In spite of the fact that migraine seems to have been present throughout the history of man (Areteus of Cappadocia gave a detailed description of it in the first century AD) and has a high prevalence, its pathophysiology is poorly understood. This is probably due to the fact that it is an episodic and self-limiting, although discomforting, disorder.
It is only in the last few decades that migraine has undergone systematic investigation exploring possible genetic, hormonal, biochemical, and psychological factors. As a result, its nature is now becoming less enigmatic, and some comprehensive models on the underlying mechanisms are available.
We review the most intriguing hypotheses related to the pathophysiology of migraine, focusing especially on theories of serotonin dysfunction, which may also explain the high prevalence of psychiatric disorders detected in migraine patients.