Migraine & ALPIMS
Migraine is more than a headache condition. For some people, it sits within a much wider pattern involving autonomic regulation, connective tissue, pain processing, immune and inflammatory processes, mood and trauma, sensory processing and neurodevelopmental differences.
Migraine can be part of a bigger picture
People with migraine can experience symptoms and conditions affecting many different parts of the body.
Some are part of migraine itself. Some are separate conditions that occur more often alongside migraine. Others may coexist and add to the person’s overall symptom, treatment and everyday-life burden.
ALPIMS provides a way to organise this wider picture.
Migraine frequently sits within broader patterns involving autonomic regulation, connective tissue, pain processing, immune and inflammatory processes, mood and trauma, and sensory or neurodevelopmental differences.
That does not mean everyone with migraine has these conditions, or that migraine causes them.
A broader way to look at migraine
Someone seeking help for migraine may also be managing dizziness, joint problems, widespread pain, gut symptoms, allergies, fatigue, sensory sensitivity, sleep problems, anxiety or neurodevelopmental differences.
Explore migraine through the ALPIMS domains
Tap a domain to see some of the conditions and experiences that may occur alongside migraine.
Anxiety & Autonomic
Migraine and autonomic symptoms can overlap. The autonomic nervous system helps regulate functions such as heart rate, blood pressure, digestion, temperature, sweating and responses to standing.
Migraine itself can also produce autonomic symptoms, so an autonomic symptom does not automatically mean a separate autonomic disorder is present.
Laxity & Connective Tissue
Migraine is commonly reported in people with hypermobility and connective-tissue disorders.
The wider picture may include joint instability, neck symptoms, TMJ problems, musculoskeletal pain and autonomic conditions such as POTS.
Pain & Bodily Sensitivity
Migraine can occur alongside other persistent pain conditions. When several pain conditions coexist, the person’s overall pain burden may be much greater than any individual diagnosis suggests.
Immune & Inflammatory
Some people with migraine also live with allergic, inflammatory, autoimmune or post-infectious conditions.
These should not automatically be assumed to share one cause. They can, however, interact through symptoms, sleep, fatigue, medication tolerance and overall physiological load.
Mood & Mental Health
Anxiety, depression and PTSD occur more often among people with migraine than in the general population.
This does not mean migraine is caused by anxiety, psychological weakness or negative thinking. Living with recurrent neurological symptoms can itself create substantial emotional, social and functional burden.
Sensory & Neurodevelopmental
Migraine itself can substantially change sensory processing. Light, sound, smell, touch and movement may become much more difficult to tolerate before, during or after an attack.
Some people also have longer-standing sensory or neurodevelopmental differences that exist independently of migraine.
Not everything fits neatly into one box
ALPIMS domains are organising tools rather than rigid biological categories. Some conditions and experiences naturally cross several domains.
ME/CFS
ME/CFS can involve energy limitation, post-exertional malaise, sleep disturbance, cognitive symptoms, autonomic dysfunction, sensory sensitivity and pain.
Migraine is also common in people with ME/CFS. Management needs to account for both conditions, particularly where activity advice could worsen post-exertional symptoms.
MCAS
Mast-cell-related symptoms can involve several body systems, including skin, gastrointestinal, respiratory and cardiovascular symptoms.
For someone who has both migraine and MCAS, it may be useful to distinguish migraine symptoms, mast-cell or allergic symptoms, and areas where the two patterns may interact.
Environmental Sensitivity / MCS
Odours and environmental exposures can be particularly difficult for some people with migraine because smell sensitivity — including osmophobia — can be part of migraine.
Environmental sensitivity or Multiple Chemical Sensitivity may describe a broader pattern in which a person experiences symptoms around low-level environmental exposures.
ALPIMS can acknowledge these experiences while keeping migraine-related smell sensitivity, allergy, airway conditions and other possible contributors distinguishable.
Environmental Sensitivity — Coming SoonVasomotor / Non-Allergic Rhinitis
Vasomotor or non-allergic rhinitis can involve congestion, runny nose and sensitivity to factors such as temperature, odours and environmental irritants.
Migraine itself can also produce nasal and facial autonomic symptoms. This is one reason migraine may sometimes be mistaken for a sinus problem.
Within ALPIMS, vasomotor rhinitis can sit primarily within the Anxiety & Autonomic domain while also crossing sensory and environmental areas.
Vocal Cord Dysfunction / Inducible Laryngeal Obstruction
Vocal cord dysfunction — also described as inducible laryngeal obstruction or ILO — involves inappropriate narrowing around the larynx and may cause throat tightness, breathing difficulty or noisy breathing.
It is not a migraine disorder. However, respiratory irritants, sensory exposures, exertion and autonomic arousal may be relevant for people who experience both.
Within ALPIMS it can be considered a cross-domain respiratory, autonomic and sensory condition.
IBS & Gastrointestinal Symptoms
Migraine commonly involves nausea and can affect gastrointestinal function during an attack. IBS and other gastrointestinal conditions may also coexist with migraine.
This matters because eating, hydration, medication absorption, food restriction and gastrointestinal symptoms can all become part of the management picture.
Hormones, perimenopause & menopause
Hormonal change deserves a place in the wider migraine picture even though it is not an ALPIMS domain of its own.
Migraine can change around menstruation, pregnancy, postpartum hormonal changes, perimenopause and menopause.
During perimenopause, changing hormone levels may occur alongside changes in sleep, temperature regulation, mood, cognition, pain and sensory tolerance. This can make the overall picture considerably more complex.
Comorbidity does not necessarily mean causation
Finding that two conditions occur together more often does not automatically tell us why they occur together.
What an association can tell us
It may help clinicians know what symptoms to ask about and may help explain why a person’s health picture extends beyond migraine alone.
What it cannot tell us
It does not prove that migraine caused the other condition, that the other condition caused migraine, or that every person with migraine should be tested for every associated condition.
Managing migraine may help more than migraine
When migraine is one part of a larger multisystem picture, reducing migraine burden may also reduce some of the load affecting sleep, sensory tolerance, pain, regulation, capacity and everyday life.
At the same time, recognising and managing important conditions alongside migraine may make migraine easier to manage.
Tap a box to explore. Use the × when you are ready to close it.
Reduce sensory load Migraine can increase sensitivity to light, sound, smell, movement and other sensory input.
Reduce sensory load
Photophobia, phonophobia, smell sensitivity and motion sensitivity can all occur as part of migraine.
When migraine is better controlled, some people may spend less time in these highly sensitised states.
Improve sleep Sleep and migraine can influence each other in both directions.
Improve sleep
Poor, disrupted or irregular sleep can make migraine harder to manage. Migraine can also interfere with sleep.
Reduce total pain load Migraine may sit alongside several other sources of persistent pain.
Reduce total pain load
A person may simultaneously be managing migraine, fibromyalgia, TMJ, neck pain, neuropathic pain, pelvic pain or another persistent pain condition.
Improving one important source of pain may reduce the total burden even when it does not directly treat another condition.
Support autonomic function Dizziness, nausea and autonomic symptoms can overlap with migraine, POTS and dysautonomia.
Support autonomic function
Migraine itself can involve autonomic symptoms. Some people also have POTS, orthostatic intolerance or another autonomic disorder requiring its own management.
What problems are present, how might they interact, and which parts can reasonably be addressed?
Protect capacity Migraine can consume physical, cognitive and sensory capacity.
Protect capacity
Migraine can affect capacity during prodrome, the attack itself and postdrome.
Reducing migraine frequency or severity may leave more usable capacity for everyday life, relationships, participation and recovery.
Support regulation Pain, sensory overload, nausea and poor sleep can make regulation harder.
Support regulation
Pain, nausea, disrupted sleep and intense sensory input all place demands on regulatory capacity.
Reducing some of these demands may make physiological and emotional regulation easier.
Manage other conditions MCAS, allergy, gut problems and other illnesses may need parallel management.
Manage other conditions alongside migraine
Not every symptom experienced by someone with migraine is necessarily a migraine symptom.
Allergy, MCAS, asthma, gastrointestinal conditions, post-viral illness and other health problems may require their own assessment and management.
Notice hormonal patterns Menstruation, perimenopause and menopause can influence migraine patterns.
Notice hormonal patterns
Hormonal changes can influence migraine in some people.
During perimenopause, changing migraine patterns may occur alongside changes in sleep, temperature regulation, mood, cognition and sensory tolerance.
Simplify the whole plan Look for supports that help several parts of the health picture without creating more overload.
Simplify the whole management plan
People with migraine and multisystem conditions can accumulate many separate recommendations, appointments, treatments and self-management tasks.
Managing health can eventually become a substantial workload in itself.
Could one change reduce load or provide support across several domains at the same time?
The goal is not necessarily to do more. It may be to identify the most useful things to do and make the overall plan manageable.
Building My Management Plan — Coming SoonTreat migraine — then adapt the plan to the person
Migraine management can provide an important foundation, but the plan should make sense for the person’s wider health picture.
You don’t need to solve the whole picture at once
Start with the part that seems most relevant now. You might begin by understanding migraine itself, exploring treatment, looking at what may help, or opening the ALPIMS domain that best matches what is currently making life difficult.
General information only. Associations between migraine and other conditions do not necessarily establish causation, and not every condition or symptom listed here will be relevant to every person with migraine. ALPIMS is intended to help organise and understand information. It does not diagnose conditions or replace individual medical advice.