DOPAMINERGIC DYSFUNCTION IN MIGRAINE AND PSYCHOSIS: A NEUROPSYCHIATRIC REVIEW

Migraine is increasingly recognized as a disorder with both neurological and psychiatric dimensions, withincreasing evidence suggesting a strong link between migraine and psychotic disorders through shareddopaminergic dysfunction. Both conditions exhibit dopamine hypersensitivity, neurotransmitter imbalances, andaltered cortical excitability, raising concerns that migraineurs, particularly those with aura, may be at increasedrisk of developing psychotic symptoms. This review explores the neurobiological overlap between migraine andpsychosis, focusing on shared pathophysiological mechanisms, nseuroimaging findings, and clinical evidence. Acomprehensive analysis of neuroimaging studies, pharmacological trials, and clinical cohort data indicates thatcompared with nonmigraine individuals, migraineurs have a greater prevalence of psychiatric comorbidities,including transient psychotic symptoms. Additionally, dopamine receptor dysfunction, a hallmark of psychoticdisorders, has been implicated in migraine pathophysiology, further reinforcing their connection. Neuroimagingstudies revealed increased presynaptic dopamine activity under both conditions, whereas dopamine antagonists—commonly used to treat psychosis—have demonstrated efficacy in alleviating migraine symptoms, suggestingpotential therapeutic overlap. However, long-term use of dopamine-modulating treatments carries risks, includingextrapyramidal side effects and metabolic disturbances, necessitating careful clinical consideration. Despitecompelling associations, the causal relationship between migraine and psychosis remains uncertain owing tomethodological limitations in existing research, such as cross-sectional designs and small cohort sizes. Futurestudies should prioritize longitudinal analyses, genetic investigations, and advanced neuroimaging techniques toclarify this relationship and identify high-risk individuals. Recognizing the psychiatric risks associated withmigraine may improve early intervention strategies and support the development of integrated neurological andpsychiatric treatment approaches, ultimately enhancing patient outcomes. Categories: Neurology, Psychiatry.