Migraine is a prevalent neurological disorder which encompasses severe headaches accompanied by various sensory sensitivities. When it becomes chronic, characterized by frequent attacks, it can be a very disabling disease with significant social and economic burdens. The typical treatment options for chronic migraine are pharmacological and non-pharmacological, with mixed and unsatisfying outcomes. Indeed, the effective management involves identifying triggers, modifying risk factors, and balancing pharmacological and non-pharmacological treatments to minimize medication overuse and address other possible associated factors, included mental health issues. In this chapter, we will analyze the topic of catastrophizing in migraine. Catastrophizing is a psychological characteristic of migraineurs. It consists of a disadaptive mindset made of irrational beliefs where negative events are exaggerated leading to heightened emotional distress and a belief in worst-case scenarios, while doubting one’s ability to cope. Catastrophic thinking can result in feelings of helplessness, depression, and anxiety, representing an extreme form of worrying that extends into pathological symptoms. Many literature studies documented catastrophizing in migraine, in both clinical and experimental settings, and some studies also revealed that some social variables, such as stigma for chronic illness, can mediate the relationship between migraine symptoms and catastrophizing. This negative mindset impacts not only adults but also children with migraines, with consequences on their overall quality of life, and parental catastrophizing can worsen their tendency toward catastrophic thoughts. Recently, also neuroscience investigated the relation between migraine and catastrophizing, finding changes in brain connectivity and central sensitization mechanisms as possible contributors. Nevertheless, the exact underlying mechanisms remain incompletely understood. To date, pharmacological treatments such as erenumab and OnabotulinumtoxinA and non-pharmacological treatments such as neurostimulation or behavioral approaches showed efficacy in relieving both migraine symptoms and catastrophizing, sometimes revealing some placebo effects. In this case as well, further studies delving into techniques such as mindfulness, psychoeducational interventions, and cognitive-behavioral therapy will be useful in determining the effectiveness of these treatments. To conclude, migraine is not the only chronic pain disease characterized by the catastrophic thinking. Indeed, many studies documented the presence of this cognitive feature in rheumatic diseases such as fibromyalgia, or in painful neuropathies. Also in this case, neuroimaging helped in revealing some cortical abnormalities which may contribute to the relation between catastrophizing and chronic pain symptoms. Further studies are needed to explore this relation while psychological intervention aimed at this cognitive schema would be helpful for patients in getting out from the negative loop of catastrophizing and awfulizing, possibly developing a more optimistic outlook, or at least acceptance, toward debilitating conditions such as those characterized by chronic pain.