[Migraine and evolutionary theory: paths for a clinical approach]

Area of Science:

• Evolutionary biology
• Neuroscience
• Genetics

Background:

• Migraine prevalence is increasing, with evolutionary theories suggesting ancestral benefits from stimulus overreactivity.
• Headache and pain can be viewed as adaptive, homeostatic responses crucial for survival.

Purpose of the Study:

• To analyze the evolutionary origins of migraine.
• To explore the role of modern environmental factors in migraine prevalence.
• To understand migraine as a mismatch disorder.

Main Methods:

• Analysis of evolutionary advantages of stimulus overreactivity in Homo sapiens.
• Examination of neurophysiological data, including habituation, sensitization, and preactivation.
• Investigation of genetic factors, polygenic inheritance, and gene-environment interactions.
• Assessment of environmental influences in modern societies, such as estrogenic cycles and stress.

Main Results:

• The migrainous phenotype is frequent, particularly in secondary and syndromic migraine forms.
• Specific neurophysiological traits (lack of habituation, sensitization, low preactivation) contribute to migraine.
• Genetic predisposition (polygenic, low penetrance) interacts with environmental factors and comorbidities like depression and anxiety.
• Modern societal factors, including increased estrogenic cycles and stress, exacerbate migraine.

Conclusions:

• Migraine, an evolutionary advantage, is now a disabling disorder due to internal (estrogenic cycles) and external (stress) stimuli, representing a mismatch disorder.
• Epigenetic effects of migraine manifest in childhood.
• Educational interventions incorporating evolutionary and epigenetic aspects could enhance therapeutic outcomes.