Altered metabolism of HDLs is associated with migraine and could offer a plasma-based biomarker, according to a new study by Gerrit Onderwater and co-workers. The researchers used a 1H-NMR-based metabolics platform to analyse plasma samples from 2,800 patients with migraine and 7,353 controls. Low levels of apolipoprotein A1 and a low ratio of free cholesterol to total lipids were consistently associated with migraine. Analysis of the samples by sex also revealed that low levels of omega-3 fatty acids were associated with migraine in men but not in women. The findings suggest that migraine is associated with changes in HDL metabolism rather than with general dyslipidaemia. The authors propose that these alterations could contribute to the association of migraine with cerebrovascular and cardiovascular disease.