A Retrospective Analysis of the Impact of Bariatric Surgery on the Management of Chronic Migraine.

ABSTRACT

PURPOSE: To investigate the association of the two most common bariatric surgical procedures, vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB), with sustained remission from chronic migraine. MATERIALS AND METHODS: Using IBM MarketScan® research database to examine inpatient and pharmacy claims from 2010 through 2017. A cohort of bariatric patients with chronic migraine was created using inclusion and exclusion criteria. Remission was defined as no refill of first-line migraine medication for 180 days after a patients' medication was expected to run out, and recurrence as medication refill after at least 180 days of remission. RESULTS: Of 1680 patients in our cohort, 931 (55.4%) experienced remission of migraine. Of these, 462 (49.6%) had undergone VSG, while 469 (50.4%) had undergone RYGB. Patients who underwent RYGB had an 11% (RR = 1.11, 95% CI 1.05, 1.17) increase in likelihood of remission of migraine and a 20% (RR = 0.80, 95% CI 0.63, 1.04) decrease in likelihood of recurrence of migraine compared to patients who underwent VSG. Older age group, higher number of medications at time of surgery, and female sex were associated with a decreased likelihood of remission. CONCLUSION: Type of bariatric procedure, age, number of medications at surgery, and sex were the most important predictors of migraine remission after surgery.