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Genetic Factors in Migraine
Genes and genetic variations contribute to migraine development, making the disorder commonly inherited within families. Studies show that having a first-degree relative (such as a parent or sibling) with migraines significantly increases your risk. Twin studies reveal that identical twins, who share identical genetic material, are more likely to both suffer from migraines compared to fraternal twins, who share only half of their DNA.
Although most migraine cases are not caused by a single gene, there are exceptions. Hemiplegic Migraine is a rare subtype often mistaken for a stroke or transient ischemic attack (TIA), caused by mutations in four specific genes. These genetic mutations disrupt ion channels in the brain, leading to abnormal nerve activity and triggering Hemiplegic Migraine. Children with a parent affected by this form have a 50% chance of inheriting the condition.

For other migraine types, large-scale genetic studies have identified numerous genes associated with increased susceptibility. These findings suggest that certain genetic mutations heighten the likelihood of experiencing migraine attacks. Future research into the genetic basis of migraines could deepen our understanding of their pathology, support the development of personalized treatment plans, and lead to the discovery of more effective therapeutic targets.

Environmental Triggers
Recent studies have begun exploring how environmental factors influence migraine risk, frequency, and severity. Identified triggers include air pollution, weather changes, limited access to green spaces, pesticide exposure, and proximity to oil and gas wells. To date, there is limited evidence that noise pollution significantly impacts migraine frequency or severity.

Data are currently lacking on the effects of water pollution, wildfire smoke, microplastics, ultrafine particulate matter, and metal exposure on migraine outcomes. Likewise, the impact of socioeconomic status and mental health challenges on migraine is not well understood, despite anecdotal evidence suggesting these factors may negatively affect symptoms.

Hormonal Influences
Migraine is predominantly a female disorder among adults. Women are three times more likely than men to experience migraines and typically report more frequent and intense attacks. Migraine symptoms often emerge around puberty, intensify during reproductive years, and decline after menopause or andropause (a testosterone drop in men that mimics menopause).

About 60% of women with migraines experience menstrual migraines triggered by hormonal fluctuations. These typically occur just before or after menstruation, when estrogen and progesterone levels drop as the previous cycle ends. Many women report improvement in symptoms during pregnancy, when hormones are relatively stable. However, migraines usually return after childbirth. Some women experience worsening symptoms during perimenopause, when hormone levels fluctuate irregularly, although menopause often brings symptom relief.

The biological mechanisms by which hormonal changes trigger migraines are not fully understood. Estrogen withdrawal may release inflammatory molecules in the brain, negatively affect blood vessels in the central nervous system, and alter interactions with neurotransmitters. These changes can contribute to migraine pain. Hormonal contraceptives that stabilize hormone levels may offer relief to some patients, though others show limited response. Understanding how hormones affect the brain and pain pathways may lead to new treatment strategies.

Nutrition, Sensory, and Lifestyle Factors
Unlike genetic or hormonal influences, lifestyle factors can often be modified to prevent or reduce migraine attacks. As the saying goes, “you are what you eat” — and this is particularly true for migraine sufferers. Patients and healthcare professionals agree that diet can significantly influence migraine frequency and intensity.

Various foods and additives have been identified as potential migraine triggers, though sensitivity varies among individuals. Timing and amount of exposure are also important. Both consumption and withdrawal of certain foods can provoke migraines. Common dietary triggers include alcoholic beverages, caffeine, chocolate, nuts, citrus fruits, aged cheeses containing tyramine, processed meats with nitrites, monosodium glutamate (MSG), and artificial sweeteners like aspartame.

Interestingly, migraines are often accompanied by gastrointestinal symptoms such as nausea, vomiting, and bowel irregularities. Migraine sufferers are also more likely to have gastrointestinal disorders like irritable bowel syndrome (IBS). In recent years, the gut-brain axis—the bidirectional communication between the gastrointestinal system and the brain—has become a topic of research. Some studies show promise in linking gut microbiota to migraine, but results have been inconsistent. A recent meta-analysis on probiotics and migraines found mixed outcomes, highlighting the need for further investigation.

Besides diet, other frequently reported migraine triggers include bright or flickering lights, certain odors, loud noises, emotional stress, lack of sleep, and dehydration. Interestingly, overuse of migraine medications and pain relievers can worsen symptoms over time, a phenomenon known as medication-overuse headache. This condition can also increase sensory sensitivities to light, sound, and smell between attacks.

Because triggers differ among individuals, healthcare providers often recommend keeping detailed records of migraine episodes. Tracking factors such as diet, sleep, stress levels, and environmental exposures can help identify personal triggers and improve treatment strategies.

Conclusion
A wide range of genetic, hormonal, environmental, dietary, sensory, and lifestyle factors contribute to migraine development and symptom severity. As research continues, better understanding of these elements and their mechanisms will enable more individualized and effective therapies for migraine sufferers.
 
 
Sources:
Raggi et al: Hallmarks of primary headache: part 1 – migraine. J Headache Pain. 2024; 25:189.
Grodzka and Domitrz: Gut microbiota, probiotics, and migraine: a clinical review and meta-analysis. J Oral Facial Pain Headache. 2025; 39:13-26.
Elser et al: The Environment and Headache: a Narrative Review. Curr Environ Health Rep. 2024; 11:184-203.
 
About the Authors:
Dr. Largent-Milnes is an Associate Professor at the University of Arizona College of Medicine in the Department of Pharmacology. Dr. Liktor-Busa is a Senior Scientist in the Largent-Milnes laboratory. For more information about their work, please visit: https://www.largentmilneslab.com/