Theory of mind and metacognition in migraine patients

Abstract

Objective: Theory of Mind (ToM) and metacognition are distinct psychological constructs, involving the understanding of emotions and mental states in oneself and others. Despite their relevance, these concepts have been poorly investigated in adult migraine groups and the findings in the existing literature are inconsistent. Our objective was to assess the hypothesis that theory of mind skills and metacognitive abilities are impaired in individuals with migraine. Material-Method: We included 23 individuals with Episodic Migraine (EM), 19 with Chronic Migraine (CM) and 30 Healthy Controls (HCs). To assess Theory of Mind (ToM) skills and metacognitive abilities, participants, including both EM and CM patients in an attack-free period, as well as HCs, underwent the Beck Depression Inventory (BDI), Reading Mind in the Eyes test (RMET) and Metacognition Scale (MCQ). Results: Patients with CM exhibited higher BDI scores compared to both EM patients and HCs (p=.018, p=.032, respectively). Furthermore, the RMET scores of CM patients were significantly lower than those of the HCs (p=.011). MCQ scores did not show significant differences between the groups (p=.288). Notably, MCQ scores were positively correlated with BDI scores (r=0.42, p<0.0001), and RMET scores were negatively correlated with the duration of migraine (r=-0.46, p=0.003). Conclusion: Our findings highlight the presence of ToM skills impairments in adult migraine patients, particularly associated with the chronicity of the disease. Managing migraine in patients should consider addressing the observed low ToM skills as part of the overall approach.