Epidemiological Determinants of Migraine and Analysis of Modifiable Risk Factors Triggering Attacks: Hormones, Stress, and Diet – A Narrative Review
Abstract
Background: Migraine is a complex, primary neurological disorder characterized by a deficit in sensory processing and habituation. Despite its high global prevalence, the underlying pathophysiology remains multifaceted. Historically viewed through a vascular prism, current models emphasize the role of the central nervous system, particularly the hypothalamus and the trigeminovascular system. This review aims to integrate recent findings regarding neuroendocrine, metabolic, pharmacological, and environmental modulators to provide a comprehensive overview of the "Migraine Threshold Theory." Methods: A narrative review of medical literature published between 2000 and 2024 was conducted. The analysis focused on the pathophysiology of migraine, hormonal influences, the gut-brain axis, lifestyle factors, and the impact of pharmacological agents. Priority was given to data describing the transition from episodic to chronic migraine, the "estrogen withdrawal" hypothesis, and mechanisms of medication overuse. Results: The synthesis indicates that the migraine attack is initiated in the hypothalamus up to 48 hours prior to pain onset. Key mechanisms include trigeminovascular activation and the release of CGRP and PACAP. Hormonal fluctuations, particularly estrogen withdrawal, are identified as potent triggers modulating TRP channel sensitivity. Emerging evidence highlights the gut-brain axis, where dysbiosis lowers the migraine threshold via systemic inflammation. Furthermore, the…
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