REVIEW ARTICLE Migraine in childhood: an organic, biobehavioral, or psychosomatic disorder? Vincenzo Guidetti 1 & Rita Cerutti 2 & Noemi Faedda 1 & Giulia Natalucci 1 # Fondazione Società Italiana di Neurologia 2019 Abstract Migraine is one of the most frequent complaints in children and adolescents and it can have a significant impact on quality of life. There are several factors underlying the onset and the maintenance of this disorder and there is still no a clear etiopathogenesis common to all subjects suffering from migraine. Psychological factors such as individual characteristics, psychiatric comorbid- ities, and temperament are strictly related to psychosomatic disorders and to migraine. Also, the environmental influence is very relevant and studied: socio-economic status, family dysfunctions, attachment style, or psychiatric disease in parents can influence the onset of migraine in children. Finally, many studies are trying to find out any alteration in genetics or in cerebral areas or networks that can explain migraine vulnerability. In this review, we analyze the most recent findings on neurological, psycho- logical, and environmental factors that may potentially cause migraine. Keywords Migraine . Childhood . Biobehavioral . Psychosomatic Introduction Headache, and in particular migraine, may be considered as a complex disorder in which genetic predisposition interplays with internal and/or external environmental factors such as stress, hormonal fluctuations, sleep disturbances, and meal skipping [1, 2]. Migraine can have a significant negative im- pact on the quality of life of children and adolescents and often, these patients have psychiatric comorbidity [3]], espe- cially with internalizing disorders such as anxiety and depres- sion [4]. Children quality of life is strongly influenced by pain severity and degree of disability of headache or migraine [3]. Several studies have emphasized the role of different risk fac- tors for migraine in children. Among these risk factors, obesity and overweight, dysfunctional family situation, physical or emotional abuse, and bullying by peers seem to be strictly related to migraine onset or progression [1]. It has been verified that there is a mutual pathogenetic link between mi- graine and psychological, social and biological factors and all of them can influence the individual homeostasis and cause migraine. The aim of this review is to analyze recent evidences on biological and psychological factors that may cause migraine in childhood and adolescence. Neural, biological, and genetic factors Regarding biological and neural substrate of migraine, some studies provided evidences for an abnormal brain activity, especially in frontal and temporal regions [5, 6]. Several fMRI studies on migraine patients suggested an association with cortical functional alteration. In particular, some specific cerebral areas, such as right rostral anterior cingulate cortex, prefrontal cortex, orbitofrontal cortex, and supplementary mo- tor area, seem to have an increased activation [7]. These con- nectivity modifications could indicate intrinsic pathophysio- logical changes in migraine, even if only a very few studies explored the different functional connectivity in migraine with and without aura [8]. In a recent systematic review and meta-analysis, Jia Z and YuS[9] analyzed changes in gray matter (GM) in patients with migraine. Structural and functional changes in the GM in * Vincenzo Guidetti vincenzo.guidetti@uniroma1.it 1 Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, BSapienza^ University, Via dei Sabelli n°108, 00185 Rome, Italy 2 Department of Dynamic and Clinical Psychology, BSapienza^ University, Rome, Italy Neurological Sciences https://doi.org/10.1007/s10072-019-03827-1