TNF and obesity due to melanocortin 4 receptor deficiency: Migraine patients may have multiple metabolic abnormalities associated with obesity, including cerebrospinal fluid (CSF) neuropeptide Y elevation (Valenzuela et al., 2000), CSF tumor necrosis factor alpha (TNF) elevation (Rozen and Swidan, 2007), and systemic adiponectin depression (Peterlin et al., 2007).