For something so common, migraine remains one of the most misunderstood conditions in Australian healthcare. It is frequently dismissed as "just a bad headache," yet for the people living with it, migraine is a complex neurological disorder that can shape careers, relationships and daily routines for decades.
New data from the Australian Institute of Health and Welfare puts the scale of the problem in sharp focus. According to the AIHW's first national report on neurological conditions, around 1.7 million Australians were living with migraine in 2022, making it the most common long term neurological condition in the country (AIHW, 2025). Women are disproportionately affected, with the same report noting that 9.2% of Australian females live with migraine compared with 4.1% of males (AIHW, 2025).
Despite how common it is, migraine is still poorly recognised in general practice and in the wider community. Painaustralia estimates that close to 4.9 million Australians experience migraine at some point, yet the majority remain undiagnosed or undertreated, often managing symptoms for years without a clear explanation or an effective plan (Painaustralia). This gap between how many people are affected and how few receive appropriate care is one of the reasons specialists in headache medicine, including Raelene Clark at the Perth Headache Network, are pushing for earlier diagnosis and more coordinated treatment pathways.
The cost of this gap is also rising. The AIHW report found that health system spending on migraine reached 592.6 million dollars in 2023 to 24, around 1.7 times higher in real terms than a decade earlier (AIHW, 2025). That trend suggests the burden of migraine on the health system is growing faster than the population, not simply tracking it, which adds further weight to calls for earlier and more accurate diagnosis.
A Condition That Runs in Families
One of the clearest signals that migraine is not simply a lifestyle issue is its strong genetic component. Researchers have long observed that migraine clusters in families, and Australian scientists have played a leading role in identifying why.
The Genomics Research Centre at Queensland University of Technology, led by Distinguished Professor Lyn Griffiths, has spent decades mapping the genes involved in migraine susceptibility. A 2019 review from the centre, published in The Journal of Headache and Pain, described both rare single gene forms of migraine and the more common polygenic forms, where many genetic variants each contribute a small amount of risk (Sutherland, Albury and Griffiths, 2019). This matters clinically because it helps explain why migraine can look so different from one patient to the next, and why a treatment that works well for one person may do very little for another.
Understanding the genetic architecture of migraine is also the foundation for better diagnostic tools. Migraine is currently diagnosed almost entirely on clinical history rather than a blood test or scan, which leaves room for misdiagnosis, particularly when symptoms overlap with sinus problems, tension headache or jaw related pain.
Epigenetics: Why Genes Are Not the Whole Story
Genetics explains part of the picture, but it does not explain why migraine frequency can change over a person's lifetime, or why some people respond well to treatment while others do not. This is where epigenetics comes in, and it is the specific area Raelene Clark is researching as part of her PhD at QUT's Centre for Genomics and Personalised Health.
Epigenetics refers to chemical changes that switch genes on or off without altering the underlying DNA sequence. These changes can be influenced by medication use, hormones, stress and other environmental factors, and they appear to play a meaningful role in how migraine behaves over time.
A 2023 QUT study led by Professor Divya Mehta, working with Professor Griffiths and colleagues from Leiden University Medical Centre, looked at people with chronic migraine who gradually withdrew from overused acute pain medication. The researchers found epigenetic changes in two genes, HDAC4 and MARK3, that were associated with a reduction in monthly migraine days following withdrawal. Lower DNA methylation at the MARK3 gene at baseline was linked to a better treatment response, suggesting it could eventually serve as a biomarker to help predict who will benefit from this approach (QUT Centre for Data Science, 2023). The same research team noted that medication overuse is an important factor in around 2% of the population who experience chronic migraine, underlining how closely treatment history and biology are linked.
Findings like these are still early stage, but they point toward a future where blood based markers could help guide treatment decisions rather than relying on a slower process of trial and error.
From Research to the Clinic Room
For patients, the practical value of this research lies in what it means for treatment planning. Migraine care has traditionally followed a fairly generic pathway: try a preventive medication, wait several months to see if it helps, then try another if it does not. For people with frequent or disabling attacks, this process can take years.
A genetics and epigenetics informed approach aims to shorten that process by identifying, earlier on, which patients are more likely to respond to a particular medication, lifestyle intervention or procedure. While Australia is not yet at the point where genetic testing is routine for migraine, the research occurring at QUT is part of the international effort to get there.
In the meantime, multidisciplinary care models are showing strong real world results using the treatments already available. A retrospective Australian study of 211 patients with chronic migraine treated with onabotulinumtoxinA (Botox) found that 74% achieved at least a 50% reduction in headache days after two treatment cycles, with average monthly headache days falling from 25.2 to 10.6 (Stark et al., 2019). Results like this reinforce why specialist assessment, rather than a single generalist appointment, often makes the difference between ongoing disability and meaningful improvement.
This is the model behind the Perth Headache Network, which Raelene Clark coordinates. By bringing together neurology, general practice with a special interest in migraine, infusion therapy and allied health under one coordinated structure, the network reflects an emerging international approach to complex headache disorders, treating migraine as the multifactorial neurological condition it is, rather than a single symptom to be managed in isolation.
The Cost of Getting Diagnosis Wrong
The financial and personal cost of unmanaged migraine in Australia is substantial. QUT's Statistical and Genomic Epidemiology Laboratory estimates the total annual economic cost of migraine in Australia at 35.7 billion dollars, made up of 14.3 billion in health system costs, 16.3 billion in lost productivity and 5.1 billion in other costs (QUT SGEL). A separate peer reviewed Australian modelling study estimated that migraine creates a significant health and productivity burden specifically among working age adults, concluding that interventions which reduce migraine prevalence or severity are likely to deliver a strong return on investment (Tu et al., 2020).
These figures matter because they show that better diagnosis and treatment are not just a clinical nicety. They have a measurable effect on workforce participation, healthcare spending and quality of life across the population, particularly for women aged 20 to 64, who carry a disproportionate share of the burden.
What This Means If You Live With Migraine
If you experience frequent or severe headaches, a few practical steps can help when seeking care.
Keeping a headache diary that records frequency, duration, triggers and response to medication gives a treating practitioner far more useful information than a description from memory. Healthdirect notes that this kind of record can help a doctor distinguish migraine from other headache types and identify patterns worth investigating further (healthdirect).
It is also worth asking directly whether your headache pattern meets the clinical criteria for chronic migraine, defined as 15 or more headache days per month, with at least 8 of those being migraine days. Around 400,000 Australians currently fall into this category, and it is a specific qualifying criterion for some advanced treatments (Migraine Australia).
For many women, migraine also follows a hormonal pattern, worsening around menstruation, pregnancy or perimenopause. This pattern is a clinically useful piece of information, since it can point toward specific treatment strategies and is part of why the AIHW data shows such a marked difference in migraine prevalence between women and men. Mentioning these patterns to a treating practitioner, rather than assuming they are unrelated, can speed up the path to an accurate diagnosis.
Finally, if standard treatment has not worked after a genuine trial, a referral to a specialist headache clinic or neurologist is a reasonable next step rather than a last resort.
A Research Led Approach to Headache Care
Raelene Clark brings together clinical practice in orofacial pain and headache disorders with active research into the epigenetics of migraine through her PhD candidacy at QUT's Centre for Genomics and Personalised Health. As Clinical Coordinator of the Perth Headache Network, her work sits at the intersection of bench research and day to day patient care, with the goal of translating emerging genetic findings into more accurate diagnosis and more personalised treatment for people living with migraine and chronic headache.
Health Hunter connects people with preventative and integrative healthcare practitioners across Australia, including specialists such as Raelene Clark who focus on the underlying biology of complex pain and headache conditions. If migraine or chronic headache is affecting your daily life, exploring a specialist assessment may open up treatment options beyond standard first line care.
Book an appointment with Raelene Clark
References
- AIHW (2025). New report finds 1.7 million Australians are living with migraine. https://www.aihw.gov.au/news-media/media-releases/2025/2025-december/new-report-finds-1-7-million-australians-are-living-with-migraine
- AIHW (2025). Neurological conditions in Australia: Migraine and headache disorders. https://www.aihw.gov.au/reports/neurological-conditions/migraine-and-headache-disorders
- Painaustralia. Headache and Migraine. https://www.painaustralia.org.au/about-pain/forms-of-pain/headache-migraine
- Sutherland, H., Albury, C., Griffiths, L. (2019). Advances in genetics of migraine. Journal of Headache and Pain. https://pubmed.ncbi.nlm.nih.gov/31226929/
- QUT Centre for Data Science (2023). Chronic migraine research finds genetic mechanism to lower migraine frequency. https://research.qut.edu.au/qutcds/2023/12/18/chronic-migraine-research-finds-genetic-mechanism-to-lower-migraine-frequency/
- QUT Statistical and Genomic Epidemiology Laboratory. Migraine research summary. https://research.qut.edu.au/sgel/research/migraine/
- Tu, H., et al. (2020). The Health and Productivity Burden of Migraines in Australia. Headache: The Journal of Head and Face Pain. https://pubmed.ncbi.nlm.nih.gov/33026675/
- Stark, C., et al. (2019). Real-world effectiveness of onabotulinumtoxinA treatment for the prevention of headaches in adults with chronic migraine in Australia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734349/
- healthdirect. Migraine: symptoms, causes and treatment. https://www.healthdirect.gov.au/migraine
- Migraine Australia. Chronic Migraine. https://www.migraine.org.au/chronic
