Migraine in the context of chronic primary pain, chronic overlapping pain disorders, and functional somatic disorders: A narrative review

Abstract

Objective To contextualize migraine as the most common primary headache disorder in relation to other chronic primary pain and non‐pain functional somatic and mental conditions. Background Migraine is increasingly understood as a sensory processing disorder within a broader spectrum of symptom disorders. This has implications for diagnosis and treatment. Method Narrative review based on a search of the literature of the last 15 years on the overlap of migraine with other symptom disorders. Results Migraine as the prototypical primary headache disorder not only comprises many non‐headache symptoms in itself, it also shows high comorbidity with other chronic pain and non‐pain conditions (e.g., fibromyalgia syndrome, irritable bowel syndrome, functional non‐epileptic seizures, depression, anxiety, and posttraumatic stress disorder). Such “symptom disorders” share several etiological factors (e.g., female preponderance, psychological vulnerability) and psychophysiological mechanisms (e.g., altered sensory processing, pain expectancy). These facts are acknowledged by several recent integrative conceptualizations such as chronic primary pain, chronic overlapping pain conditions, or functional somatic disorders. Accordingly, migraine management increasingly addresses the total symptom burden and individual contributors to symptom experience, and thus incorporates centrally acting pharmacological and non‐pharmacological, that is, psychological and behavioral, treatment approaches. Conclusions Migraine and also other primary headache disorders should be seen as particular phenotypes within a broader spectrum of symptom perception and processing disorders that require integrative diagnostics and treatment. A harmonization of classifications and better interdisciplinary collaboration are desirable.

Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine

“…Co-morbid pain conditions are very common in migraine with one study reporting that 51% of patients with migraine have one or more concurrent pain condition(s) ( 38 ). That number increases past 70% in patients with chronic migraine ( 38 ).…”

“…Co-morbid pain conditions are very common in migraine with one study reporting that 51% of patients with migraine have one or more concurrent pain condition(s) ( 38 ). That number increases past 70% in patients with chronic migraine ( 38 ). Fibromyalgia has been reported in 10–30% of patients with migraine with one study finding increased headache frequency to be predictive ( 38 ).…”

Does pain self-efficacy predict, moderate or mediate outcomes in people with chronic headache; an exploratory analysis of the CHESS trial

“…Self-efficacy is a person’s conviction in their ability to manage events, situations and reach goals especially when under stress [ 12 ]. It is increasingly recognised that the management of primary headache disorder such as migraine needs to be embedded in a biopsychosocial context recognising the overlap with psychological distress and other primary pain disorders [ 13 ]. The same authors advocate the promotion of self-efficacy and an internal locus of control as first-line non-pharmacological treatments for migraine [ 13 ].…”

Does pain self-efficacy predict outcomes in people with migraine; an exploratory analysis of the CHESS trial

“…(12) It is increasingly recognised that the management of primary headache disorder such as migraine needs to be embedded in a biopsychosocial context recognising the overlap with psychological distress and other primary pain disorders. (13) The same authors advocate the promotion of self-e cacy and an internal locus of control as rst-line non-pharmacological treatments for migraine. (13) In 2022, following a substantial amount of preparatory work we published a randomised controlled trial (N = 727) of an education and self-management support intervention for people with chronic headaches (chronic migraine + chronic tension type headache and episodic migraine) (14,15); the CHESS trial.…”

“…(13) The same authors advocate the promotion of self-e cacy and an internal locus of control as rst-line non-pharmacological treatments for migraine. (13) In 2022, following a substantial amount of preparatory work we published a randomised controlled trial (N = 727) of an education and self-management support intervention for people with chronic headaches (chronic migraine + chronic tension type headache and episodic migraine) (14,15); the CHESS trial. The primary outcome was the Headache Impact Test − 6 (HIT-6) at 12 months.…”