Research from all parts of the globe—including Norway, Germany, Israel and the United States—confirms that lifestyle is a major player in not only the frequency of headaches but also in their severity and treatment. Physicians and researchers agree that factors such as sleep, diet, hydration, exercise, smoking and stress all play an important role. One major determinant for all populations is obesity, a medical condition in which a person has excess body fat.
The obesity problem is reaching epidemic proportions worldwide. But when most people think of obesity, they picture a sedentary adult population. In reality, this condition is taking its toll on children and adolescents, as well. According to the American Academy of Child and Adolescent psychiatry, between 16 and 33 percent of children and adolescents in the U.S. are obese, and this can have a significant impact on almost every aspect of their lives.
Obese children and adolescents have lower health-related quality of life (HRQoL) scores in physical, social and school domains when compared with children of normal weight. Overweight children are stereotyped as being unhealthy, academically unsuccessful, socially inept, unhygienic and lazy. They also tend to show symptoms of decreased self-esteem, sadness, loneliness, nervousness and high-risk behaviors.
In addition, this group is much more likely than their normal-weight counterparts to have headaches, according to Andrew M. Hershey, MD, phD, pediatric neurologist and director of the Headache Center at Cincinnati Children’s Hospital Medical Center. Although obesity does not cause headaches, it can increase headache frequency and the likelihood of disability in predisposed populations.
In a study published in the journal Headache, Dr. Hershey reported on data gathered from seven pediatric headache centers. The prevalence of overweight patients was similar in both the general and headache population. However, body mass index (BMI) percentile significantly correlated with headache frequency and disability. As the BMI percentile increased, headache frequency and disability increased. Lowered BMI was associated with a positive change in headache frequency at both the three- and six-month follow-up visit. This study and others have shown that weight loss can contribute to a reduction in headache over time.
So why do obese children have more headaches? We simply do not know. The mechanisms are unknown, and the effects of physiological and environmental factors are also unclear. But study after study has con- firmed the headache-obesity link.
In a 2008 study conducted in Israel and published in the journal Obesity, 16.5 percent of children were considered at risk for being overweight and 41 percent were overweight. In these groups, researchers found that females had an almost four-fold risk of headaches compared with girls of normal weight.
A comprehensive 2010 study of 6,000 teens in Norway, which was led by John Anker-Zwart, MD, of Oslo University and published in the journal Neurology, analyzed negative factors associated with increased risk of headache. These included obesity, smoking and lack of exercise. Both separately and collectively, these factors increased the frequency of headaches. However, it was not clear if negative lifestyle factors caused the headaches or simply triggered them in an already vulnerable population.
Although certain medical disorders can lead to weight problems in children and adolescents, these conditions account for less than 1 percent of all cases of obesity. The main cause is making poor lifestyle choices. To help keep childhood obesity in check, intervention programs should be aimed at both parents and children.
It’s important to focus on modifiable factors. Children and adolescents should be encouraged to eat regular, well-balanced meals, and they should never skip breakfast. They also should get at least eight hours of sleep each night, maintain good hydration and exercise for at least one hour at a time, three to four times per week.
If kids are prescribed preventive headache medications, it’s important to avoid medicines that increase appetite and promote weight gain. Some medications, such as Topamax, have actually been shown to decrease appetite and weight.
For young people who are overweight, BMI should be discussed at the initial doctor visit, and educational intervention should be initiated immediately. Such efforts to improve the management of obesity in children and adolescents will improve not only headache control but also emotional and academic well-being.
Tips for Controlling Weight
The following tips from the American Academy of Pediatrics can positively impact weight in children and adolescents:
- Eat five fruits and vegetables every day.
- Get one hour of physical activity per day.
- Limit TV and computer time to fewer than two hours per day.
- Limit consumption of sugar-sweetened beverages.
- Eat breakfast daily.
- Switch to low-fat dairy products.
- Eat family meals together.
- Limit fast food, takeout and eating out.
- Eat a calcium-rich, high-fiber diet.
