Association of migraine severity and disability with body mass index.
Objectives: To explore the association of migraine severity and disability with body mass index. Study Design: Cross sectional study. Setting: Department of Medicine and Physiology of Indus Medical College, Tando Muhammad Khan. Period: August 2018 and March 2019. Material & Methods: It included all patients both female and male diagnosed with migraine of age group 18-55 years. Diagnosis of migraine was done according to the guidelines by international headache society. Approval was taken from the ethical review committee of the Institute. Severity of migraine was evaluated according to MIDAS questionnaire obesity was determined from Body mass index (BMI). Patients were divided into four groups according to various body mass index categories as per the revised guidelines into underweight: m2, Overweight: 23.0-24.9 kg/m2, Obesity: >25 kg/ m2. Clinical features of migraine were compared in these groups. The collected data was analyzed in SPSS version 18.00. Results: A total 189 (n=189) participants recruited in this study, meeting selection criteria were included. Out of 189, 73 presented with aura while 116 presented without aura. So the study population divided into two groups one wit aura (n=73) and other without aura (n=116). The overall mean age + SD (range) was 28.80+ 8.54(18 to 48 years). There was no significant difference of age (compare means) between male and female subjects (p value = 0.99). The study participants (n=189) divided into two types, first migraine with Aura n=73 (38.62%) and second Migraine without aura n=116 (61.36%). Mean±SD of MIDAS score, waist hip ratio, age of onset of headache (in years), frequency of headache per month and the duration of headache (in hours), of the study participants were 12.18+4.48, 0.87+.066, 18.89+2.97, 10.93+2.70 and 67.32+12.52 respectively. Mean±SD of MIDAS Score among the miranieuers without aura (n=116) was 12.18±4.48 but among the patients who presented with aura (n=73), it was 16.39±6.39. (P value<0.01) that presents statistically significant association of the type of migraine with MIDAS score. Out of 189 migraine patients (n=189), 30(15.87%) were with normal BMI, 11(5.82%) were underweight, 111(58.73%) were overweight and remaining 37(19.58%) were obese. Mean of the MIDAS score among normal BMI (n=30), underweight (n=11), overweight (n=111) and obese (n=37), when compared by applying ANOVA test; MIDAS score among these four groups were 11.43, 11.18, 10.81 and 17.18 respectively. (f value 27.3 and p value 0.001). That reveals the significant disability and disturbed quality of life among the migraineurs who are overweight and obese. Similarly, when mean ±SD of the duration of headache (in hours) compared among normal BMI (n=30), underweight (n=11), overweight (n=111) and obese (n=37), it was 66.06±10.70, 58.9091±15.62, 66.64±9.01 and 72.86±18.82 respectively. (p value 0.004 and f value 4.52) that is statistically significant. Duration of headache he was more among obese migraine patients. When Body mass index evaluated according to type of migraine, among the migraine patients without aura (n=116), 18 (60%) were of normal BMI, 8(72.7%) of underweight BMI, 89(80.2%) were overweight and 1 (2.7%) was obese. Instead, among the migraine patients with aura, 12(40.0%) were of normal BMI, 3(27.3%) of underweight, 22(19.8%) were overweight and 36(97.3%) were obese. P value <0.001 with Pearson chi aquare value 70.910a When MIDAS grade compared among the patients with aura (n=116) and without aura (n=37) there was significant difference of MIDAS grade between these two groups. (p value 0.005) Waist hip ratio was more among the patients of migraine with aura when compared with the patients without aura. (P value <0.01). Conclusion: This study demonstrates that there is strong positive association between the severity and disability due to migraine with increase in body nass index. Future research is required to fill the gap to explore the pathophysiologic mechanisms beside this association.