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Pathophysiology and Therapy of Associated Features of Migraine

Research output: Contribution to journalReview articlepeer-review

Original languageEnglish
Article number2767
Issue number17
Published5 Sep 2022

Bibliographical note

Funding Information: M.D.V.-M. has no conflict of interest. P.J.G. reports, over the last 36 months, grants and personal fees from Eli-Lilly and Company, a grant from Celgene, and personal fees from Aeon Biopharma, Allergan/Abbvie, Amgen, Biodelivery Sciences Intern, Biohaven Pharmaceuticals Inc., CoolTech LLC, Reddys, Epalex, Impel Neuropharma, Lundbeck, Novartis, Praxis, Sanofi, Satsuma and Teva Pharmaceuticals, and personal fees for advice through the Gerson Lehrman Group, Guidepoint, SAI Med Partners, Vector Metric, and fees for educational materials from CME Outfitters, Omnia Education, WebMD, and publishing royalties or fees from the Massachusetts Medical Society, Oxford University Press, UptoDate and Wolters Kluwer, and for medicolegal advice on headaches, and a patent magnetic stimulation for headaches (No. WO2016090333 A1) assigned to eNeura without fees. Funding Information: The research was funded, in part, by the National Institute for Health and Social Care Research (NIHR203970). The APC was funded by King’s College London. Publisher Copyright: © 2022 by the authors.

King's Authors


Migraine is a complex and debilitating disorder that is broadly recognised by its characteristic headache. However, given the wide array of clinical presentations in migraineurs, the headache might not represent the main troublesome symptom and it can even go unnoticed. Understanding migraines exclusively as a pain process is simplistic and certainly hinders management. We describe the mechanisms behind some of the most disabling associated symptoms of migraine, including the relationship between the central and peripheral processes that take part in nausea, osmophobia, phonophobia, vertigo and allodynia. The rationale for the efficacy of the current therapeutic arsenal is also depicted in this article. The associated symptoms to migraine, apart from the painful component, are frequent, under-recognised and can be more deleterious than the headache itself. The clinical anamnesis of a headache patient should enquire about the associated symptoms, and treatment should be considered and individualised. Acknowledging the associated symptoms as a fundamental part of migraine has permitted a deeper and more coherent comprehension of the pathophysiology of migraine.

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