Migraine: A disorder of metabolism?

•Migraine is associated with the development of a metabolic challenge.•Migraine triggers can differentially alter energy metabolism and utilization.•Common factor linking triggers is an ability to promote insulin resistance.•Insulin resistance may underlie the pathogenesis of migraine.

The treatment and prevention of migraine within the last decade has become largely pharmacological. While there is little doubt that the advent of drugs (e.g. triptans) has helped many migraine sufferers to lead a normal life, there is still little knowledge with respect to the factors responsible for precipitating a migraine attack. Evidence from biochemical and behavioural studies from a number of disciplines is integrated to put forward the proposal that migraine is part of a cascade of events, which together act to protect the organism when confronted by a metabolic challenge.