REFERENCE · CO-OCCURRING CONDITION

Migraine Alongside FND

This page covers: Migraine, including chronic migraine; attack treatment, prevention and its interaction with FND.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For the Person With FND

Understanding the connection

Migraine can bring head pain, nausea, light or sound sensitivity, and sometimes temporary neurological symptoms called aura. Between attacks, some people remain sensitive or exhausted. Chronic migraine means headache on at least 15 days a month for over three months, with migraine features on at least eight days. It is a neurological condition in its own right. [1]

Migraine involves pain-signalling pathways connecting the coverings of the brain, the trigeminal nerve and the brain itself. Chemical signals, including CGRP, help explain why specific migraine medicines can work. FND and migraine may both involve changes in how the nervous system weighs sensation, attention and bodily state; a single shared mechanism has not been established. A normal scan does not make migraine pain less real. [2]

An attack may leave less capacity for walking practice, conversation or sensory activity. Migraine can also trigger functional seizures in some people. Treating it may make FND rehabilitation more manageable; early reports of fewer functional seizures after migraine treatment are encouraging, but do not establish a general treatment for FND. [2][3]

Recovery and treatment options

An attack plan: agree what to take, when to take it and what to do if it fails. Options include migraine-specific medicines such as triptans, suitable pain relief and treatment for nausea. The plan should account for other medicines and medical conditions. [4] [Guideline-based practice]
Preventive treatment: frequent or disabling attacks may justify a daily preventive medicine or a migraine-specific preventive. These aim to reduce future attacks, rather than end today’s pain. Choice depends on benefit, side effects and individual circumstances, including pregnancy considerations. [4] [Guideline-based practice]
Specialist options for chronic migraine: botulinum toxin and CGRP-targeted treatments are options for selected people. Eligibility and access vary. They act on migraine pathways; an injection is not proof that a nervous system has been permanently “reset.” [4] [Guideline-based practice]
Reviewing frequent rescue-medication use: some headache medicines can help maintain headache when used too often. Make any withdrawal or replacement plan with the prescriber, particularly for opioids; this is not a reason to leave pain untreated. [4] [Guideline-based practice]
A manageable daily rhythm: support regular meals, sleep and hydration, with tolerable activity and sensory adjustments during attacks. A brief diary can guide care without turning each day into a search for every possible trigger. Coordinate rehabilitation with available capacity. [2][4] [Clinical guidance and individualized adaptation]
Selected procedural or non-drug options: acupuncture is a guideline option in some circumstances. Greater occipital nerve blocks have some trial support for chronic migraine, but the evidence is smaller and shorter-term; discuss expected duration and adverse effects with a specialist. [4][5] [Guideline-based practice; limited trial evidence for nerve blocks]
Migraine-focused behavioural treatment: CBT develops practical ways to manage migraine-related stress and responses; relaxation teaches deliberate settling of muscle tension or arousal; mindfulness practises noticing experiences without repeatedly reacting to them. These approaches may reduce attacks, but the evidence is low-certainty. Biofeedback uses measured bodily signals to guide practice; evidence for its effect alone in adults is less clear. These are optional skills, not a claim that stress caused the migraine. [6] [Low-certainty research evidence]

During a familiar flare: use the agreed attack plan and reduce demands temporarily. A changed pattern: a sudden explosive headache or new persistent neurological deficit needs urgent assessment, even if migraine and FND are already diagnosed. [4]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For Family, Friends, and Other Supporters

Offer a quieter space, practical help and flexibility with plans. Ask which help is useful rather than assuming the person should practise through an attack. Do not make every food, emotion or missed activity into an explanation for the migraine. A shorter attack or easier recovery can matter even when attacks still occur.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

Document migraine phenotype, headache and migraine days, disability, acute-medication days and possible aura. Coordinate migraine and FND treatment rather than making one contingent on success with the other. Track migraine outcomes separately from functional symptoms. Migraine–functional seizure treatment evidence is preliminary and does not establish causality for every event. [2][3][4]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Research and Sources

Evidence reviewed: September 23, 2026. Most treatment evidence concerns migraine populations, not people selected for both migraine and FND. Shared-mechanism explanations are proposed models; medication response does not diagnose FND.

Technique labels describe the evidence for the named condition. A treatment working does not confirm an FND diagnosis or prove a shared mechanism.

No.	Source and stable record	What it supports and limits	Figure
1	Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1–211. Classification. doi:10.1177/0333102417738202. FND-CIT-0200	Diagnostic classification; supports distinctions between migraine and other persistent headache patterns, not treatment efficacy.	—
2	Stone J, Coebergh J, Khoja L, Butler M, Nicholson TR, Dodick DW. Migraine and functional neurological disorder (FND)—a review of comorbidity and potential overlap. Brain Communications. 2025;7(4):fcaf288. https://doi.org/10.1093/braincomms/fcaf288 FND-CIT-0049	Migraine–FND review; proposed overlap and clinical interactions, with limited direct treatment evidence.	—
3	Duque L, Garza I, Cascino GD, Staab JP. Functional neurological seizures and migraine: A systematic review and case series. Epilepsy Behav. 2023;147:109437. doi:10.1016/j.yebeh.2023.109437. FND-CIT-0209	Review and uncontrolled case series suggest migraine can trigger functional seizures in some people; treatment associations require prospective confirmation.	—
4	National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Recommendations. Accessed September 23, 2026. FND-CIT-0199	Guideline for headache treatment and medication-overuse management; not an FND treatment trial.	—
5	Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia. 2023;43:03331024221143541. doi:10.1177/03331024221143541. FND-CIT-0212	Small, short-term chronic migraine trial; supports a selected specialist option, not a lasting neurological reset or established FND treatment.	—
6	Agency for Healthcare Research and Quality. Behavioral Interventions for Migraine Prevention. Comparative Effectiveness Review No. 270. 2024. Report. FND-CIT-0213	Systematic review: low-strength evidence for adult CBT, relaxation and mindfulness-based approaches; evidence insufficient for firm conclusions about adult biofeedback alone. Not an FND trial.	—

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —