Migraine Chronification as a Loss of Predictability: An Integrative Hypothesis Linking Interoceptive Precision, Felt Uncertainty, Salience-Network Capture and Allostatic Overload

Allostatic accounts explain migraine chronification as the cumulative cost of repeated attacks, and an active-inference account explains the single attack as a reset forced by unresolved interoceptive prediction errors. This article proposes that one variable joins them: the predictability of the attacks themselves. As attack frequency approaches 15 days a month, the uncertainty left by cues as weak as those patients report nears its maximum, and the hypothesis adds that threshold-driven attacks dilute the reliability of the cues. The proposed response is a rise in the weight given to bodily signals, felt as uncertainty and clinically as anticipatory anxiety, expressed in the salience network and paid for in fragmented sleep and strained clearance and energy supply, which lower the attack threshold. Graded against the evidence, salience-network change and rising allostatic load have direct but small support, the interoceptive findings are small and conflicting, the anxiety link is indirect and confounded by medication overuse, the sleep link indirect and unstratified, the clearance findings rest on an indirect imaging proxy, and slow-wave sleep loss is contradicted. Six predictions are stated with the results that would refute them and with what rival accounts expect; one tests the ordering of the loop directly.