The principal finding of the current study was that cinnamon intake significantly prevented weight gain, increasing BMI, WC, and it reduced HC and WHR in migraine patients compared with the placebo group. It also significantly reduced the rate of disability in patients by decreasing the HDR in moderate to severe Grades. With regard to the bilateral relationship between obesity and migraine frequency, our findings might be useful in clinical settings to prevent obesity and development of migraine headaches thus improving the functional capacity of migraine patients.
Although the mechanisms contributing to migraine pathophysiology are not completely clear, recent evidence has indicated that the neuroinflammatory state has a critical role in the development of migraine attacks [19]. One of the factors that cause inflammation in the body is the increase in body fat [20]. Also, there has been some evidence that indicates that obesity is comorbid with increasing the severity and frequency of migraine attacks[21].
The weight gain leads to the expansion of adipose tissue and creates a state of chronic low-grade inflammation. Also, the adipose tissue, as a neuroendocrine organ has a role in energy homeostasis and inflammation by adipokines including cytokines, such as tumor necrosis factor TNF-α, interleukins (IL-1, IL-6, IL-10), leptin, resistin, adiponectin, chemokines, such as IL-8, etc. These adipocytokines are one of the suggested causes of the association between obesity and migraine [1]. Most patients suffering from migraines have to use the medications [22]. One side effect of some common drugs used to treat migraines is weight gain which occurs as a result of increased appetite. Therefore, one of the main challenges regarding migraine medication is weight gain and an increase in BMI of patients. [23, 24].
Considering several challenges to follow a healthy lifestyle, particularly for a long time for some of the patients, herbal supplements without considerable side effects are an attractive alternative to prevent the side effects of medication such as overweight and obesity [25]. In the current study, we found that cinnamon could be effective to prevent weight gain among the migraine patients, which is in accordance with the results of the previous reviews which showed that cinnamon is an effective agent for weight loss and improving metabolic syndrome [8, 10].
To explain these results, it should be mentioned that cinnamon is a potent antioxidant and anti-obesity herb because of its high amounts of polyphenols, flavanols, and cinnamaldehyde [10, 26]. Cinnamon lessens glucose absorption in the small intestine by postponing gastric emptying, increasing glucosidase enzymes, and inhibiting ATPase of intestinal brush borders. In addition, activating glycogen synthase and inhibiting glycogen synthase kinase 3β lead to decrease glycogenolysis, and increase glycogen synthesis [27]. Also, polyphenolic compounds of cinnamon with anti-obesogenic effects can inhibit lipolysis, lipogenesis, and intestinal lipid absorption [28]. Also, these induce fatty acid oxidation and antagonist at cannabinoid receptors [29]. Therefore, these actions can be effective in decreasing the synthesis and storage of fat and improvement of anthropometric status.
Another compound in cinnamon, which might be effective against increasing weight is Methyl Hydroxy chalcone polymers (MHCP). MHCP causes the enhancement of insulin sensitivity in adipose cells and helps the increasing body metabolism through activating the insulin-receptor kinase and inhibiting the insulin-receptor-phosphatase [8].
The cinnamon consumption can be prevented proinflammatory cytokines production, oxidative stress condition and the risk of developing a number of chronic diseases, including cancer, heart disease, and diabetes caused by insulin resistance in obese migraine patients [10].
In addition to preventing weight gain, in the current study, cinnamon reduced disability in moderate to svere sufferers of migraine by reducing the HDR suggesting cinnamon powder consumption might be a novel approach to reduce the headache disability and control the weight gain in such migraine patients. It seems that cinnamon with anti-inflammatory properties reduces the production of inflammatory cytokines [30] and headache attack time.
Although this study was the first randomized double-blind clinical trial that investigated the effect of cinnamon as a natural, inexpensive, and accessible herbal medicine on anthropometry factors and headache disability in migraine, some limitations should be noted. The duration of the intervention was relatively short and there was no long-term follow-up. Also, the sample size was small. More randomized controlled trails are warranted before causal relationship can be established. Moreover, because of ethical issues, the dosage of cinnamon was considered with caution. Therefore, longer and larger trials with different dosages of cinnamon are recommended.