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Migraine: beyond pain
  1. Nazia Karsan1,
  2. Peter J Goadsby1,2
  1. 1 NIHR-Welcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, London, UK
  2. 2 University of California, Los Angeles, California, USA
  1. Correspondence to Dr Nazia Karsan, Headache Group, King's College London, London, UK; nazia.karsan{at}


Most people who see, treat or experience migraine will be aware that its clinical manifestations exceed the symptom of head pain. However, available acute treatments so far have targeted migraine symptoms only in the context of the pain phase of an attack. The associated disability clearly involves more than just these symptoms, and the phenotype can include additional painless features, including alterations in mood, cognition and homeostasis and sensory sensitivities. Recognising these symptoms, understanding their neurobiological basis and systematically recording them prospectively in clinical therapeutic trials are likely to offer valuable pathophysiological and therapeutic insights into this complex brain disorder, ultimately helping to improve the quality of lives of sufferers. We aim to explore the multifaceted disorder that is migraine, with a particular focus on the non-painful non-aura symptoms.

  • migraine
  • headache
  • paediatric neurology
  • pain

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  • Contributors NK was responsible for reviewing the literature, collating opinions and writing the manuscript, including formulations of the tables and figure. PJG provided expert opinion and reviewed and edited the manuscript prior to submission.

  • Funding Some of the work of our team discussed here was funded by the Migraine Trust and an Association of British Neurologists and Guarantors of Brain Clinical Research Training Fellowship awarded to NK.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally reviewed by Nicola Giffin, Bath, UK.

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  • Editors’ commentary
    Phil E M Smith Geraint N Fuller

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