OBJECTIVES:  Migraine and obesity add significant personal and societal burden, diminished quality of life, and increase health care utilization. Several studies suggest multifactorial pathophysiological associations between migraine and obesity that contribute to the prevalence of migraine in adults with obesity. This study aims to identify sociodemographic and health-related factors associated with migraine, and examine the effect of migraine on health care utilization and expenses in a nationally representative sample of obese US adults. METHODS:  This study used Medical Expenditure Panel Survey (MEPS) longitudinal data (2006-2013) representing the US civilian noninstitutionalized population. The study included individuals aged > 18 years and with a body mass index (BMI, kg/m) ≥ 30. After identifying migraine from the MEPS medical condition files, obese adults were divided into two groups: (1) obese with migraine and (2) obese without migraine. Outcomes measured included annualized per subject total health care expenses, and delineated medical services and pharmacy expenses. Multivariate logistic regression identified significant risk factors associated with migraine and a generalized linear model with a log link and gamma distribution assessed the effect of migraine on total health care expenses. RESULTS:  Among 23,596 eligible obese adults, 4.7% (n=1025) reported migraine. Younger age, female sex, white race, poor perceived health status, and greater comorbidity increased the migraine risk among this obese cohort. Migraine versus no migraine showed higher outpatient, emergency, and prescription drug utilization (p<0.001). The medical, prescription drug, and total health expenses in the migraine group were $1321 (p=0.007), $760 (p<0.001), and $1991(p=0.001) higher than the non-migraine group. Migraine increased total health care expenses 31.6% in the obese population after controlling for sociodemographic and health-related variables. CONCLUSIONS:  Sociodemographic characteristics, health status, and comorbidity level increased the risk for migraine among obese adults. Migraine in obese adults significantly increased total health care utilization and expenses.