Beyond air pollution: Green space, water minerals, and genetic predisposition in migraine onset

The long-term impact of green spaces, coastal proximity, and water minerals on migraine onset remains unclear. This prospective cohort study included 295,881 migraine-free participants from the UK Biobank with a median follow-up of 14.47 years, during which 3,785 incident migraine cases occurred. Higher residential green space was associated with a reduced migraine risk (HR 0.90 [0.82-0.99]), whereas greater coastal distance increased risk (HR 1.30 [1.18-1.43]). Low water magnesium (HR 1.51 [1.36-1.67]) and soft water (HR 1.38 [1.16-1.64]) were associated with increased risk, while water calcium showed a U-shaped association. Air pollution (PM_2.5, PM₁₀, NO₂, NO_x) increased risk by 13%-15%, whereas noise pollution showed no significant association. Participants with both high genetic risk (polygenic risk score) and high environmental exposure had a 32%-102% greater migraine risk. These findings suggest that multiple environmental factors, particularly water minerals and green space, interact with genetic susceptibility to influence migraine onset.