Understanding Migraine: A Comprehensive Overview

Migraine is not merely a severe headache. It is a complex disorder affecting how the nervous system processes incoming information. This condition manifests in various ways, extending far beyond just head pain. Understanding migraine in this context alters our perception of the condition, the individuals it impacts, and the associated issues that may initially seem unrelated.

This post continues a theme from previous articles at Peek Practice: pain is an output of the nervous system, not merely a reflection of damage. Some nervous systems are more prone to generating pain, and migraine serves as a clear example of this concept.

Sensory Overwhelm

Every moment, the nervous system receives two streams of information. The first stream comes from the external world—light, sound, smell, touch, and movement. The second stream originates from within the body, encompassing sensations like gut activity, heartbeat, breath, and balance. The first stream is termed exteroception, while the second is known as interoception. Both streams require processing by the brain, which handles billions of sensory inputs continuously. Most of this data is not consciously experienced, allowing us to function effectively.

The regulation or inhibition of incoming signals is an active process. The nervous system works to quiet signals deemed unimportant. This process is referred to as inhibition. A well-regulated system inhibits effectively: you do not feel your clothing against your skin, hear the hum of the room, or notice your own digestion. However, when inhibition weakens, irrelevant information may "escape," activating brain areas that may warrant attention, regardless of their actual importance.

Migraine Is a Problem of Weak Inhibition

Migraine represents an inherited tendency for the brain to lose control over its inputs. The migraine nervous system is hyper-responsive to light, sound, smell, and mechanical inputs. It is slower to settle when the same signal repeats and does not adapt to stimuli like a typical system. Importantly, these characteristics persist even between attacks. The migraine nervous system does not fully reset; it remains closer to the edge, with less inhibition available.

From this perspective, a migraine attack signifies the system tipping over a threshold it has been hovering near. Recognizable triggers—such as bright screens, strong smells, missed meals, poor sleep, or barometric shifts—are not causes but rather the final push for a system with little margin to spare. This understanding positions migraine as a disorder of sensory processing, rather than a problem confined to the head.

The Body's Inner Signals Count Too

Migraine is not solely about external stimuli. It also involves how the nervous system interprets internal signals. Symptoms like nausea, a sensitive gut, light-headedness, and various autonomic symptoms are part of the same event—indicating that the inner stream of information is left unregulated and overreacted to. Contemporary research frames part of migraine as a problem of interoceptive prediction. The nervous system continuously forecasts what the body is about to do, but in migraine, these forecasts and the responses to them can become distorted.

Interestingly, recent studies suggest that the raw signal itself may not be louder; interoceptive accuracy can be broadly normal. However, the interpretation of these signals and the behavioral responses to them are altered. The issue lies not in the volume of the signals but in the failure to modulate them. This explains why migraine frequently coexists with conditions like irritable bowel syndrome, dizziness, and autonomic symptoms. These are not separate coincidences but rather manifestations of the same weak inhibition within the body's internal environment. When the balance system is involved, the presentation may resemble vestibular migraine or changes in inner ear pressure, as seen in Menière’s disease. This is why a vestibular migraine expert may consider the entire sensory system rather than focusing solely on the inner ear.

Why Migraine Permeates a Whole Life

Migraine ranks among the most disabling conditions globally and is the second most common neurological disorder. This ranking is not solely based on the duration of an attack. Literature indicates that migraine often co-occurs with insomnia, anxiety, depression, and gut disorders at approximately three times the background rate. The more frequent the attacks, the more these associated conditions cluster together.

The aspect that the phrase "just a headache" overlooks is the life experienced between attacks. This includes the anticipation of the next episode, cognitive fog, and the careful management of everyday environments that most people take for granted. A supermarket aisle, an open-plan office, or a fluorescent-lit waiting room can be overwhelming for a nervous system unable to quieten its inputs. Migraine shapes work, sleep, mood, and relationships long after the pain has subsided. Treating only the attack while neglecting the underlying system that produces it addresses only a fraction of the burden.

ADHD and the Same Regulatory Theme

ADHD fundamentally involves difficulties with regulation—holding back irrelevant information, managing responses amid competing demands, and restraining impulses before they escalate. This regulatory challenge mirrors the issues seen in migraine, albeit expressed in a different context. Research indicates a significant overlap between the two conditions: migraine is approximately three times more common in children with ADHD and their mothers. Adults with ADHD also exhibit altered pain responses that may partially normalise with stimulant medication.

This suggests a shared theme underlying both conditions—a nervous system that inhibits and regulates incoming information less efficiently, whether that information is sensory, bodily, or cognitive. It is essential to recognise that this does not mean merging distinct diagnoses into one or suggesting that everyone with migraine has ADHD or vice versa. Rather, it highlights the regulatory thread that informs a sensible assessment and treatment plan.

The Quieter Members of the Family

Full-blown migraine can be viewed as one of the more evident expressions of the sensitivity spectrum. Chronic tension-type headache (CTTHA), recurrent neck and back pain, and body pain often represent less obvious signs of a system that is more responsive. These conditions reflect a nervous system with a weaker off-switch, generating pain at a lower input threshold than the tissue state alone would warrant. For instance, mechanical stimuli from everyday activities may be interpreted as damage or threat, resulting in a life filled with more pain. The International Association for the Study of Pain now categorises such conditions under nociplastic pain. Clinicians increasingly refer to chronic overlapping pain conditions to capture how frequently these issues appear together in the same individual.

A person experiencing migraine, recurrent neck pain, a sensitive gut, and disrupted sleep likely shares this predisposition, rather than being classified as having separate conditions.

What This Means When We Assess You

Recognising these patterns alters the assessment process. There are two critical questions to consider: the first is structural—are there any mechanical issues, such as a joint, nerve, or tissue problem that requires specific diagnosis and management? The second question is regulatory—why is this nervous system generating pain or amplifying sensations at this level of input?

A comprehensive assessment must address both questions. Focusing solely on the first question leaves the larger driver unexamined. This is often the value of seeking a second opinion on persistent headaches, neck, or back pain. The initial inquiry should not only be about which structure is at fault but also about why the system is responding in this manner. At Peek Practice, our Chiropractic Orthopaedist in Auckland is well-equipped to address both questions simultaneously. The combination of expert diagnostic skills and formal postgraduate training in pain allows for a thorough examination of both structural and regulatory aspects in a single consultation.

Where a structural problem exists, it is diagnosed and managed directly. If a more sensitive nervous system with weak inhibition significantly contributes to the situation, management may involve explaining the underlying mechanisms in straightforward terms, gradually returning to activity and sensory load, and focusing on sleep and autonomic regulation. In cases requiring further investigation, referrals to musculoskeletal, neurology, or pain medicine specialists may be appropriate.

The essential question to start with is not just where the pain is located, but why this nervous system is shaping this person's behavior in such a manner.

FAQs

Is migraine just a severe headache?

No. Migraine is a disorder of how the nervous system processes and regulates information—from the external environment and from within the body. Headache is only one symptom among many, including sensitivity to light and sound, nausea, dizziness, and cognitive fog.

How are migraine and ADHD connected?

They appear to share a regulatory theme—a nervous system that inhibits incoming information less efficiently. Research shows that migraine is around three times more common in children with ADHD and their mothers. While they are distinct conditions, the overlap is significant.

What is interoception and why does it matter in migraine?

Interoception refers to the sense of the body's internal state—such as gut activity, heartbeat, breath, and balance. In migraine, the interpretation and response to these internal signals can be altered, explaining the nausea, gut sensitivity, and dizziness that often accompany attacks and persist between them.

Why do my migraine, neck pain, and gut symptoms occur together?

These may be expressions of how the nervous system responds to its environment rather than separate problems. Such conditions are classified as nociplastic pain and chronic overlapping pain conditions, reflecting shared central nervous system mechanisms rather than mere coincidence.

Can a Chiropractic Orthopaedist help with migraine?

Yes. A full assessment at Peek Practice, Grey Lynn, Auckland evaluates both the structural and regulatory dimensions of a presentation. This process explains the mechanisms involved, guides graded management, and coordinates referrals to neurology or vestibular services when necessary.

References

Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. (2017). Pathophysiology of migraine: a disorder of sensory processing. Physiological Reviews, 97(2), 553-622.

de Tommaso M, et al. (2014). Altered processing of sensory stimuli in patients with migraine. Nature Reviews Neurology, 10(3), 144-155.

Charles A. (2018). The pathophysiology of migraine: implications for clinical management. Lancet Neurology, 17(2), 174-182.

Burch RC, Buse DC, Lipton RB. (2019). Migraine: epidemiology, burden, and comorbidity. Neurologic Clinics, 37(4), 631-649.

Buse DC, et al. (2020). Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and frequency (MAST Study). Journal of Headache and Pain, 21, 23.

Kutuk MO, et al. (2018). Migraine and associated comorbidities are three times more frequent in children with ADHD and their mothers. Brain & Development, 40(10), 857-864.

Miglis MG. (2018). Migraine and autonomic dysfunction: which is the horse and which is the jockey? Current Pain and Headache Reports, 22, 19.

Fitzcharles MA, et al. (2021). Nociplastic pain: towards an understanding of prevalent pain conditions. The Lancet, 397(10289), 2098-2110.