Metabolic syndrome (MetS) are consist of central obesity, diabetes, dyslipidemia 
and hypertension. Previous studies have reported possible association of 
migraine and MetS were reviewed. Migraine is a prevalent disabling disorder and 
have been regarded as an episodic and functional disorder. However, recent 
evidence suggests that in some cases, the disease may follow a chronic and 
progressive course. On the basis of available evidence, obesity is considered to 
be associated with migraine frequency and progression. The association between 
diabetes and migraine is unclear. Similarly, association of migraine with 
hypertension is also unclear. Female migraineurs commonly have an unfavorable 
cholesterol profile, i.e. one with high total cholesterol and low HDL levels. 
Obesity can be considered as a proinflammatory state in which increased 
inflammatory mediators, vascular hyperreactivity, plasma calcitonin gene-related 
peptide (CGRP) concentrations and decreased adiponectin concentrations are 
observed. These alterations can cause an increase in the frequency of migraine 
attacks developed of central sensitization, and thereafter, chronic migraine. 
Migraine and obesity may share some neurobiological abnormalities. Orexins 
modulate both pain and metabolism. Dysfunction in the orexin pathways seems to 
be a risk factor for both conditions. The methylene-tetrahydrofolate reductase 
(MTHFR) gene and the angiotensin converting enzyme (ACE) gene exhibit 
polymorphism. C677Tmutation in the MTHFR gene and the D-allele of the ACE gene 
are the shared risk factors for the development of migraine and cardiovascular 
disease. Certain beta-blockers, Ca blockers, ACE inhibitors, and angionten II 
receptor blocker (ARB) have excellent efficacy in migraine prophylaxis. The 
pharmacological mechanism of these agents do not seem to stand on their 
antihypertensive effect, but the other mechanism of action. Appropriate meal, 
sleep, and exercise are important for the management of MetS and migraine 
headaches.