Alexithymia Increases the Headache Pain Index in Women with Migraine: Preliminary Results

Background: Alexithymia is characterized by a deficit in identifying and communicating feelings. Emerging evidence suggests that it is highly prevalent in migraine, where it could affect the pain expression. This pilot study on female migraineurs aimed at assessing any relationship between alexithymia and headache attacks in terms of frequency and pain intensity. Methods: All the patients (42) who fulfilled the diagnostic criteria for migraine were enrolled in this pilot, observational, cross-sectional study after having obtained written informed consent. A psychological assessment was made of each patient to identify any alexithymia using the TAS-20 scale, for anxiety/mood comorbidity (the STAI-Y1, STAI-Y2, and BDI-II) and for migraine-related disability (the HIT-6). An HPI index (attack frequency x pain intensity) was also calculated for each patient, based on their headache diaries. A multivariate analysis was performed to investigate any association among the TAS-20 score, HPI score, and the following covariates: BDI-II, STAI-Y1, STAI-Y2, HIT-6 scores, age, education, and disease duration. Results: Overall, 35.6% of the sample were given a diagnosis of alexithymia. After removing a subgroup of 7 subjects with HPI > 100, with more severe psychiatric comorbidity and a longer disease duration from the whole sample, a multivariate analysis detected a statistically significant (p = 0.010) association between the HPI and TAS-20 scores. Conclusions: This pilot study suggests that alexithymia may play a role in increasing the frequency and pain intensity of migraine attacks, consequently worsening disability in female migraineurs. Further studies are required to confirm this finding.