Psychosocial and environmental influences on episodic migraine explored through the Four P model

Migraine is a prevalent and disabling condition affecting more than 12% of the global population that remains enigmatic due to its multifaceted nature. Despite its high global burden, the underlying psychosocial and environmental dynamics contributing to episodic migraine (EM) remain underexplored, particularly within structured theoretical frameworks. Guided by the Four P model, this qualitative study, one of the first to apply the Four P model specifically to EM, investigates how psychosocial and environmental factors operate across predisposing, precipitating, perpetuating, and protective domains in EM. Twenty participants with EM took part in semi-structured interviews. Thematic analysis revealed strong inter-coder reliability and generated a comprehensive map of factors using network analysis of qualitative data, a novel method that visualizes the interconnectivity of themes. Predisposing factors included hormonal influence, long-term stressors, childhood trauma, personality traits, and genetic vulnerability. Academic pressure, interpersonal stress, health changes, diet-related factors, and life transitions emerged as key factors responsible for the onset of migraine. Perpetuating factors included environmental and routine instability, occupational strain, hormones, and personality rigidity sustained migraine vulnerability. Conversely, protective factors involved life management, self-awareness, absence of stress stimuli, and social support. The findings underscore the psychological and relational dimensions of migraine, offering implications for culturally sensitive prevention and intervention strategies. This study contributes to an integrative understanding of EM through a psychosocial and environmental lens. It highlights the need for further research into the role of social relationships in the experience and management of migraine.