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Migraine as an allostatic reset triggered by unresolved interoceptive prediction errors

Lookup NU author(s): Dr Will Sedley, Siobhan Jones, Professor Tim GriffithsORCiD, Dr Paul Goldsmith


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© 2024 The AuthorsUntil now, a satisfying account of the cause and purpose of migraine has remained elusive. We explain migraine within the frameworks of allostasis (the situationally-flexible, forward-looking equivalent of homeostasis) and active inference (interacting with the environment via internally-generated predictions). Due to its multimodality, and long timescales between cause and effect, allostasis is inherently prone to catastrophic error, which might be impossible to correct once fully manifest, an early indicator which is elevated prediction error (discrepancy between prediction and sensory input) associated with internal sensations (interoception). Errors can usually be resolved in a targeted manner by action (correcting the physiological state) or perception (updating predictions in light of sensory input); persistent errors are amplified broadly and multimodally, to prioritise their resolution (the migraine premonitory phase); finally, if still unresolved, progressive amplification renders further changes to internal or external sensory inputs intolerably intense, enforcing physiological stability, and facilitating accurate allostatic prediction updating. As such, migraine is an effective 'failsafe' for allostasis, however it has potential to become excessively triggered, therefore maladaptive.

Publication metadata

Author(s): Sedley W, Kumar S, Jones S, Levy A, Friston K, Griffiths T, Goldsmith P

Publication type: Review

Publication status: Published

Journal: Neuroscience and Biobehavioral Reviews

Year: 2024

Volume: 157

Print publication date: 01/02/2024

Online publication date: 06/01/2024

Acceptance date: 03/01/2024

ISSN (print): 0149-7634

ISSN (electronic): 1873-7528

Publisher: Elsevier Ltd


DOI: 10.1016/j.neubiorev.2024.105536

PubMed id: 38185265