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Kwak et al¹ report that the frequency of migraine in patients with Tourette syndrome (TS) is 4-fold higher than in the general population, regardless of the presence of an obsessive-compulsive trait. The authors conclude that the co-occurrence of migraine might be attributable to another TS comorbidity and that the presence of migraine in family members of patients with TS "may be used as a clinical marker for this complex genetic disorder."^1(p1597)

We believe that there may be another explanation for their results. The high frequency of migraine in patients with TS may be due not only to an aminergic involvement or genetic or psychiatric comorbidities but also to a disturbance in the basal ganglia–thalamocortical circuitry.² Substantial evidence points to an involvement of the extrapyramidal system in migraine.³ Interestingly, migraine is common in movement disorders. Case-control studies indicate that the lifetime prevalence of migraine is also high in essential tremor (36.5%) . . . [Full Text of this Article]

Piero Barbanti, MD, PhD; Giovanni Fabbrini, MD
Rome, Italy

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