but in the vast majority of cases they are mild and will go away in time even if you stay on the medication. In my 35 years of headache work and prescribing a lot of medications, I can’t remember any serious side effects.  I do know of countless patients whose lives were totally ruined by headaches because they refused treatment.  That’s what the sufferer should really fear. I also know many who overused pain killers to the point they have overdosed from them. Pain killers, when used too often, can make the headaches worse and you can die from an overdose.  Oddly, many people who fear the good preventative medications, don’t fear the really dangerous pain killers . . . or no treatment at all.