Exploring the Dynamic Relationship Between Migraine and Functional Neurological Disorders: A Narrative Review

Headache and functional neurologic disorders (FND) are the most diagnosed neurologic disorders, yet their relationship has not been comprehensively detailed. Understandings of migraine and FND have each progressed tremendously. Headache may be the most common neurologic comorbidity in FND. Migraine may be identified as a predisposing factor and predate FND up to ten years. Schemas have been proposed to explain potential relationship and shared pathophysiologic mechanisms; the disorders share multiple comorbidities. Headache may contribute to disability in FND. Treatment of migraine may improve functional symptoms; both entities respond to multidisciplinary approaches. Migraine and FND commonly coexist, contributing to overall disability and decreased quality of life (QOL). Pathophysiologic interactions may impact management and outcomes. Headache history should be obtained in FND patients; headache when present should be treated appropriately. Future research should evaluate FND in cohorts of headache patients and if headache treatment could improve symptoms and QOL for specific FND phenotypes.