Applying a biopsychosocial model to migraine: rationale and clinical implications

Abstract

Migraine is a complex condition in which genetic predisposition interacts with other biological and environmental factors determining its course. A hyperresponsive brain cortex, peripheral and central alterations in pain processing, and comorbidities play a role from an individual biological standpoint. Besides, dysfunctional psychological mechanisms, social and lifestyle factors may intervene and impact on the clinical phenotype of the disease, promote its transformation from episodic into chronic migraine and may increase migraine-related disability.Thus, given the multifactorial origin of the condition, the application of a biopsychosocial approach in the management of migraine could favor therapeutic success. While in chronic pain conditions the biopsychosocial approach is already a mainstay of treatment, in migraine the biomedical approach is still dominant. It is instead advisable to carefully consider the individual with migraine as a whole, in order to plan a tailored treatment. In this review, we first reported an analytical and critical discussion of the biological, psychological, and social factors involved in migraine. Then, we addressed the management implications of the application of a biopsychosocial model discussing how the integration between non-pharmacological management and conventional biomedical treatment may provide advantages to migraine care.

Does the Intensity of the Headache Differ According to the Level of Neck Disability in Chronic Migraine Patients?

“…In light of the results of the literature studies and our findings, we think that evaluation and treatment methods may need to be shaped differently. In addition to drug therapy, patients can be given patient and pain education [ 34 ], a biopsychosocial model can be applied [ 35 ] or physical therapy and rehabilitation practices can be recommended [ 36 ]. Rezaeian et al evaluated migraine patients in two groups as treatment and control groups and used myofascial release and stretching methods in the treatment group.…”

“…In future studies, this situation can be generalized with different clinics and sample sizes. Finally, while NDI evaluates activities that require strength and stability, it also evaluates concentration and pain parameters, which can be affected by psychological, social, and work conditions [ 35 , 38 ]. Since our study was a retrospective study, we could not evaluate psychological, social, and work conditions.…”

A Preliminary Analysis on the Feasibility and Short-Term Efficacy of a Phase-III RCT on Mindfulness Added to Treatment as Usual for Patients with Chronic Migraine and Medication Overuse Headache

“…Migraines arise out of the interaction between biological mechanisms, environmental and lifestyle issues, and psychological factors [ 7 ]. Examples of the first include genetic predisposition and comorbidities [ 8 ], which support the use of medications for prophylaxis and acute treatment.…”

“…In addition to this, many studies compared mindfulness against waitlist, i.e., to non-treatment, which is clearly not what would be undertaken in standard practice. As previously stated, migraines (including CM-MOH) require a biopsychosocial approach in which biological mechanisms, environmental and lifestyle issues, and psychological factors are jointly addressed [ 7 ]. In a pilot non-randomized study, we showed that the 12-month course of headache frequency and medication intake in patients with CM and MOH, was similar between patients under pharmacological prophylaxis only and patients attending six mindfulness-based sessions only [ 34 ].…”

Correction: Applying a biopsychosocial model to migraine: rationale and clinical implications

“…Following the publication of the original article [ 1 ], we were notified that the arrows displayed in Fig. 4 were misaligned in the pdf version of the paper.…”