Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Neuroalgology Unit and Headache Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
J Headache Pain. 2022 Aug 11;23(1):100. doi: 10.1186/s10194-022-01471-3.
Migraine is a complex condition in which genetic predisposition interacts with other biological and environmental factors determining its course. A hyperresponsive brain cortex, peripheral and central alterations in pain processing, and comorbidities play a role from an individual biological standpoint. Besides, dysfunctional psychological mechanisms, social and lifestyle factors may intervene and impact on the clinical phenotype of the disease, promote its transformation from episodic into chronic migraine and may increase migraine-related disability.Thus, given the multifactorial origin of the condition, the application of a biopsychosocial approach in the management of migraine could favor therapeutic success. While in chronic pain conditions the biopsychosocial approach is already a mainstay of treatment, in migraine the biomedical approach is still dominant. It is instead advisable to carefully consider the individual with migraine as a whole, in order to plan a tailored treatment. In this review, we first reported an analytical and critical discussion of the biological, psychological, and social factors involved in migraine. Then, we addressed the management implications of the application of a biopsychosocial model discussing how the integration between non-pharmacological management and conventional biomedical treatment may provide advantages to migraine care.
偏头痛是一种复杂的疾病，其遗传易感性与其他生物和环境因素相互作用，决定其病程。从个体生物学角度来看，大脑皮质过度反应、疼痛处理的外周和中枢改变以及合并症都起着一定的作用。此外，功能失调的心理机制、社会和生活方式因素可能会介入并影响疾病的临床表型，促使其从偶发性偏头痛转变为慢性偏头痛，并可能增加偏头痛相关的残疾。因此，鉴于偏头痛的多因素发病机制，在偏头痛的管理中应用生物心理社会方法可能有助于治疗成功。虽然在慢性疼痛疾病中，生物心理社会方法已经是治疗的主要方法，但在偏头痛中，生物医学方法仍然占主导地位。相反，建议仔细考虑偏头痛患者作为一个整体，以便制定个性化的治疗方案。在这篇综述中，我们首先报告了偏头痛中涉及的生物学、心理学和社会因素的分析和批判性讨论。然后，我们讨论了应用生物心理社会模型的管理意义，探讨了非药物管理与传统生物医学治疗相结合如何为偏头痛护理提供优势。
