PROJECT SUMMARY Migraine is a highly prevalent chronic pain disorder with sensory, affective, and cognitive symptoms. Many neural systems contribute to the pathophysiology of migraine, and in particular the insula is known to play a major role in integrating somatosensory and interoceptive signals that contribute to the experience of migraines. Despite the insula being a hub for both interoceptive processing3 and migraine, however, little is known about the specific role that the insula and interoceptive awareness (i.e., the capacity to attend to and regulate internal sensations) play in the symptomology of migraines. Migraine symptoms are cyclical, with sensitization to pain increasing throughout the interictal phase (i.e., between migraine attacks) and peaking just before or during the attack. We propose that increased sensitivity to pain stimuli as the interictal phase progresses might extend to interoceptive processing; our central hypothesis is that migraine is linked with dysregulated interoceptive processing that builds over the interictal phase and peaks close to or during the next migraine. The research project proposed in this Small Research Grant (R03) Award will use functional magnetic resonance imaging, measures of interoceptive awareness, and daily tracking of migraine phase and symptom severity to understand the role that interoceptive awareness plays in the time course of migraine. We will measure brain response during interoceptive attention among both people with episodic migraine and healthy control participants. Participants will focus on sensations from their heart or lungs, and brain response during this condition will be contrasted with the response during external attention to sounds and visual patterns. We will collect data about participants’ migraine phases and symptoms using daily electronic headache diaries, and use this to time-lock each MRI scan relative to participants’ migraine cycles. The specific goals of this proposal are to 1) Examine associations between insula response to interoceptive attention and migraine cycle phase in people with episodic migraine; and to 2) Investigate differences in brain response to interoceptive attention between people with episodic migraine and healthy control participants. This award will contribute to our understanding of the pathophysiology and time course of episodic migraine, and may identify novel neural mechanisms of interoceptive awareness that can be targeted in clinical interventions for migraine.