Reinterpreting migraine in a societal evolutionary context

To the Editor,

I read with great interest the recent letter by Lisicki and Schoenen (1), proposing that migraine prevalence is inversely related to the Biological State Index (IBS), suggesting it is a maladaptive byproduct of relaxed natural selection. While I appreciate the authors’ evolutionary framing, I propose a fundamentally different interpretation: high migraine prevalence may not signal unchallenged evolutionary disadvantage, but rather a higher evolutionary level of society.

Societal evolution, like biological evolution (2), reflects adaptation—not through genes but through culture, institutions, and values. Anthropologist Margaret Mead is often credited (3) with the observation that “the first sign of civilization is a healed femur”—a statement illustrating how the capacity to protect and care for the vulnerable marks a defining feature of human society, proof that someone was protected long enough to recover. This principle extends to conditions like migraine, which are episodic in nature: disabling during attacks but compatible with full participation between them. Societies that shelter individuals during periods of vulnerability and reintegrate them when well do not exhibit weakness—they exhibit advancement. Such societies harness the full range of human potential by enabling those with intermittent impairments to contribute across time. In this light, high migraine prevalence is not a sign of evolutionary failure, but a marker of successful societies.

Using publicly available global datasets, I conducted a preliminary analysis examining the correlation between migraine prevalence (4) and country-level behavioral traits (5) such as trust, altruism, and patience, as well as national indicators of well-being and success, including the World Happiness Score (6) and GDP per capita (7) (Figure 1). This exploratory analysis revealed that higher migraine prevalence is modestly but consistently associated with stronger prosocial values, higher national happiness scores, and greater economic prosperity. These correlations challenge the view that migraine reflects biological ‘failure’ and instead suggest its persistence may be supported by cultural conditions that enable individuals to thrive despite episodic neurological vulnerability.

Figure 1.

Migraine prevalence and societal indicators. This figure illustrates the relationship between migraine prevalence and (1) log GDP per capita, (2) behavioral traits, and (3) national happiness scores. Correlation coefficients and p-values are shown.

In sum, high migraine prevalence may not reflect the unchecked perpetuation of a flawed human genome but rather a feature of societies that evolved to prioritize inclusion, interdependence, and cognitive labor. The high prevalence of migraine does not represent a failure in human evolution. It represents evolved, adaptable, and prosperous societies.