Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?

Nazia Karsan, Peter J Goadsby, Nazia Karsan, Peter J Goadsby

Abstract

Migraine is a symptomatically heterogeneous condition, of which headache is just one manifestation. Migraine is a disorder of altered sensory thresholding, with hypersensitivity among sufferers to sensory input. Advances in functional neuroimaging have highlighted that several brain areas are involved even prior to pain onset. Clinically, patients can experience symptoms hours to days prior to migraine pain, which can warn of impending headache. These symptoms can include mood and cognitive change, fatigue, and neck discomfort. Some epidemiological studies have suggested that migraine is associated in a bidirectional fashion with other disorders, such as mood disorders and chronic fatigue, as well as with other pain conditions such as fibromyalgia. This review will focus on the literature surrounding alterations in fatigue, mood, and cognition in particular, in association with migraine, and the suggested links to disorders such as chronic fatigue syndrome and depression. We hypothesize that migraine should be considered a neural disorder of brain function, in which alterations in aminergic networks integrating the limbic system with the sensory and homeostatic systems occur early and persist after headache resolution and perhaps interictally. The associations with some of these other disorders may allude to the inherent sensory sensitivity of the migraine brain and shared neurobiology and neurotransmitter systems rather than true co-morbidity.

Keywords: cognition; fatigue; migraine; mood; sleep.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Karsan and Goadsby.

Figures

FIGURE 1
FIGURE 1
A summary of brain areas likely to be involved in mediating both pain and mood and arousal complaints in migraine via structural and functional connections. Thalamocortical pathways that modulate sensory and cognitive processing are also involved. Neurotransmitters implicated in these areas in migraine are shown in green. *Specific cortical areas implicated include dorsolateral prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, and the primary somatosensory cortex. Areas highlighted in red are likely to also have a role with their associated neurotransmitters in fatigue and mood.

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