Risk Factors Contributing to Migraine Impact Risk Accumulation (MIRA): A Systematic Review

OBJECTIVE To systematically synthesize the evidence on MIRA in patients.SPECIFIC OBJECTIVES 1.To identify the sociodemographic, clinical, and psychosocial risk factors reported to be associated with MIRA. 2. To summarize the evidence on the burden of MIRA in terms of physical, psychological, social, and functional outcomes.3. To examine the reported associations between identified risk factors and MIRA-related burden.Rationale Migraine is a common chronic neurological disorder that significantly affects patients' physical, emotional, and social wellbeing.Beyond severe headaches and sensory symptoms, migraine often leads to substantial psychological burden, social disability, and increased risk of anxiety, depression, and suicidal ideation.Stigma and under-treatment further worsen its impact.Various risk factors, such as clinical severity, psychiatric comorbidities, and sociodemographic characteristics, are linked to greater impairment and reduced quality of life.The concept of migraine impact risk accumulation (MIRA) highlights how migraine can cause lasting disadvantages over time, affecting education, work, and social participation, yet this remains under-researched.This systematic review aims to synthesize existing evidence on risk factors contributing to MIRA, to clarify how these factors accumulate, and to identify knowledge gaps that can inform better prevention and intervention strategies.