Pathophysiological Bases of Comorbidity in Migraine

Abstract

Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.

Questionnaire-based survey on the prevalence of medication-overuse headache in Japanese one city—Itoigawa study

“…Although it is a matter of speculation, we may categorize MOH into three types: young people who have just started working and experienced severe stress specific to the young workers [ 32 ], middle-aged people who are busy with both work and child-rearing, and the older probably with mild cognitive disorder or anxiety who uses frequent analgesic. The older also tend to have common comorbidities like other pain syndromes, sleep-related disorders, and gastrointestinal disorders, which aggravate migraine, supposedly leading to MOH development [ 33 ]. Given the social background where developing MOH, classification based on age and frequency of medication may be an important perspective.…”

Changes in Plasma Lipid Levels Following Cortical Spreading Depolarization in a Transgenic Mouse Model of Familial Hemiplegic Migraine

“…Taken together, our findings are consistent with previously identified migraine-relevant lipid mediators associated with headache pain mechanisms and associated neuroinflammatory changes, and underscore the potential that peripheral plasma lipid mediator changes can give insights to central migraine mechanisms, in particular in the context of the aura phase and hemiplegic migraine. Given the overlap in their pathophysiology, the observed changes in peripheral body fluids may be of relevance also for other central nervous system disorders that are comorbid with migraine, such as epilepsy and stroke [ 67 ].…”

Kynurenine Pathway of Tryptophan Metabolism in Migraine and Functional Gastrointestinal Disorders

“…Migraine was associated with Helicobacter pylori infection in several studies (reviewed in [ 1 , 2 ]). A meta-analysis including five case–control studies showed a higher H. pylori infection in migraineurs than controls (33%) [ 140 ].…”

“…Functional disorders of the gastrointestinal (GI) tract are frequently associated with neurological diseases, including migraine, and are a serious diagnostic problem due to nonspecific syndromes (reviewed in [ 1 , 2 ]). Migraine is bidirectionally comorbid with several other disorders, including neurological, psychiatric, cardio- and cerebrovascular, GI, metaboloendocrine, and immunological diseases [ 3 ].…”

“…Many papers report an association between migraine and functional GI disorders, and most of them underline the need for further research to identify common areas of physiology, but few works show a specific direction of such studies (reviewed in, e.g., [ 1 , 2 , 5 , 27 , 28 ]).…”