Migraine and frontostriatal circuit disorders: What have we learned until now?

Abstract

Even though there is a recognized association, the causation between chronic migraine (CM) and frontostriatal circuit (FSC) disorders that were commonly presented as anxiety disorders, depression, tic disorders, and attention-deficit hyperactivity disorders in routine headache outpatient is yet to be fully disclosed. Medication-overuse headache (MOH) and CM recognizedly affect complex neural systems, including the FSC. Referenced circuits constitute a part of a circle that consists of the cortex, striatum, and thalamus regions and they transmit the data from the cerebral cortex to the subcortex. The above-mentioned circles end up once again in the determined region of the cerebral cortex. Five different FSCs have been described above which circulate among the specific parts of the cortex, namely supplementary motor area, frontal eye fields, dorsolateral prefrontal cortex, lateral orbitofrontal cortex, and anterior cingulate cortex with various subconnections and serve to various functions. Based on the scientific data with an emphasis on the clinical perspective, this paper aims to show the potential causative relationship between common FSC disorders and CM with or without MOH. The results also highlighted the importance of psychiatric comorbidities, as being far from a coincidence, and promoted the application of preventive medicine and interventions including lifestyle changes, cognitive-behavioral treatment, and neuromodulation. Integrative and multidisciplinary management strategies are essential for a comprehensive migraine coping approach in the society.