Could drugs like Ozempic, Saxenda, and Zepbound help migraines?
Extra weight often increases migraine headache frequency and makes standard treatments less effective. But a study just published in the journal Headache shows that a medication commonly used for weight loss and diabetes, liraglutide (Saxenda), might offer relief for tough-to-treat migraines in people with obesity.
Migraines affect about 15% of people worldwide, causing massive disruption to daily life. For many, standard preventive meds like blood pressure drugs (beta-blockers and others), antidepressants, or anti-seizure drugs don't always help.
Several studies have shown that carrying extra weight can worsen migraines, while losing weight improves them. It may be due to an increase in inflammation in the body with increasing weight or due to changes in various hormone levels. Those with obesity are also more likely to have headaches due to increased intracranial pressure (IIH). Headaches due to IIH are distinct from migraines but there is a significant overlap of symptoms.
Liraglutide belongs to a class of drugs called GLP-1receptor agonists. These meds are famous for helping with weight loss by curbing appetite and stabilizing blood sugar. But they were also found to lower intracranial pressure (ICP) in animal studies.
The researchers in this study, led by Dr. Simone Braca and Dr. Roberto De Simone from the University of Naples in Italy, conducted a small "pilot" study of using liraglutide to treat obese migraine sufferers. They enrolled 31 adults (mostly women, average age 45) who had obesity (BMI over 30) and either high-frequency or chronic migraines. These patients had already tried at least two other preventive treatments without much success and continued taking those meds during the study.
A daily injection of liraglutide was started at a low dose and then gradually increased up to 1.2 mg. They tracked everyone for 12 weeks, using headache diaries to count monthly headache days (the main goal), plus measures of disability (MIDAS score), and BMI changes. Notably, they excluded anyone with signs of true IIH, to focus on "regular" migraine sufferers.
Headache days dropped dramatically—from an average of about20 per month to just 11 after 12 weeks. That is a reduction of 9 days on average, and it was statistically significant (meaning it's unlikely due to chance). About half the participants saw their headaches cut by 50% or more, and one person even became headache-free. Disability scores also dropped, from60 to 29, showing real improvements in quality of life.
A surprising finding is that the BMI did not change, going from 34 to 33.9. And the headache relief wasn't linked to weight loss at all. Age, sex, or other meds didn't influence the results either. Side effects were mild—mostly nausea or constipation in about 40% of people—and no one quit the study.
In summary, liraglutide seemed to help migraines directly, possibly by reducing brain pressure or through other mechanisms, rather than just through weight loss.
However, this was a small, open-label study without a placebo group, and everyone knew they were getting the drug. Also, the study only looked at obese patients, so it might not apply to everyone. Also, the authors do not explain why a proven weight loss drug did not produce any weight loss.
In my practice, I do prescribe an old diabetes drug, metformin, which can also help lose weight. I prescribe it not only to obese patients but also to normal-weight patients who report getting migraines when they are hungry. Metformin helps prevent blood glucose levels from becoming too high or too low. I do recommend GLP-1 drugs to overweight patients to reduce weight, which may also improve migraines.
