The Insula: A “Hub of Activity” in Migraine
Open accessAbstract
The insula, a “cortical hub” buried within the lateral sulcus, is involved in a number of processes including goal-directed cognition, conscious awareness, autonomic regulation, interoception, and somatosensation. While some of these processes are well known in the clinical presentation of migraine (i.e., autonomic and somatosensory alterations), other more complex behaviors in migraine, such as conscious awareness and error detection, are less well described. Since the insula processes and relays afferent inputs from brain areas involved in these functions to areas involved in higher cortical function such as frontal, temporal, and parietal regions, it may be implicated as a brain region that translates the signals of altered internal milieu in migraine, along with other chronic pain conditions, through the insula into complex behaviors. Here we review how the insula function and structure is altered in migraine. As a brain region of a number of brain functions, it may serve as a model to study new potential clinical perspectives for migraine treatment.
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Interoceptive awareness localizes to the insula, a brain area considered a hub of activity in migraine that plays a key role in integrating sensory, autonomic, cognitive, and emotional processes.
“Interoceptive awareness localizes to the insula,39 an area of the brain considered a “hub of activity” in migraine, playing a key role in integrating many of the dynamic processes of migraine (sensory, autonomic, cognitive, and emotional).40”
From Mechanisms of mindfulness in patients with migraine: Results of a qualitative study. (2023) · cites this paper as [39]
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Functional connectivity alterations in migraineurs with Alice in Wonderland syndrome
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Cao, W., Jiao, L., Zhou, H., Zhong, J., Wang, N., & Yang, J. (2024) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2024.1432525 · Cited by 7 · see citing works
Functional connectivity of the language area in migraine: a preliminary classification model
Gou, C., Yang, S., Hou, Q., Rudder, P., Tanglay, O., Young, I. M., Peng, T., He, W., Yang, L., Osipowicz, K. Z., et al. (2023) · BMC Neurology · doi:10.1186/s12883-023-03183-w · Cited by 7 · see citing works
Ouyang, C., Chiang, C., Yang, R., Wu, R., & Lin, L. (2020) · The Kaohsiung Journal of Medical Sciences · doi:10.1002/kjm2.12213 · Cited by 7 · see citing works
Schulz, E., Mayr, A., Jahn, P., & Stankewitz, A. (2024) · Brain Communications · doi:10.1093/braincomms/fcaf045 · Cited by 6 · see citing works
Wang, X., Gao, X., Ouyang, X., Zhang, Y., Zhang, Z., Qi, W., Zhao, Y., Mou, X., Luo, X., Wang, Z., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-98193-8 · Cited by 6 · see citing works
Ramaswamy, K. A., Shetty, S., & Shetty, P. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1197026 · Cited by 6 · see citing works
- Authors
- Borsook, D., Veggeberg, R., Erpelding, N., Borra, R., Linnman, C., Burstein, R., & Becerra, L.
- Affiliations
- Boston Children's Hospital (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Borsook, David
- Venue
- The Neuroscientist
- Publisher
- SAGE Publications
- Published
- 2016-07-07
- Volume
- 22
- Issue
- 6
- Pages
- 632-652
- ISSN
- 1073-8584 (ISSN-L)
- 1089-4098
- PMC
- PMC5723020
- OpenAlex
- W1758874480
- Cited by
- 146
- References
- 276
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 11 · 2023: 16 · 2022: 14 · 2021: 17 · 2020: 20 · 2019: 14 · 2018: 8 · 2017: 15 · 2016: 6 · 2014: 1
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Neuroscientist (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke (R01NS056195, K24NS064050)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- insula, migraine, interoception, somatosensory perception, autonomic regulation, conscious awareness, error detection, goal-directed cognition, chronic pain, migraine treatment
- MeSH terms
- Animals, Brain Mapping, Cerebral Cortex, Cognition, Humans, Migraine Disorders, Nerve Net, Neural Pathways
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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