Headache condition linked to weight-loss surgery

By reshaping the gastrointestinal tract, bariatric surgery appears to set in motion a cascade of physiological changes — most obviously weight loss. But a new study suggests that such surgery may also be linked, in rare cases, to a headache condition caused by a leak of cerebrospinal fluid from the brain.Neurologists generally diagnose spontaneous intracranial hypotension, which can bring on sudden headaches and nausea while a person is upright, in tall, lanky people. But research published this week in the journal Neurology found, in searching through the medical records of some 338 patients with the condition, 11 — or 3.3% — had had bariatric surgery.That suggests that a history of weight-loss surgery may put a person at slightly increased risk of developing these headaches. While lying down often causes the symptoms to disappear, the condition can be disabling.The study appears in the journal Neurology this week.On average, bariatric patients who developed the painful condition did so anywhere from three months to close to five years after the surgery, and after they had lost, on average, about 116 pounds.A growing mountain of evidence is finding that bariatric surgery prompts physiological changes in patients that are not just a downstream effect of weight loss: improvement in a metabolic function — and in many cases, resolution of type 2 diabetes — is at the top of that list.So why would bariatric surgery nudge a patient’s risk of developing spontaneous intracranial hypotension higher? The authors of the new study, a team led by Cedars-Sinai microvascular neurosurgeon Wouter I. Schievink, suggest several ways that might happen.Noting that intracranial hypertension — too much fluid competing for space in the brain’s ventricles — is more common in the obese, Schievink’s team suggested that dramatic weight loss may reverse that, allowing cerebrospinal fluid to leak from the brain and driving pressure inside the cranium down. Pads of fat that may previously have “plugged” such leaks have likely disappeared.Alternatively, the malnutrition that some patients suffer as a result of poorer absorption of nutrients may play a role, the authors wrote. Or the headache condition may be linked to the metabolic improvements often seen in these patients, they added. Either way, understanding that link may not only allow physicians to anticipate this problem after bariatric surgery, as well as understand it in other patients who spontaneously develop the condition.Follow me on Twitter at @LATMelissaHealy and “like” Los Angeles Times Science & Health on Facebook. Copyright © 2014, Los Angeles Times

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