Abstract: Headache disorders, particularly migraine and cluster headache, are increasingly recognized as complex brain disorders extending beyond mere pain syndromes. Emerging research reveals that alterations in consciousness, cognition, and affective states are intrinsic to the pathophysiology of primary headache disorders and not merely epiphenomena of chronic pain. This lecture explores the spectrum of disordered mental states- ranging from transient cognitive fog and dissociative experiences to persistent mood disturbances and, in rare cases, encephalopathy-like syndromes- that accompany headache syndromes.
Through a synthesis of clinical observations, neuroimaging findings, and neurophysiological models, we will examine how disruptions in thalamo-cortical connectivity, brainstem arousal circuits, and neuromodulatory systems (notably serotonergic, dopaminergic, and CGRP pathways) contribute to altered states of consciousness in headache patients. Special focus will be placed on migraine aura as a model for transient cortical dysfunction, hemiplegic migraine as a window into genetic disruptions of consciousness, and medication overuse as a state of drug-induced cognitive decline.
Cognitive impairments- particularly in attention, working memory, and executive function—are prevalent in chronic migraine and often precede or outlast pain episodes, suggesting trait-like neurocognitive vulnerability. Furthermore, the lecture will discuss the bidirectional interface between headache disorders and psychiatric comorbidities, such as anxiety, depression, and depersonalization, framing them not merely as comorbidities but as shared neurobiological and phenomenological processes.
By bridging clinical neurology, cognitive neuroscience, and philosophy of mind, this talk aims to provoke a rethinking of headaches not only as pain syndromes but as disorders of consciousness and cognition. Implications for diagnosis, therapeutic strategy, and future interdisciplinary research will be discussed.
About the Speaker: Dr. Pravin Thomas is a neurologist and researcher driven by an unwavering commitment to advancing care for headache disorders, chronic pain, and altered states of consciousness. Bridging meticulous clinical practice with cutting-edge science, he pioneers multidisciplinary strategies that redefine patient outcomes. As Senior Consultant Neurologist and Director at Narayana Health’s Comprehensive Headache and Facial Pain Centre of Excellence (India), he orchestrates innovative therapies for complex cases, while globally shaping education as Director of the World Headache Society Academy and Affiliate Professor at Loyola University (Chicago). His work spans: Research: Leading international registries (e.g., Idiopathic Intracranial Hypertension Registry) and groundbreaking discoveries like “Burning Vertex Syndrome.” Education: Mentoring clinicians across continents and editing seminal textbooks that standardize pain management. Advocacy: Championing equitable access to neurological care in underserved regions. Rooted in empathy and rigor, his mission is to unravel the mysteries of consciousness and pain, transforming insights into hope for patients worldwide.