Research Topic

The Multiple Comorbidities of Migraine: clues to pathophysiology and a challenge for treatment

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There is an increasing evidence linking migraine to a wide range of comorbid psychiatric and somatic disorders, including depression, bipolar and anxiety disorders, sub-clinical vascular brain lesions, coronary heart disease, hypertension, patent foramen ovale and stroke. ...

There is an increasing evidence linking migraine to a wide range of comorbid psychiatric and somatic disorders, including depression, bipolar and anxiety disorders, sub-clinical vascular brain lesions, coronary heart disease, hypertension, patent foramen ovale and stroke.
The proposed pathophysiological background underlying the association between migraine and affective disorders is the shared serotoninergic dysfunction, whereas genetic and epigenetic risk factors are possible shared mechanisms between migraine and cardio/cerebro-vascular diseases.
Migraine appears to be also associated with irritable bowel syndrome, asthma, mitral valve prolapse, chronic fatigue syndrome, low-tension glaucoma, restless legs syndrome and Raynaud phenomenon.
The association between epilepsy and migraine has been long recognized and, more recently, some antiepileptic drugs have been proven effective in migraine prophylaxis. Although the common molecular mechanisms remain so far quite elusive, increased cortical excitability may be a shared feature underlying such comorbidity between epilepsy and migraine.
Migraine, dizziness, and vertigo are all common in the general population, but their co-occurrence is higher than expected by chance, suggesting that vestibular symptoms may be part of the migraine presentation.
Also metabolic factors have been recently related to migraine and, especially, to migraine chronicization. Impairment of glucose metabolism has been reported in migraine, and recent data on the effects of insulin on brain functions lend support to the possibility that insulin is involved in the pathogenesis of migraine.
Psychiatric and physical comorbidities of migraine, not only may highlight some pathophysiological aspects, but have relevant implications for both the diagnosis and treatment of this primary headache.
Identifying and managing comorbidities of migraine is mandatory for an integrated disease management strategy. For instance, reduction of cardiovascular risk factors, smoking cessation and use of non-oestrogen-containing oral contraceptives in female patients are beneficial strategies to reduce the risk of ischaemic events in patients with migraine, especially those with aura. Although antidepressants in general share comparable efficacy in reducing symptoms of comorbid depression in headache patients, their efficacy as headache preventives varies widely and requires further studies to be better clarified.
This research topic is aimed at outlining “the state of the art” about migraine and its plentiful comorbidities. We are interested in original research articles, opinion articles, reviews, case studies, or any original contribution focusing on: 1) epidemiological aspects of migraine psychiatric and somatic comorbidities; 2) pathophysiological aspects of migraine psychiatric and somatic comorbidities; 3) implications of comorbidities for the diagnosis and treatment of migraine; 4) economical implications of migraine comorbidities.


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