To what extent is a family history of migraines a risk factor for developing migraines, particularly in individuals with a first-degree relative who has been diagnosed with the condition?

Migraines Have a Strong Hereditary Component

Yes, migraines are hereditary—having a first-degree relative with migraine substantially increases your risk of developing the condition, with the magnitude of risk depending on the specific migraine subtype.

Quantifying the Hereditary Risk

Family history of migraine increases risk by 1.9 to 4-fold depending on migraine type. 1, 2

Migraine Without Aura (MO)

• First-degree relatives of probands with migraine without aura have a 1.9-fold increased risk compared to the general population 2
• Notably, even spouses of migraine patients show a 1.5-fold increased risk, indicating that both genetic AND environmental factors contribute to migraine without aura 2
• This suggests that familial factors (genetic or shared environment) account for less than half of all migraine cases in the population 1

Migraine With Aura (MA)

• First-degree relatives of probands with migraine with aura have a 4-fold increased risk of developing migraine with aura 2
• Critically, spouses show no increased risk of migraine with aura, indicating this subtype is determined largely by genetic factors rather than shared environment 2
• Among relatives of male probands with migraine with aura, the relative risk reaches 4.04 1

Familial Hemiplegic Migraine (FHM)

• This rare monogenic subtype has identified three specific genes (CACNA1A, ATP1A2, and SCN1A) that cause the condition, all affecting ion channel function 3, 4
• These genes provide the strongest evidence that migraine is a genetic illness 5
• Some children with familial hemiplegic migraine mutations develop persistent neurological deficits, suggesting higher stroke risk than other migraine forms 3

Genetic Evidence Supporting Heritability

Twin studies and molecular genetics confirm migraine's hereditary nature. 5

• Monozygotic twins show significantly higher concordance rates for migraine than dizygotic twins 5
• Both migraine without aura and migraine with aura demonstrate multifactorial inheritance without generational differences 2
• The distinct familial patterns indicate that migraine without aura and migraine with aura have different etiologies 2
• Large genome-wide association studies have identified multiple genes involved in neuronal and vascular functions that contribute to polygenic migraine susceptibility 4

Clinical Implications for Risk Assessment

The presence of family history strengthens diagnostic suspicion and should be actively documented. 6, 7

Key Assessment Points

• Family history of migraine has a strong genetic component with higher prevalence among first-degree relatives 6, 7
• The degree of disability in the proband influences familial risk—relatives of probands with disabling migraine show considerably higher risk than relatives of probands with minimal disability 1
• For probands with minimal disability, no excess risk in female relatives was observed 1

Important Caveats

• When evaluating patients with migraine and stroke risk, pay special attention to hereditary disorders that feature migraine-like headache, including CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy), moyamoya, and MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) 3
• Hormonal and X-linked components may contribute to the 3:1 female predominance in migraine 4
• Epigenetic factors, including DNA methylation changes related to hormonal variation, also play a role 4