What is the Best Migraine Medicine for Weight Loss?

Migraine is more common in people who are overweight or obese. In those of healthy weight, about 3 out of 100 people have migraines.

People who are overweight or obese are 3 to 5 times more likely to get migraines compared to those of normal weight.

If you’re overweight or obese and also have migraines, losing weight is a goal you should aim for.

Some migraine medications can affect your weight. Knowing which ones might make you gain weight and which might help you lose weight is important.

We’ll recommend the best migraine medication for weight loss based on clinical studies.

What are the different migraine medications?

Migraine medications are divided into two main types based on how they are used:

• Abortive medications:

These are used to relieve pain and are taken as needed when a migraine attack occurs.

• Preventive medications:

For individuals who experience frequent migraine headaches, these medications are taken regularly to reduce the frequency and severity of migraines.

Here is a list of commonly used medicines to treat migraine headaches:

Effect of Migraine Medications on Body Weight:

Migraine medications can impact body weight in different ways. Some medications may cause weight gain once you start taking them, while others might lead to weight loss.

Below is a summary of the various migraine medications that affect weight, based on clinical trial data:

Weight Change Associated with Abortive Pain Relief Medications for Migraine

Serotonin 5-HT1F agonists (Ditans)

• Lasmiditan (Reyvow):

  • Indicated for the acute treatment of migraine.
  • There is no data about Lasmiditan on changes in body weight.

Selective serotonin receptor (5-HT1B/1D) agonists (triptans)

• Sumatriptan (Imitrex, Sumavel DosePro, Alsuma, Onzetra, Sumavel, Zecuity, Zembrace):

  • Sumatriptan is not associated with weight gain. However, Sumatriptan and naproxen (Treximet) have been linked with weight gain.
  • Naproxen is an NSAID and can cause weight gain as a result of fluid retention [Ref]

Calcitonin gene-related peptide (CGRP) receptor antagonists

• Ubrogepant (Ubrelvy):

  • No data are available.

• Rimegepant (Nurtec ODT)

  • Rimegepant (Nurtec ODT) is the only CGRP antagonist that is approved for acute treatment as well as preventive migraine headaches.
  • We conducted a POLL on dibesity.com to see if patients with migraine who are using Nurtec noticed weight gain or weight loss after treatment initiation.
  • Among 31 responses, 28 (90%) individuals noticed a change in their body weight.
  • 53% of the individuals reported weight gain of 5 to 10 lbs while 20% reported a significant weight gain of more than 10 lbs.
  • Overall, 76% reported weight gain, 10% reported no change, and 13% reported weight loss.

• Atogepant (Qulipta):

  • No data are available

• Zavegepant intranasal (Zavzpret):

  • No data are available

Prophylactic Migraine Medications and Weight Change:

Antiepileptic drugs

• Valproic acid (Depakote, Depacon, Depakene, Stavzor):

  • Weight gain: Weight gain is a well-known side effect of Valproic acid. There has been a documented weight gain of 0.9 to 3 kg when used in a dose of 150 to 1500 mg daily.
  • Comments: Weight gain has been seen more commonly in men than women.

• Topiramate (Topamax, Qudexy XR, Topiragen, Trokendi XR):

  • Weight Loss: Topiramate is one of the most effective migraine preventive medications. It is associated with significant weight loss ranging from 2 to 5 kgs in doses ranging from 50 to 200 mg per day.
  • Comments: Topiramate use has also been reported to cause weight loss in children. It is one of the FDA-approved weight loss medicines indicated for the treatment of obesity.

• Gabapentin:

  • Weight gain: Gabapentin is associated with weight gain of 1.9 to 2.9 kg when used in a mean dose of up to 2300 mg per day for 6 to 12 months.
  • Comments: Gabapentin is a USHC class 2 medicine for migraine prevention. It is less effective than valproic acid and topiramate.

• Lamotrigine:

  • Weight Loss: Weight loss has been documented with Lamotrigine use. However, most weight loss documented in clinical trials is in patients with bipolar disorder.
  • Comments: Lamotrigine is considered weight neutral. However, there is limited data.

• Levetiracetam and Zonisamide:

  • Weight changes: There is minimal data. Most studies documented a weight-neutral effect.
  • Comments: These are uncommonly used for migraine prophylaxis.

Beta-blockers

• Propranolol (Inderal, Inderal LA, Hemangeol, InnoPran XL):

  • Weight gain: Propranolol in a dose of 160 mg per day (80 mg twice daily) for 6 to 9 months resulted in a weight gain of 6 to 9 kg.
  • Comments: Compared to placebo, a net weight gain of 2.3% has been reported with propranolol. However, propranolol use in children has not been associated with weight gain.

• Timolol (Apo-Timol, Nu-Timolol, Teva-Timolol):

  • Weight gain: Timolol is considered weight neutral. No weight gain or weight loss has been documented with Timolol.
  • Comments: Timolol, like propranolol, is another highly effective medicine. There are very few studies on Timolol and associated weight changes.

• Other beta-blockers:

  • Weight gain: Beta-blockers generally cause slight weight gain.
    • Metoprolol: Mixed results of weight gain and weight-neutral effects have been reported. In one study, metoprolol in a dose of 200 mg per day resulted in a weight gain of 1.4 kg over 16 months
    • Atenolol: Atenolol in a dose of 50 to 100 mg per day was associated with a weight gain of 1.7 kg over 6 months
    • Nadolol: No studies available.
  • Comments: Metoprolol, Atenolol, and Nadolol are less effective than propranolol and timolol.

Tricyclic antidepressants

• Amitriptyline (Elavil):

  • Weight gain: 20 mg per day for six months resulted in a mean increase in body weight of 5.4 kg.
  • Comments: Amitriptyline is a commonly used highly effective migraine preventive medicine. It was associated with the most weight gain compared to other preventive medications.

• Nortriptyline (Pamelor):

  • Weight gain: Nortriptyline for 09 months resulted in a weight gain of 1.9 kg
  • Comments: The clinical efficacy is variable. Most weight gain documented with these medications is in non-headache patients.

Calcium channel blockers

• Verapamil (Calan, Isoptin SR, Verelan):

  • Weight gain: Verapamil in a dose of 160 mg per day caused weight gain of 2.5 kg over 6 months [Ref].
  • Comments: Verapamil is uncommonly used for migraine prophylaxis. After the initial weight gain, it was not associated with a further weight gain when used for extended periods.

Botulinum toxin

• OnabotulinumtoxinA (Botox):

  • Weight Neutral: Weight changes are not linked with the use of Botox injections.
  • Comments: Botox is indicated for refractory migraine and patients who are intolerant to preventive migraine medications.

CGRP Monoclonal antibodies:

CGRP monoclonal antibodies are the latest approved medications for migraine prevention. These medications are considered weight-neutral.

However, in obese individuals with migraine, these drugs are relatively less effective compared to thin lean patients with migraine.

• Erenumab (Aimovig):

  • Weight gain: In an online survey, 54% of the participants reported weight gain [Ref]

• Fremanezumab (Ajovy, fremanezumab-vfrm):

  • No data available

• Galcanezumab (Emgality, galcanezumab-gnlm):

  • No data available

• Eptinezumab (Vyepti):

  • No data available

Miscellaneous Medications:

• Pizotifen (Mosegor):

  • Weight gain: Pizotifen has been associated with a significant weight gain of about 4.4 kg when used in a dose of 1 mg over 6 months.
  • Comments: Pizotifen is a medicine used in children to improve satiety and weight gain. It is also indicated for the treatment of migraine prevention.

• Flunarizine (Sibelium):

  • Weight gain: Flunarizine is associated with weight gain. In 12 weeks study, Flunarizine in a dose of 10 mg per day was associated with a weight gain of 3.3 kg
  • Comments: Flunarizine is a calcium channel blocker commonly used in Europe for migraine prevention. However, it is not available in the US.

What is the Best Migraine Medicine for Weight Loss?

Based on the above information, let’s classify migraine medications based on their weight loss/ weight gain/ weight neutral potential.