Metacognition and Headache: Which Is the Role in Childhood and Adolescence?

Abstract

Headache, in particular migraine, is one of the most frequent neurological symptoms in children and adolescents and it affects about 60% of children and adolescents all over the world. Headache can affect several areas of child’s functioning, such as school, physical activities, peer, and family relationship. The global and severe burden of this disease requires a multidisciplinary strategy and an effective treatment addressed all of the patient’s needs and based on cutting-edge scientific research. In recent years, research has focused on cognitive factors specifically in functions called metacognitive processes. Metacognition can be defined as the knowledge, beliefs, and cognitive processes involved in monitoring, control, and assessment of cognition. Metacognition seems to be closely related to the ability of theory of mind, the ability to infer, and reason about the mental states of other people in order to predict and explain own behavior. Recent studies found a relationship between metacognitive skills and anxiety, depression, motivation, academic performance, human social interactions, and stress symptoms. This relationship is very interesting for headache treatment, because these factors are the most commonly reported triggers in this disorder and there is a high comorbidity with anxiety and depression in children and adolescents with headache. So, headache and these comorbidities, in particular anxiety and depression, may have in common persistent and maladaptive patterns of thinking which are related to maladaptive metacognitive beliefs. Further research should assess metacognitive processes of children and adolescents with headache in order to increase their ability to control their own cognitive processes and consequently monitor factors which may trigger the attacks.

Social and emotional cognition in patients with severe migraine consulting in a tertiary headache center: A preliminary study

“…This suggests that the greater the severity of alexithymia (meaning that patients have difficulty identifying and describing their own mental states), the greater the difficulty in recognizing social faux pas and inferring others intentions and emotions. This link has already been highlighted in literature [5][6][7][8][9][10][11][12][13][14]. It should be noted that the mean score for the mFP control questions, which aim to assess the general understanding of the stories, was near the optimal score, thus ruling out the possibility that comprehension problems caused the poorer performance in this test.…”

“…to be important determinants of quality of life, well-being, and daily functioning [6]. Although several studies have been conducted in children with migraine, showing the presence of social cognition impairments [7], few studies have investigated social cognition in adult migraine patients. Emotion recognition and mental state inference have been shown to be associated with a higher rate of depression and medication overuse in patients with chronic but not episodic migraine [8].…”

Alexithymia, Metacognition, and Theory of Mind in Children and Preadolescents With Migraine Without Aura (MWoA): A Case-Control Study

“…There are not many studies that investigated the association between metacognition and TOM abilities and headache in childhood and adolescence (16). However, given the importance of beliefs and metacognitive processes for emotional regulation, it has been hypothesized that the cephalalgic subjects, in addition to having greater alexithymic traits, may also have lower metacognitive skills than healthy subjects.…”

“…Cognitive monitoring and the ability to mentally represent one's own and others' mental state can be considered fundamental pre-requisites for the recognition and the autonomous regulation of emotions (15). Currently only few studies have addressed the association between headache or migraine and impairment on metacognitive or TOM abilities in children and adolescents (16).…”

Effect of Sex and Adaptation on Migraine Frequency and Perceived Stress: A Cross-Sectional Case-Control Study

“…Since childhood, headache affects about 60% of children and adolescents worldwide, thus affecting school, physical activities, peer and family relationships. (6) Several triggers may increase migraine frequency, such as (1) variations in hormones; (2) changes in weather, meals, caffeine, medication, obesity, sleep quality, and (3) stressful events (7). Mounting evidence indicates that several comorbidities, such as anxiety, depression, sleep disturbances, vascular accidents, epilepsy, restless legs syndrome, and stress, are associated with migraine (4, 8, 9).…”