Bariatric surgery may be risk factor for condition that causes severe headaches

Bariatric surgery may be a risk factor for a condition that causes severe headaches, according to a study published in the October 22, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology.

In the study, gastric bypass surgery and gastric banding surgery were associated with later developing a condition called spontaneous intracranial hypotension in a small percentage of people. Spontaneous intracranial hypotension is often caused by a leak of the cerebrospinal fluid (CSF) out of the spinal canal. The leak causes low pressure of the spinal fluid, triggering sudden headaches in the upright position, which are relieved when lying down. Other symptoms include nausea, vomiting, neck stiffness and difficulty concentrating.

"It's important for people who have had bariatric surgery and their doctors to be aware of this possible link, which has not been reported before," said study author Wouter I. Schievink, MD, of Cedars-Sinai Medical Center in Los Angeles, Calif. "This could be the cause of sudden, severe headaches that can be treated effectively, but there can be serious consequences if misdiagnosed."

For the study, researchers compared a group of 338 people with spontaneous intracranial hypotension to a control group of 245 people with unruptured intracranial aneurysms. A total of 11 of the 338 people with spontaneous intracranial hypotension, or 3.3 percent, had previously had bariatric surgery, compared to two of the 245 people with intracranial aneurysms, or 0.8 percent.

Schievink said body weight plays an important role in CSF pressure. The typical person with spontaneous intracranial hypotension has a tall and lanky build, while obesity is a risk factor for intracranial hypertension, or high CSF pressure. "While more research is needed to understand the relationship between body weight and spinal pressure, it's possible that the loss of fat tissue may uncover a susceptibility to spontaneous intracranial hypotension," Schievink said.

Of the 11 people with bariatric surgery and spontaneous intracranial hypotension, nine had no more symptoms after treatment, while symptoms persisted for two. The symptoms started from three months to 20 years after the bariatric surgery, and participants had lost an average of 116 pounds during that time.