XASIM Feb. p56-64

Migraine is a constellation of neurological symptoms with variable disease progression. Despite the standardization of migraine diagnosis with the International Headache Society (IHS) criteria, its etiology eludes medical research because its complexity as a disease lies in the multiple factors involved in migraine onset. The study of migraine genetics is providing important clues to the pathophysiology of migraine, but the results indicate a complex interaction between numerous factors. The frequent comorbidity of migraine with several other disorders may be used to discover the mechanisms of onset as well as optimizing therapeutic strategies. This paper reviews the current hypotheses regarding migraine nature and the role of comorbidity in migraine diagnosis and management. Implications for therapeutic strategies are also discussed. (Advanced Studies in Medicine 2001;1(2):55–63) M igraine is a complex, chronic disease characterized by intermittent attacks of severe headache and autonomic and neurological symptoms. It is a very common disorder with a wide range of clinical presentations. The diagnostic classification criteria published by the International Headache Society (IHS) have been of inestimable value in identifying and diagnosing migraine and in the differential diagnosis of other primary headache disorders. However, the complexity of migraine as a disease lies in the multiple factors involved in its pathophysiology. These factors include gender, psychosocial factors/life events, genetics, and comorbidity with other diseases. Thus, while we appear to understand migraine on the surface based on its nosology, there are many aspects of its pathophysiology that remain under investigation. The disease mechanisms result in myriad clinical presentations, and our lack of understanding potentially limits our ability to optimally treat migraine patients. The IHS criteria help define migraine in terms of attack (ie, the duration, the pain characteristics, the presence of nausea or vomiting, and the presence of photoor phonophobia as well as prodromes), while migraine is also characterized by other variable factors, such as association with other diseases and different ages of onset, response to provocative tests, response to prophylaxis, evolution, and outcome. Heterogeneity (in both attacks and disease) is referred to as the “migraine complex” and is the rule rather than the exception. Migraine heterogeneity must be considered in decisions regarding diagnosis and therapeutic approaches. PROCEEDINGS