There is room for further research in this area. As mentioned in chapter 1:1, many migraine medications affect the weight of their users. Pizotifen, a very commonly used prophylactic migraine treatment, has been shown to cause weight gain (45, 50, 53). Conversely, Topiramate, another prophylactic migraine medication, has been shown to cause weight loss(36). Potential further research could be the design of a longitudinal study that assesses the weight, appetite behaviours, migraine severity, food cravings and food intake of migraine participants on these migraine medications. Theoretically, at baseline, i.e. when participants are prescribed the relevant prophylactic medication, participants could answer the psychometric tools from this study design. Developments could then be followed up at 6 months and 1 year, reassessing the aforementioned parameters at each stage. Such a study would highlight whether particular appetite behaviours have a role in weight
change. It would be useful to assess whether participants‘ migraine severity is associated with changes in weight. Based on this author‘s current
hypothesis, it could be postulated that with Topiramate, which can causes weight loss, the participant‘s migraine severity and hypothetical aberrant appetite behaviours are reduced. Conversely, it could be postulated, that with the use of Pizotifen, which can cause weight gain, the patient‘s migraine severity and hypothetical aberrant appetite behaviours worsen. This is a novel concept that, hitherto, has not been studied. Such a future study may have wider implications for the choice of pharmacological therapy for management of migraine.
Another aspect of this further study, or even a separate study would be to assess the exercise levels of paediatric migraineurs. The type of
measurements and their respective degrees of accuracy in measuring exercise vary. Self-report questionnaires to assess number of participant activities, and parental perception of their child‘s exercise levels have previously been designed and utilised(96, 222). Objective assessment of migraineur activity could be obtained by utilising accelerometers for participants to wear for a fixed period e.g. seven days (223). Alternatively, isotopes have been utilised to assess energy expenditure in subjects(224). Both of the latter methods would be more costly and require more specialist input than a self-report
questionnaire. They may, however, offer greater insight into the activity levels of migraineurs. Irrespective of the eventual methodology chosen to assess exercise, considering that potentially exercise could mediate the relationship between migraine and obesity (see chapter 1.2.5) and, is hitherto not been studied, this is a worthwhile aspect of study for the future.
Potential further research in this field could be a population based study correlating primary headache with obesity and headache with diet. A very large cohort of children, 13,971 in total, have been monitored since in utero in a study called ―The Avon Longitudinal Study of Parents and Children (ALSPAC)(225)‖. This prospective longitudinal study of this cohort assesses all of life data (data from birth and annually hereafter), but is particularly interested in the anthropometry of these children over time.(226)
Throughout the study, details of children‘s weight, BMI, waist circumference, and Dual–Energy X-Ray Absorpitometry (DXA) measurements of total and regional fat mass, are recorded at regular
intervals(227). There is also detailed data on diet in this study, recorded at 3, 7 and 12 years old, utilizing a food frequency questionnaire on the latter two occasions (227). The study has also measured primary headache frequency at regular intervals. Ultimately, it would be interesting to collaborate with the authors of this study and exploit such a rich volume of data, the largest longitudinal data on paediatric headache in the U.K. If successful
collaboration occurs, correlation of headache with weight and headache with diet on a population based scale can be conducted; a novel design that has not been conducted in the British paediatric population. Based on previous work the hypothesis would be that increased severity of migraine is associated with increased weight. More importantly, because data have been collected since the birth of participants and it is a longitudinal study, causation between the migraine and obesity relationship could potentially be elucidated.
6:3 Implications of the study:
The implications of the quantitative results of this study are very limited due the limited sample size of the study thus far. There is not a strong enough body of results to suggest the need for a change in clinical practice. It is possible, however, to envisage that if further investigation found positive association between migraine and appetite, that there could be a number of implications for clinical practice.
Children who are overweight in youth are at increased risk of being
overweight in adulthood(69, 228). The consequences of being overweight are discussed in chapter 1.2. Theoretically, if it is identified in further study that migraineurs are at increased risk of increased adiposity, the implications are multiple; from simple implications such as increasing the frequency of a child‘s BMI measurement in migraine clinics, to ensuring all paediatric neurologists give greater attention to the weight and appetite of their migraine patients.
There are a number of behavioural methods(134, 229) that could potentially be very useful at ameliorating the effects of aberrant appetite behaviours. As the current study has no robust conclusions from the association between appetite behaviour and migraine, these potential implications are merely postulations.
More immediately, the body of work so far has implications for the experience of recruitment and utilising the psychometric tools in this preliminary work. Adopting the recommendations the study design should become more robust, and hence the full pilot study results gleaned should be reliable. Once the study is completed, it will be more appropriate to