OBJECTIVE: The objective of this study was to test whether behavioral weight loss (BWL) intervention decreases headaches in women with comorbid migraine and overweight or obesity. METHODS: This randomized, single-blind trial allocated women 18 to 50 years old with 4 to 20 migraine days per month and a BMI 25.0 to 49.9kg/m2 to 16 weeks of BWL (n = 54), which targeted exercise and eating behaviors for weight loss, or to migraine education control (ME, n = 56), which delivered didactic instruction on migraine and treatments. Participants completed a 4-week smartphone headache diary at baseline, posttreatment (16 to 20 wk), and follow-up (32 to 36 wk). The primary outcome was posttreatment change in migraine days per month, analyzed via linear mixed effects models. RESULTS: Of 110 participants randomly assigned, 85 (78%) and 80 (73%) completed posttreatment and follow-up. Although the BWL group achieved greater weight loss (mean (95% CI) in kilograms) than the ME group at posttreatment (-3.8 (-2.5 to -5.0) versus +0.9 (-0.4 to 2.2), p < 0.001) and follow-up (-3.2 (-2.0 to -4.5) versus +1.1 (-0.2 to 2.4), p < 0.001), there were no significant group (BWL versus ME) differences (mean (95% CI)) in migraine days per month at posttreatment (-3.0 (-2.0 to -4.0) versus -4.0 (-2.9 to -5.0), p = 0.185) or follow-up (-3.8 (-2.7 to -4.8) versus -4.4 (-3.4 to -5.5), p = 0.378). CONCLUSIONS: Contrary to hypotheses, BWL and ME yielded similar, sustained reductions in migraine headaches. Future research should evaluate whether adding BWL to standard pharmacological and/or nonpharmacological migraine treatment approaches yields greater benefits.

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