Theory of Mind in migraine and medication-overuse headache: A cross-sectional study

Abstract

BackgroundTheory of Mind (ToM) is the ability to predict and anticipate others' behaviors through the mental state attribution process. This study aims to investigate the ToM in patients with medication-overuse headache (MOH) and episodic migraine (EM) and to compare it with healthy controls (HC).MethodsThis study enrolled patients with MOH, patients with EM, and HC. ToM was assessed through the Theory of Mind Assessment Scale (ThOMAS), which includes four subscales: Scale A, I-Me, Scale B, Other-Self, Scale C, I-Other, and Scale D, Other-Me, through the Reading the Mind in the Eyes test (RMET), which measures complex emotion recognition, and through the Toronto Alexithymia Scale (TAS-20), which measures alexithymia. Concomitant psychiatric disturbances were evaluated through the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Dissociative Experiences Scale-II.ResultsThe study involved 21 patients with EM, 22 patients with MOH, and 18 HC. In all the four subscales of the ThOMAS, there was a significant difference between HC, EM, and MOH patients: Scale A (p = 0.009), Scale B (p = 0.004), Scale C (p = 0.039), and Scale D (p = 0.008). In the RMET, MOH patients had worse performances than EM patients and HC (p = 0.039). MOH group exhibited higher levels of alexithymia when compared to the HC (p = 0.033) and higher levels of anxiety than HC (p = 0.001).ConclusionMOH patients showed a subtle psychopathological pattern characterized by impaired social adaptation.

Medication-Overuse Headache

“…A 2022 study provides perhaps more insight by suggesting that patients with MOH, compared with patients with episodic migraine and healthy controls, exhibited higher levels of alexithymia, a reduced capacity for introspection leading to an inability to recognize and express feelings and emotions 19 . This is described as causing confusion in distinguishing between emotions and bodily sensations and, in the setting of headache, could contribute to poor coping skills and facilitate medication overuse.…”

“…18 A 2022 study provides perhaps more insight by suggesting that patients with MOH, compared with patients with episodic migraine and healthy controls, exhibited higher levels of alexithymia, a reduced capacity for introspection leading to an inability to recognize and express feelings and emotions. 19 This is described as causing confusion in distinguishing between emotions and bodily sensations and, in the setting of headache, could contribute to poor coping skills and facilitate medication overuse. Early recognition of such difficulties by the provider could aid management, for example by leading to the alteration of treatment recommendations (eg, earlier use of calcitonin gene-related peptide [CGRP] medications that are not as associated with MOH), enhanced patient education of the risks of MOH, stricter monitoring of medication use and earlier follow-up, and heightened provider awareness.…”

Social cognition in Chronic Migraine with Medication Overuse: Do you mind what I think?

“…When referring to psychosocial vulnerabilities, it is important to include also all those activity limitations and social-interactions restrictions being impacted by chronic pain [21]. Recent evidence showed an association between migraine and social cognitive functioning [22][23][24], whose decline could be responsible for dysfunctional social behaviors and personal distress. The term "social cognition" is a wide construct that refers to all mental operations that allow to decipher information about the intentions and affective states of social partners [25].…”

“…Raimo [24] explored the neuropsychological correlates of ToM and found that CM patients had evident di culties in the cognitive dimension involved in inferring other's mental states. Romozzi [23] compared CM + MO, EM, and HC in complex emotion recognition, knowledge about one's own and other person's mental states, and alexithymic levels and found an impairment in all considered dimensions in CM + MO patients. Therefore, it appears that a dysfunction in social cognitive abilities may represent a critical characteristic of CM/CM + MO.…”

“…Regarding the ToM construct, one of the main distinctions refers to the affective (i.e., attributions regarding others' emotional mental states) and cognitive (i.e., knowledge of others' mental states such as beliefs, thoughts and intentions) components [37,38]. One might expect these two components to be altered in CM + MO [22][23][24], but to what extent has not been explored yet. As socio-cognitive functioning also includes other aspects, such as di culty in expressing one's emotional states [34], what one thinks about one's abilities in social situations [39], and the perception of social engagement [40], personal beliefs about social interactions represent a further eld of investigation.…”