Abstract

Dopaminergic Dysfunction in Migraine and Psychosis: A Neuropsychiatric Review

Author(s): Rithin Jacob Antony Rajan, Roshini Esther

Migraine is increasingly recognized as a disorder with both neurological and psychiatric dimensions, with growing evidence suggesting a strong link between migraine and psychotic disorders through shared dopaminergic dysfunction. Both conditions exhibit dopamine hypersensitivity, neurotransmitter imbalances, and altered cortical excitability, raising concerns that migraineurs, particularly those with aura, may be at increased risk of developing psychotic symptoms. This review explores the neurobiological overlap between migraine and psychosis, focusing on shared pathophysiological mechanisms, neuroimaging f indings, and clinical evidence. A comprehensive analysis of neuroimaging studies, pharmacological trials, and clinical cohort data indicates that migraineurs experience a higher prevalence of psychiatric comorbidities, including transient psychotic symptoms, compared to non-migraine populations. Additionally, dopamine receptor dysfunction, a hallmark of psychotic disorders, has been implicated in migraine pathophysiology, further reinforcing their connection. Neuroimaging studies reveal increased presynaptic dopamine activity in both conditions, while dopamine antagonists—commonly used to treat psychosis—have demonstrated efficacy in alleviating migraine symptoms, suggesting a potential therapeutic overlap. However, long-term use of dopamine modulating treatments carries risks, including extrapyramidal side effects and metabolic disturbances, necessitating careful clinical consideration. Despite compelling associations, the causal relationship between migraine and psychosis remains uncertain due to methodological limitations in existing research, such as cross-sectional designs and small cohort sizes. Future studies should prioritize longitudinal analyses, genetic investigations, and advanced neuroimaging techniques to clarify this relationship and identify high-risk individuals. Recognizing the psychiatric risks associated with migraine may improve early intervention strategies and support the development of integrated neurological and psychiatric treatment approaches, ultimately enhancing patient outcomes.