This study aims to report the prevalence of obesity and overlapping comorbidities in a rural population of children and adolescents with migraine.  A cross-sectional, descriptive, secondary data analysis using a comprehensive patient database from the West Virginia University (WVU) Medicine Epic Clarity system will be reported. A review of electronic medical records of 990 children and adolescents, ages 7 to 17 years, evaluated for headache at a rural clinic from December 1, 2009 to December 31, 2017 was completed. The Chi-square test was used to identify any differences in demographic characteristics (age, gender, and race) and distribution of comorbidities (obstructive sleep apnea syndrome [OSAS], depression, and anxiety) among obese versus nonobese adolescents with migraine. Student's -test was used to identify any differences in the number of comorbidities between the two groups.  A total of 648 children and adolescents with a diagnosis of migraine were identified. Approximately 26.4% of the children and adolescents diagnosed with migraine ( = 648) met the criteria for being obese with a mean body mass index (BMI) of 30.6 kg/m (standard deviation [SD] = 6.5), ranging from 20.0 to 58.5 kg/m . There were no significant differences between migraineurs who were categorized as obese versus nonobese in terms of gender ( = 0.8587), age ( = 0.1703), race ( = 0.7655), anxiety ( = 0.1841), or depression ( = 0.2793). Obese individuals have more comorbidities than nonobese individuals ( = 0.015). Additionally, the prevalence of OSAS was significantly higher among obese versus nonobese migraineurs (20 vs. 9.9%, = 0.0007).  Given the prevalence of obesity in rural pediatric populations and the reported neurobiological links between migraine and obesity, BMI needs to be monitored and weight management interventions included in plans of care for rural children and adolescents with migraine.