Could Bariatric Surgery Lead to Severe Headaches?
New research suggests bariatric surgery may be a risk factor for a condition that causes severe headaches.
In a small percentage of people, gastric bypass surgery and gastric banding surgery were associated with a greater risk of later developing spontaneous intracranial hypotension, according to the new study in Neurology.
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“Spontaneous intracranial hypotension is an important and treatable cause of headaches, usually seen in young and middle-aged adults,” says lead study author Wouter I. Schievink, MD, Director of the Microvascular Neurosurgery Program in the Department of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles. “The typical patient is tall and lanky, often with joint hypermobility, and with this research, we have shown that bariatric surgery appears to be a risk factor as well.”
During a 10-year period of study, Schievink and his colleagues evaluated the link between bariatric surgery and spontaneous intracranial hypotension by comparing a group of 338 people with the condition to a control group of 245 people with unruptured intracranial aneurysms.
Of the 338 participants with spontaneous intracranial hypotension, 11 (3.3%) had undergone bariatric surgery before the onset of the condition, compared to just 2 (0.8%) of the 245 people in the control group.
Spontaneous intracranial hypotension is often caused by a leak of cerebrospinal fluid from the spinal canal. “Patients with new headaches after bariatric surgery should be asked about positional features, as the typical headaches [associated with spontaneous intracranial hypotension] are much worse when upright,” Schievink says.
That’s because the leak leads to low spinal fluid pressure, triggering sudden headaches in the upright position that are relieved when the patient is lying down. Other symptoms include nausea, vomiting, neck stiffness, and difficulty concentrating.
Among the 11 patients with spontaneous intracranial hypotension after bariatric surgery, the mean age at the time of bariatric surgery was 40.8 years and the mean age at the time of onset of spontaneous intracranial hypotension was 45.6 years.
After receiving treatment for the condition, 9 had no more symptoms while 2 experienced persistent symptoms. The symptoms started from 3 months to 20 years after the bariatric surgery, and participants had lost an average of 116 pounds during that time.
Schievink says body weight plays an important role in cerebrospinal fluid (CSF) pressure—while obesity is a risk factor for high CSF pressure, a typical patient with spontaneous intracranial hypotension (low CSF pressure) has a lanky build.
“The link [between spontaneous intracranial hypotension and bariatric surgery] may be due to loss of intraspinal fat tissue or may be due to malnutrition following the bariatric surgery,” he says.
Schievink and his colleagues plan to conduct further research in this area, looking at nutrients and body habitus as it relates to intracranial hypotension.
—Colleen Mullarkey
Reference
Schievink WI, Goseland A, Cunneen S. Bariatric surgery as a possible risk factor for spontaneous intracranial hypertension. Neurology. 22 Oct 2014. [Epub ahead of print].