What is the evolutionary advantage of migraine?


Elizabeth Loder MD, FACP, Director, Headache and Pain Management Programs, Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston, MA 02114, USA. Tel. 617-573-2493, fax 617-573-2489, e-mail eloder@partners.org


Susceptibility to migraine is determined by genetic factors and is therefore subject to the forces of natural selection. Migraine is a common and ancient disorder whose prevalence may be increasing, suggesting that a migraine-prone nervous system may be associated with reproductive or survival advantages. Five evolutionary explanations are reviewed that might account for the persistence of migraine: (i) migraine as a defence mechanism; (ii) migraine as a result of conflict with other organisms; (iii) migraine as result of novel environmental factors; (iv) migraine as a trade-off between genetic harms and benefits; and (v) migraine as a design constraint. An evolutionary perspective on migraine allows the generation of important hypotheses about the disorder and suggests rewarding possibilities for further research.