Migraine as an allostatic reset triggered by unresolved interoceptive prediction errors
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Published version
Author(s)
Type
Journal Article
Abstract
Until 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.
Date Issued
2024-02
Date Acceptance
2024-01-03
Citation
Neuroscience and Biobehavioral Reviews, 2024, 157
ISSN
0149-7634
Publisher
Elsevier
Journal / Book Title
Neuroscience and Biobehavioral Reviews
Volume
157
Copyright Statement
© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/38185265
Subjects
Allostasis
Homeostasis
Humans
Interoception
Migraine Disorders
Sensation
Active inference
Allostasis
Homeostasis
Interoception
Migraine
Publication Status
Published
Coverage Spatial
United States
Article Number
105536
Date Publish Online
2024-01-06