The proposed axis offers a fresh perspective on migraine pathophysiology. Considering the clinical heterogeneity of migraine, do the authors anticipate that the lactylation–immune axis may be particularly relevant to certain clinical subtypes (e.g., migraine with aura, chronic migraine)? Finally, what clinical scenarios do the authors envision for targeting this axis—as an alternative or adjunct for patients who do not respond to CGRP-directed therapies, or within biomarker-guided strategies that enrich for patients with lactylation-linked immune endotypes?
Clarifying these aspects will guide future mechanistic validation and translational exploration. While the reported multi-omics framework provides important hypotheses, its causal interpretation remains preliminary, given the modest sample size and indirect inference from genetic instruments.
Nevertheless, the integrative evidence presented by Wang et al. holds potential value for understanding the metabolic–immune–neural interface in migraine. The convergence of EP300, SIRT1, and SLC16A1 may highlight how metabolic stress and histone lactylation regulate immune tone and neuronal excitability. Emerging evidence indicates that lactate accumulation and mitochondrial dysfunction can trigger histone lactylation and reprogram inflammatory gene expression, thereby coupling metabolic stress to immune activation and neuronal sensitization [2,3,4]. Accordingly, the genetic associations reported by Wang et al. may represent early adaptive responses within the migraine cascade rather than mere downstream epiphenomena. This perspective underscores the need for mechanistic validation of lactylation-driven immunometabolic crosstalk in both central and peripheral contexts.