Table 2.
Treatment of headache disorders with regard to weight, diet, and activity
| Author (y) | Study design (database) | Sample population | HA sample size | TX | Race and sex | Mean age (range) | HA Dx | BMI | Findings | Notes |
|---|---|---|---|---|---|---|---|---|---|---|
| [32•] | Retro, long, multi-center, clin trial (Compared with GP Historical Data) |
Source: 1.7 U.S. Ped HA Clinics 2. Historical NHANES Data Size: Initial: 913 3 mo: 213 6 mo: 174 BMI≤5th%: 20 BMI≥5th - <85th%: 580 BMI≥85th - <95th%: 152 BMI≥95th%: 160 |
Total Any HA: 913 Total EM: MO: 645 MA: 146 Total p-M: 40 Total TTH: 38 Total CDH: CM: 204 CTTH: 8 |
Discussed nutrition, dietary behaviors, obesity, weight management options at initial and follow-up visits | White: 85 % Black: 13 % Asian: 1 % Hisp: <1 % F: 60 % |
11.9 (3–18) | ICHD-2 | M-BMI | The>the reduction in raw BMI, the>the reduction in HA frequency (r=0.32, P=0.1). In those who were not overweight to begin the trial, there was no association between HA frequency and BMI change (P >0.05. Change in raw BMI did not correlate with change in disability as noted through PedMIDAS scores. |
Obesity prevalence in HA patients were compared with historically reported obesity prevalence rates in general population data from NHANES. Patients were allowed to use preventive medications. Specific diets not addressed. Activity not assessed directly. |
| [42] | Pro, long, clin trial | Source: U.S. Ped Neuro Clinic Size: Initial: 8 3 mo: 3 |
Total HA participants (Any HA Type): 8 CDH: 8 |
Mod Atkins (high fat and low carb diet) Restricted to 15 g of carb/day No calorie or fluid restriction |
Race: NR F: 62 % |
14.9 (13–16) | ICHD-2 | M-BMI | The 3 participants that completed the trial showed weight loss (1.4, 3.8, 8.2 kg, respectively) and reduction in PedMIDAS scores (97, 35, 50 point reduction). All 3 continued to meet criteria for CDH and ultimately required pharmacologic intervention. |
Participants had failed at least 2 prophylactic drug trials. Excluded those who had previously tried Atkins diet, pregnant, significant heart or kidney disease, hypercholesterolemia, BMI <18, use of abortive treatments >11 d/last mo. |
| [45] | Pro, CS–GP | Source: 10th and 11th grade students in 11 schools in Germany Total: 1260 |
Total HA participants (Any HA Type): 1047 Mig: 129 TTH: 614 Mig+TTH: 249 Unknown: 55 |
Self-administrated questionnaires to address lifestyle factors including activity level Activity classified as low, moderate, or high |
Race: NR F: 53 % |
NR (14–20) | ICHD-2 | NR | The odds of HA disorder were increased in those with low physical activity compared with those with high physical activity as follows: 1. All HA: OR 2.0; 95 % CI: 1.3–3.1 2.Mig: OR: 4.2; 95 % CI: 2.2–7.9 3.TTH: OR 1.7; 95 % CI: 1.1–2.7 4.Mig+TTH: OR 2.2; 95 % CI:1.3–3.7 |
Physical activity based on questions assessing frequency, duration, and intensity. BMI not obtained; did not address overweight or obesity. |
| [33••] | Pro, CS–GP | Source: Junior High and High Schools in Norway Total: 5588 Total Overweight and Obese Participants: Male: 421 Female: 470 |
Total HA participants (Any HA Type): 1591 M: 554 F: 1047 Total Mig:392 M: 126 F: 266 Total TTH:950 M: 320 F: 630 |
Evaluation of physical activity using a self-admin questionnaire. <2 times / wk=low Physical activity | White: 98 % Other: 2 % F: 52 % |
NR (13–18) | ICHD-2 | M-BMI | Recurrent HA in both girls and boys were found to be associated with inactivity (girls OR 1.2, 95 % CI: 1.0–1.4, P=0.05, boys OR 1.3; 95 % CI: 1.1–1.7, P=0.006). Association between migraine and inactivity (adj for age, sex, smoking, and overweight) (OR 1.5; 95 % CI: 1.0–2.2, P=0.09). Association between TTH and inactivity (OR 1.2; 95 % CI: 1.0–1.4, P=0.02). |
Participants not reported to be excluded based on medication use. HA frequency NR. Diet and weight loss not addressed specifically. |
| [43•] | Pro, long multicenter, clin trial | Source: 6 Italian Ped Neurology Clinics Size: Initial: 150 12mo: 135 BMI≥97th%: 135 |
Total HA participants (Any HA Type): 135 Mig participants: 135 |
Dietary education/balanced diet physical training (aerobic exercise), and behavioral treatment | White: 100 % F: 58 % |
15.9 (14–18) | ICHD-2 | M-BMI | BMI: Initial: 32.9±4.6 6 mo: 30.5±5.1 12 mo: 29.9±6.0 P<0.01 vs initial HA frequency: Initial: 5.3±2.1 6 mo: 2.4±1.1 12 mo: 2.2±0.9 P <0.01 vs initial HA intensity (10 pt): Initial: 7.4±1.7 6 mo: 3.9±2.1 12 mo: 4.2±2.5 P <0.01 vs initial Lowered BMI was associated with better migraine outcomes 1 yr later. Change in BMI over 1 yr was correlated with decreased HA frequency intensity, and disability as measured with PedMIDAS. |
Excluded those with baseline endocrine disorders, eating disorders, or taking any medications. Physical activity: 60 min of moderate-intensity most days of the wk, preferably daily. Diet: good nutrition with the lowest energy intake; reduce calorie intake by 15 %–20 % below daily calorie maintenance; increase in fiber; decrease high-fat foods and sweetened fruit drinks. |
Notes:
Admin administrated, BMI body mass index, carb carbohydrate, CDH chronic daily headache, Clin clinical, CM chronic migraine, CS cross-sectional, CTTH chronic tension type headache, Dx diagnosis, EM episodic migraine, F female, GP general population, HA headache, Hisp Hispanic, ICHD-2 international classification headache disorders 2, Long longitudinal, m measured, MA migraine with aura, Mig migraine, MO migraine without aura, mo month, mod modified, NR not reported, p probable, Ped pediatric, Pro prospective, pt point, Retro retrospective, TTH tension-type headache, TX treatment, U.S. United States