Migraine is a very common neurologic disorder, characterized by recurrent attacks of severe
headache, autonomic nervous system dysfunction and in some patients by an aura.
Background: Migraine is a very common neurologic disorder of neuro-vascular origin, being
amongst the 20 most disabling diseases. Migraine attacks are characterized by severe headache, associated
to autonomic nervous system dysfunction and in some patients by aura.
Pathophysiology and Role of Central Sensitization: Abnormal neuronal excitability may subtend altered
processing of sensory stimuli, leading to cortical spreading depression and trigeminal activation.
A dysfunction of pain modulation enhances central sensitization phenomena, contributing to acute allodynia and headache
persistence. The peculiarity of migraine pain facilitates the use of analgesics, and causes an adjunctive invalidating tendency
toward drug over-use.
Comorbidity: Chronic migraine patients are frequently affected by diffuse pain, framed in fibromyalgia diagnosis. This
comorbidity seems to be supported by common pathophysiological mechanisms. It may aggravate migraine invalidity being
worth of consideration for therapeutic management.
Migraine Management: Acute and preventive treatments need to be tailored to single cases. Main comorbidity and factors
facilitating central sensitization should be taken into account. The management of migraine patients should include a
link between headache centers and general practitioner, in order to provide for a better patient information and treatment
just at the onset of the disease.
Conclusions: Despite its high epidemiologic impact, migraine is frequently underestimated and destined to evolve into
chronic form and drugs abuse. A more focused attention to factors facilitating central sensitization and invalidating comorbidities,
should reduce the global burden of the disease. Key words: migraine, pathophysiology, central sensitization,
fibromyalgia comorbidity, acute and preventive therapy, patients – centered approach.